Cost-Effectiveness Analysis of the Bivalent and Quadrivalent Human Papillomavirus Vaccines from a Societal Perspective in Colombia

Abstract

ObjectiveTo compare costs and effectiveness of three strategies used against cervical cancer (CC) and genital warts: (i) Screening for CC; (ii) Bivalent Human Papillomavirus (HPV) 16/18 vaccine added to screening; (iii) Quadrivalent HPV 6/11/16/18 vaccine added to screening. MethodsA Markov model was designed in order to simulate the natural history of the disease from 12 years of age (vaccination) until death. Transition probabilities were selected or adjusted to match the HPV infection profile in Colombia. A systematic review was undertaken in order to derive efficacy values for the two vaccines as well as for the operational characteristics of the cytology test. The societal perspective was used. Effectiveness was measured in number of averted Disability Adjusted Life Years (DALYS). ResultsAt commercial prices reported for 2010 the two vaccines were shown to be non-cost-effective alternatives when compared with the existing screening strategy. Sensitivity analyses showed that results are affected by the cost of vaccines and their efficacy values, making it difficult to determine with certainty which of the two vaccines has the best cost-effectiveness profile. To be ‘cost-effective’ vaccines should cost between 141 and 147 USD (Unite States Dollars) per vaccinated girl at the most. But at lower prices such as those recommended by WHO or the price of other vaccines in Colombia, HPV vaccination could be considered very cost-effective.ConclusionsHPV vaccination could be a convenient alternative for the prevention of CC in Colombia. However, the price of the vaccine should be lower for this vaccination strategy to be cost-effective. It is also important to take into consideration the willingness to pay, budgetary impact, and program implications, in order to determine the relevance of a vaccination program in this country, as well as which vaccine should be selected for use in the program.

The cost–effectiveness of HPV vaccination in addition to screening: a Dutch perspective

“…These results were in line with the results from previous studies in other countries, which confirmed that the ICER of HPV vaccination has been considered to be sensitive to vaccine price [68,69] and discount rate [70][71][72]. Regarding duration of protection, since most of the long-term effectiveness of the vaccine has not been obtained yet, the authors were forced to use assumptions and/or intermediate outcomes for their model.…”

Cost-Effectiveness Analysis of HPV Vaccination: Comparing the General Population with Socially Vulnerable Individuals

“…Of course, some studies about HPV vaccination of targeted groups have demonstrated economic value (Aponte-Gonzalez et al, 2013;Demarteau et al, 2013;Drolet et al, 2013;Elbasha et al, 2009;English et al, 2013;Fesenfeld et al, 2013;Kim et al, 2007;Natunen et al, 2013;Turner et al, 2013;Woertman and van der Wilt, 2013). However, the present study also considered the home environment when defining the socially vulnerable group.…”

Evaluación costo-efectividad de dos alternativas de vacunación para el virus del papiloma humano en la prevención del cáncer cervical uterino

“…Se ha reportado también que la vacunación de mujeres tendría un impacto beneficioso en varones debido a la protección comunitaria (25) . En relación al tipo de vacuna a emplear, diversos estudios han reportado que la vacuna cuadrivalente es más costo-efectiva que la vacuna bivalente (25,27,40) , principalmente debido al efecto a corto plazo sobre las VAG. Debemos resaltar el estudio de Jit et al, en el cual reportan que si bien la vacuna cuadrivalente es más costo-efectiva, las diferencias con la vacuna bivalente serían muy marginales, similar a lo reportado por nosotros (40) .…”

“…Existen estudios en otras realidades que han reportado que la vacunación de niñas no infectadas contra el VPH es costo-efectiva (25)(26)(27) . Sin embargo, no es posible extrapolar los resultados al Perú, ya que dichos estudios se basan en costos y frecuencias de las patologías y sus complicaciones a nivel local.…”