No abstract

Background: An infection with high-risk human papillomavirus (HPV) is the obligatory aetiological factor for the development of cervical cancer. In Switzerland, the prevention strategy for cervical cancer is based on primary prevention via HPV vaccination and secondary prevention with an opportunistic screening programme for precancerous lesions. Vaccination is recommended to 11-26 years old male and female persons. The objective of the study was to assess the epidemiological impact on cervical cancer of switching from the currently implemented programme with the 4-valent vaccine to the 9-valent vaccine, in an 11-26 years old gender-neutral vaccination programme in Switzerland. Methods: A previously validated dynamic transmission model of HPV infections was adapted and calibrated to the Swiss setting assuming an 80% coverage rate in HPV-vaccination and lifelong vaccine type-specific protection. A gender-neutral vaccination programme (males and females) for 11-26 years old with a 9-valent HPV vaccine was compared with the current 11-26 years old gender-neutral 4-valent vaccination programme. Sensitivity analyses were conducted in order to test the impact of lower vaccination coverage rates and a shorter duration of protection on the model outcomes. Results: In Switzerland, a 9-valent gender-neutral vaccination programme would result in an additional prevention of 2979 cervical cancer cases, 13,862 CIN3 and 15,000 CIN2 cases, compared with the 4-valent gender-neutral vaccination programme over 100 years. These additional disease cases avoided would correspond to a 24, 36 and 48% cumulative incidence decrease in cervical cancer, CIN3 and CIN2 cases, respectively. It would also prevent additional 741 cervical cancer-related deaths over 100 years. A substantial additional reduction in cervical cancer and precancerous lesions burden is still observed when varying the vaccination coverage rate from 30 to 60% or reducing the duration of protection from lifelong to 20 years.

No abstract

requirements of the updated AM-NutzenV. Comprehensive representation of the triumvirate of similarity exert a major impact on the consideration of extrapolation by IQWiG/G-BA. In conclusion, despite its statistical weakness, extrapolation can act as a powerful tool to substantiate the body of evidence generated with often small pediatric study populations.

OBJECTIVES:The changing serotype distribution of pneumococcal disease in the older population since the introduction of PCV13 in infants has led to a renewed interest in the value of PPV23 vaccine. This study assessed the cost-effectiveness of revaccinating adults aged 65 years or above with PPV23 after 5 years, when compared to a single dose of PPV23. METHODS: A population-based Markov model was developed based on five health states including no pneumococcal disease, invasive pneumococcal disease (IPD), non-bacteremic pneumococcal pneumonia (NBPP), post-meningitis sequelae and death. Adults aged 65 years or above in the UK were followed up to 100 years of age or until death, if earlier. Vaccine efficacy against IPD was based on a meta-analysis and a clinical trial. Vaccine efficacy against NBPP was based on a population-based cohort study and a clinical trial. Cost and utility were discounted at a rate of 3.5% annually. The main outcome estimated was the incremental cost-effectiveness ratio (ICER), expressed as additional cost per quality-adjusted life year (QALY) gained . A threshold of £20,000 was considered cost-effectiveness. Sensitivity analyses were conducted to test the robustness of the result.