Economic evaluation of the human papillomavirus (HPV)-vaccination in Norway

Abstract

Cost-effectiveness of human papillomavirus (HPV) vaccination in Norway Background: HPV vaccination is highly efficacious against the development of high risk HPV 16/18 type related infections, the most common cause of cervical cancer. In Norway, the current screening strategy (since 1995) is to screen every 3 years, woman aged 25 to 69. How effective and cost-effective HPV vaccination alongside screening would be over the long-term remain key issues for decision makers considering programme introduction. Methods: The objective of this report was to estimate the potential cost-effectiveness of an HPV 16/18 type vaccination alongside screening compared to screening alone. A dynamic model of HPV transmission was used to predict cases of cervical dysplasia, cervical cancers and deaths and the results compared against age-specific Norwegian data representing a situation without vaccination. We then explored the potential impact of a vaccine given to 12-year-old girls under a base case assumption of 90% efficacy and 90% coverage for a hypothetical time period of 2008−2060. Model outputs (e.g. reductions in cancers and cancer deaths) together with screening programme data were used to perform cost-effectiveness calculations from the health care sector perspective and society. Analyses used available Norwegian data on resource consumption patterns and published unit costs. Cost-effectiveness was measured as the incremental cost per life year gained (LYG) and quality-adjusted life year (QALY) gained. Results: Introduction of vaccination, and maintaining the screening programme unchanged yielded a base case incremental cost-effectiveness ratio (ICER) that varied from NOK 477,000/LY (NOK 399,00/ QALY) to NOK 141,000/ LY (NOK 118,000/QALY) from the healthcare sector and societal perspectives respectively. Estimates were sensitive to alternative assumptions relating to efficacy, coverage, vaccine cost, discount rate, and time horizon of the analysis. Conclusion: Under several plausible assumptions, our economic evaluation suggest that introduction of HPV 16/18 type vaccination to current screening in Norway may be a cost-effective strategy for further reductions in cervical cancer incidence and mortality. However, the estimates were susceptible to both the perspective adopted, and assumptions used in the modelling analyses.