The impact and cost-effectiveness of nonavalent HPV vaccination in the United States: Estimates from a simplified transmission model

Chesson, Harrell W.; Markowitz, Lauri E.; Hariri, Susan; Ekwueme, Donatus U.; Saraiya, Mona

doi:10.1080/21645515.2016.1140288

Cited by 38 publications

(60 citation statements)

References 48 publications

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“…Brisson et al [33] found that if the premium price of the nonavalent vaccine is below $13 per dose, the nine-valent vaccine would be cost saving with respect to the quadrivalent vaccine in the US setting. Robust cost-saving results were also found by Chesson et al [34]. In Europe, the most recent study from Boiron et al [35] showed that vaccinating 60% of girls and 40% of boys aged 9 in Austria with a nine-valent vaccine would substantially reduce the incidence of cervical cancer and be cost effective compared to the current strategy.…”

Section: Introductionmentioning

confidence: 70%

Cost-effectiveness analysis of the nine-valent HPV vaccine in Italy

Mennini

Bonanni

Bianic³

et al. 2017

Cost Eff Resour Alloc

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BackgroundIn Italy HPV vaccination with the quadrivalent vaccine (Gardasil®) is offered actively and free of charge to girls aged 12 since 2007. A nine-valent vaccine (Gardasil 9®) received the European market authorization in 2015 to protect, with only 2 doses, against around 90% of all HPV positive cancers, over 80% of high-grade precancerous lesions and 90% of genital warts caused by HPV types 6/11.MethodsA dynamic transmission model simulating the natural history of HPV-infections was calibrated to the Italian setting and used to estimate costs and QALYs associated with vaccination strategies. The analyses compared two strategies with the nine-valent vaccine (cervical cancer screening and vaccination in girls only or vaccination in boys and girls) to four alternative strategies (cervical cancer screening and vaccination with quadrialent vaccine in girls only, in both boys and girls, with bivalent vaccine in girls and screening strategy only). The National Health Service perspective was considered.ConclusionThe switch to the nine-valent vaccine in Italy can further reduce the burden associated to cervical cancer and HPV-related diseases and is highly cost-effective.ResultsCompared to the current vaccination program with quadrivalent vaccine, the nine-valent vaccine in a programme including girls and boys shows further reductions of 17% in the incidence of cervical cancer, 35 and 14% in anal cancer for males and females, as well as over a million cases of genital warts avoided after 100 years. The new technology is associated with an ICER of 10,463€ per QALY gained in universal vaccination, decreasing to 4483€ when considering the vaccine switch for girls-only.Electronic supplementary materialThe online version of this article (doi:10.1186/s12962-017-0073-8) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 70%

Cost-effectiveness analysis of the nine-valent HPV vaccine in Italy

Mennini

Bonanni

Bianic³

et al. 2017

Cost Eff Resour Alloc

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“…These studies showed that, in gender-neutral vaccination scenarios, 9vHPV was likely to be cost-effective and even cost-saving compared with 4vHPV. [25][26][27] A later study confirmed the cost-effectiveness of 9vHPV in the United States. 28 In Europe, recent studies in Austria, 29 Germany 30 , Italy 31 and, more recently, in the UK 24 , have also shown the costeffectiveness of 9vHPV in gender-neutral vaccination scenarios.…”

Section: Discussionmentioning

confidence: 96%

Estimating the epidemiological impact and cost-effectiveness profile of a nonavalent HPV vaccine in Spain

Fuente

Aguado

Martín

et al. 2019

Human Vaccines & Immunotherapeutics

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Human papillomavirus (HPV) is one of the main causes of infection-related cancer. The bivalent vaccine (2vHPV) (16/18) and quadrivalent (6/11/16/18) HPV vaccine (4vHPV) have been included in the Spanish vaccination calendar since 2007. The new nonavalent HPV vaccine (9vHPV), approved in Europe in 2015, includes nine HPV types 6/11/16/18/31/33/45/52/58 and has been available in Spain since May 2017. Our study aims to estimate the epidemiological impact and the cost-effectiveness of a girls-only and a gender-neutral vaccination program with 9vHPV compared to the current vaccination program in Spain. A dynamic transmission model simulating the natural history of HPV infections was calibrated to the Spanish setting and applied to estimate costs and quality-adjusted life years (QALYs) associated with vaccination strategies using a payer perspective and a 100-year time horizon. A girls-only vaccination strategy at age 12 years with 9vHPV was found to be a cost-effective strategy compared with 4vHPV (incremental cost-effectiveness ratio (ICER) of €7,718 per QALY). Compared with girls-only vaccination with 4vHPV, gender-neutral vaccination with 9vHPV was associated with further reductions of up to 28.5% in the incidence of cervical intraepithelial neoplasia (CIN) 2/3 and 17.1% in the incidence of cervical cancer, as well as with a 14.0% reduction in cervical cancer mortality. Furthermore, a gender-neutral vaccination program with 9vHPV could potentially be cost-effective considering some parameters as head and neck protection or discount rates, leading to a reduction in the burden of HPVrelated diseases in both sexes in the Spanish population.

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“…Of 26 selected studies 12,21-44 on gender-neutral vaccination (three in LMICs and 23 in HICs), two studies examined 2vHPV vaccine, 20 on 4vHPV, and four on 9vHPV vaccines. Sixteen studies [22][23][24][25]27,[36][37][38][39][40][41][42][43][44][45][46] demonstrated that HPV vaccination for heterosexual men with an existing female program was costeffective (ICER = $19,600-52,800/QALY gained in HICs and $49-5,860/QALY gained in LMICs, Table S1) with respect to their respective cost-effectiveness thresholds (Figure 2a).…”

Section: Cost-effectiveness Of Hpv Vaccination For Heterosexual Menmentioning

confidence: 99%

“…All four studies that assessed 9vHPV 36,38,40,42 vaccine concluded that the vaccine for both girls and boys was costeffective (ICER = $8600-49,800/QALY gained, Table S1) in comparison with 2vHPV or 4vHPV vaccination for both women and/or men. The majority (2/3) of studies with 2vHPV vaccination 24,30 was not cost-effective, while 11/20 studies with 4vHPV vaccination were cost-effective.…”

Section: Cost-effectiveness Of Hpv Vaccination For Heterosexual Menmentioning

confidence: 99%

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Should human papillomavirus vaccination target women over age 26, heterosexual men and men who have sex with men? A targeted literature review of cost-effectiveness

Soe

Ong

et al. 2018

Human Vaccines & Immunotherapeutics

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Background: Human papillomavirus (HPV) vaccination for young women up to age 26 is highly costeffective and has been implemented in 65 countries globally. We investigate the cost-effectiveness for HPV vaccination program in older women (age > 26 years), heterosexual men and men who have sex with men (MSM). Method: A targeted literature review was conducted on PubMed for publications between January 2000 and January 2017 according to the PRISMA guidelines. We included English-language articles that reported the incremental cost-effectiveness ratio (ICER) of HPV vaccination programs for women over age 26, heterosexual men, and MSM and identified the underlying factors for its cost-effectiveness. Results: We included 36 relevant articles (six, 26 and four in older women, heterosexual men and MSM, respectively) from 17 countries (12 high-income (HICs) and five low-and middle-income (LMICs) countries). Most (4/6) studies in women over age 26 did not show cost-effectiveness ($65,000-192,000/QALY gained). Two showed cost-effectiveness, but only when the vaccine cost was largely subsidised and protection to non-naïve women was also considered. Sixteen of 26 studies in heterosexual men were cost-effective (ICER = $19,600-52,800/QALY gained in HICs; $49-5,860/QALY gained in LMICs). Nonavalent vaccines, a low vaccine price, fewer required doses, and a long vaccine protection period were key drivers for cost-effectiveness. In contrast, all four studies on MSM consistently reported cost-effectiveness (ICER = $15,000-$43,000/QALY gained), particularly in MSM age < 40 years and those who were HIV-positive. Countries' vaccination coverage did not significantly correlate with its per-capita Gross National Income. Conclusion: Targeted HPV vaccination for MSM should be next priority in HPV prevention after having established a solid girls vaccination programme. Vaccination for heterosexual men should be considered when 2-dose 4vHPV/9vHPV vaccines become available with a reduced price, whereas targeted vaccination for women over age 26 is unlikely to be cost-effective.

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The impact and cost-effectiveness of nonavalent HPV vaccination in the United States: Estimates from a simplified transmission model

Cited by 38 publications

References 48 publications

Cost-effectiveness analysis of the nine-valent HPV vaccine in Italy

Cost-effectiveness analysis of the nine-valent HPV vaccine in Italy

Estimating the epidemiological impact and cost-effectiveness profile of a nonavalent HPV vaccine in Spain

Should human papillomavirus vaccination target women over age 26, heterosexual men and men who have sex with men? A targeted literature review of cost-effectiveness

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