Estimating the cost-effectiveness profile of a universal vaccination programme with a nine-valent HPV vaccine in Austria

Abstract

BackgroundHPV is a major cancer-causing factor in both sexes in the cervix, vulva, vagina, anus, penis, oropharynx as well as the causal factor in other diseases such as genital warts and recurrent respiratory papillomatis. In the context of the arrival of a nonavalent HPV vaccine (6/11/16/18/31/33/45/52/58), this analysis aims to estimate the public health impact and the incremental cost-effectiveness of a universal (girls and boys) vaccination program with a nonavalent HPV vaccine as compared to the current universal vaccination program with a quadrivalent HPV vaccine (6/11/16/18), in Austria.MethodA dynamic transmission model including a wide range of health and cost outcomes related to cervical, anal, vulvar, vaginal diseases and genital warts was calibrated to Austrian epidemiological data. The clinical impact due to the 5 new types was included for cervical and anal diseases outcomes only. In the base case, a two-dose schedule, lifelong vaccine type-specific protection and a vaccination coverage rate of 60 % and 40 % for girls and boys respectively for the 9-year old cohorts were assumed. A cost-effectiveness threshold of €30,000/QALY-gained was considered.ResultsUniversal vaccination with the nonavalent vaccine was shown to reduce the incidence of HPV16/18/31/33/45/52/58 -related cervical cancer by 92 %, the related CIN2/3 cases by 96 % and anal cancer by 83 % and 76 % respectively in females and males after 100 years, relative to 75 %, 76 %, 80 % and 74 % with the quadrivalent vaccine, respectively. Furthermore, the nonavalent vaccine was projected to prevent an additional 14,893 cases of CIN2/3 and 2544 cases of cervical cancer, over 100 years. Depending on the vaccine price, the strategy was shown to be from cost-saving to cost-effective.ConclusionThe present evaluation showed that vaccinating 60 % of girls and 40 % of boys aged 9 in Austria with a 9-valent vaccine will substantially reduce the incidence of cervical cancer, CIN and anal cancer compared to the existing strategy. The vaccination strategies performed with the 9-valent vaccine in the current study were all found to be cost-effective compared to the current quadrivalent vaccination strategy by considering a cost-effectiveness threshold of 30,000€/QALY gained.

A 5‑year update of patients with HPV positive versus negative oropharyngeal cancer after radiochemotherapy in Austria

“…Currently, a 9-valent vaccination is applied and achieved in 60% of girls and 40% of boys in Austria, leading to a predicted reduction of cervical cancer in 92%, anal cancer by 83% and should also impact on reduction of the occurrence of oropharyngeal cancer [25]. …”

Clinical and economic impact of school‐based nonavalent human papillomavirus vaccine on women in Singapore: a transmission dynamic mathematical model analysis

“…8 The dynamic mathematical model employed has been well validated. [10][11][12][13] We have further included sensitive analysis of input parameters of clinical importance: duration of vaccine protection, vaccination uptake rate, vaccine cost, and the participation rate of concurrent cytology screening. When the duration of vaccine protection was set alternatively at 20 years, although the ICERs of comparing nonavalent vaccine to quadrivalent and bivalent vaccine are 65 and 165% higher than the base case, the ICERs remained more than 75% below the 1 GDP per capita in Singapore.…”

“…9 Clinical and economic benefits of nonavalent HPV vaccines over quadrivalent vaccine have been addressed in the USA and Europe but not in other continents. [10][11][12] The information deficiency gap needs to be filled, as variation between continents in the contribution of subtypes 52 and 58 to high-grade cervical neoplasia and cancer is evident. 8 More significantly, if the policy-maker is contemplating a school-based universal HPV vaccination programme to improve HPV vaccine uptake rate in Singapore in order to address the pressing need to improve cervical cancer control, it is important to evaluate the additional benefits of nonavalent HPV vaccine compared with bivalent and quadrivalent HPV vaccines in Singapore.…”

Vacinação contra o Papiloma vírus Humano no género masculino em idade pediátrica: Qual a evidência?

“…peniano e orofaríngeo, incluem o HPV-16, 18 e 45. 1,3 As estirpes de baixo risco incluem o HPV-6 e 11, sendo maioritariamente responsáveis por condilomas genitais e papilomatose respiratória. 1,3 Existem três tipos de vacinas para o HPV, a bivalente (HPV 16 e 8), a quadrivalente (HPV 6, 11; 16 e 18) e a nonavalente (HPV 6,11,16,18,31,33,45, 52 e 58).…”