HPV 16/18 vaccination to prevent cervical cancer In The Netherlands: Model-based cost-effectiveness

Abstract

We evaluated the cost-effectiveness of HPV 16 18 vaccination for girls aged 12 years in The Netherlands in addition to cervical cancer screening. For this purpose, we developed a simulation model that describes the relation between each of the high-risk human papillomavirus (hrHPV) types and cervical disease, allowing the occurrence of multiple type-specile infections. Model parameters were derived from Dutch cohort studies, including a large population-based screening trial, and from the national cervical cancer registry. The model satisfactorily reproduced Dutch data on HPV infection and the presence of cervical lesions. For our base-case scenario in which 85% of the girls aged 12 years were vaccinated against types 16 18 (95% efficacy, lifelong protection), the model predicted a decrease of 60% in the number of cervical cancer cases and cervical cancer deaths indicating that substantial health benefits can be achieved. Health savings were robust against changes in the vaccine efficacy (varied from 85% to 98%) but savings showed a substantial reduction when the efficacy started waning 10 years after vaccination. The discounted costs per qualitv-adjuste'd life vear (QALY) were ∈ 19,500/QALY (range ∈ 11,000 to ∈ 25,(MM)/QALY) and lied near the cost-effectiveness threshold of ∈ 20,000 QUA used in The Netherlands. The simulations further showed that vaccination cannot replace screening because vaccination without screening was less effective than screening in preventing cancer in women over 40 years of age. In conclusion, our model results support the implementation of HPV 16 18 vaccination in young women in addition to cervical cancer screening, © 2008 Wiley-Liss, Inc.