Economic evaluation of human papillomavirus vaccination in the United Kingdom

Abstract

Objective To assess the cost effectiveness of routine vaccination of 12 year old schoolgirls against human papillomavirus infection in the United Kingdom.Design Economic evaluation.Setting UK.Population Schoolgirls aged 12 or older.Main outcome measures Costs, quality adjusted life years (QALYs), and incremental cost effectiveness ratios for a range of vaccination options.Results Vaccinating 12 year old schoolgirls with a quadrivalent vaccine at 80% coverage is likely to be cost effective at a willingness to pay threshold of £30 000 (€37 700; $59 163) per QALY gained, if the average duration of protection from the vaccine is more than 10 years. Implementing a catch-up campaign of girls up to age 18 is likely to be cost effective. Vaccination of boys is unlikely to be cost effective. A bivalent vaccine with the same efficacy against human papillomavirus types 16 and 18 costing £13-£21 less per dose (depending on the duration of vaccine protection) may be as cost effective as the quadrivalent vaccine although less effective as it does not prevent anogenital warts.Conclusions Routine vaccination of 12 year old schoolgirls combined with an initial catch-up campaign up to age 18 is likely to be cost effective in the UK. The results are robust to uncertainty in many parameters and processes. A key influential variable is the duration of vaccine protection.

Parental attitudes and information needs in an adolescent HPV vaccination programme

“…Two parental acceptability studies in the UK anticipated an uptake of about 80% (Brabin et al, 2006;Marlow et al, 2007a), which would be similar to the coverage achieved by the cervical screening programme. As those girls who are not vaccinated may include some who would not take advantage of future cervical screening, reducing non-acceptance is important (Jit et al, 2008).A school-based programme increases the possibility of high coverage, but the acceptability of vaccinating adolescents against a sexually transmitted infection remains uncertain, and the general public is relatively uninformed, or even misinformed, about cervical cancer and its prevention (Friedman and Shepheard, 2007;Marlow et al, 2007b). We assessed vaccine acceptability in a feasibility study ahead of the national vaccine programme.…”

“…Two parental acceptability studies in the UK anticipated an uptake of about 80% (Brabin et al, 2006;Marlow et al, 2007a), which would be similar to the coverage achieved by the cervical screening programme. As those girls who are not vaccinated may include some who would not take advantage of future cervical screening, reducing non-acceptance is important (Jit et al, 2008).…”

Unresolved questions concerning human papillomavirus infection and transmission: a modelling perspective

“…57 ), or have allowed the rate at which immunity wanes to vary over a given range (e.g. 50 ). To illustrate the importance of this assumption, the model of Regan et al 57 predicts that the relative reduction in incidence of HPV infection due to mass vaccination is considerably higher when it is assumed that naturally acquired immunity is of 10 years duration than when it is assumed to be lifelong; the model of Jit et al 50 finds that the assumed duration of naturally acquired immunity is second in importance only to the duration of vaccine-conferred immunity in the estimation of the costeffectiveness of vaccination.…”

“…From a modelling perspective, the assumed duration of naturally acquired immunity is an important parameter (e.g. 50 ). In particular, the impact on transmission will be most significant if naturally acquired immunity is assumed to wane while individuals remain sexually active.…”

Impact of human papillomavirus vaccination depends on effective vaccination strategy

“…Effective prophylactic vaccination programmes have always been and will be also in the case of HPV vaccination (quality of) life-saving and costsaving-no matter the immediate costs. 15,16 …”