PCN35 COST-EFFECTIVENESS OF HUMAN PAPILLOMAVIRUS VACCINE IN COLOMBIA IN 2007

Abstract

OBJECTIVES: To estimate the disease burden of human papillomavirus (HPV) related cancers and preneoplastic lesions in Colombia, and the cost-effectiveness of introduction of HPV vaccine. METHODS: A full economic evaluation was done regarding potential introduction of HPV vaccine. A Markov model that regards the natural history of disease was developed using software TreeAge Pro. The model allowed for evaluating four different alternatives: 1) no intervention; 2) current Colombian screening program alone; 3) vaccination alone; and 4) combination of both. A systematic review was done to identify incidence, prevalence, mortality, and probability of progression/ regression of cervical cancer, preneoplastic lesions, and vulva, anus, penis, and oropharynx cancer in Colombia. Other government and institutional databases were used to complement and validate these estimators. A similar procedure was performed to identify the cost of attending these diseases, the frequency of use of related services and the effi cacy of vaccine. All costs were assessed in international dollars of 2005 ($I). RESULTS: The burden of cervical cancer in 2007 was estimated in 54,884 DALYs, that were assumed attributable to HPV. Other HPV-related cancers accounted for 6346 YLL, and 1439 were considered attributable to HPV. At a cost per vaccinated woman (CpW) - three doses plus administrative costs- ranging from I$25 to I$75, strategy 2 was dominated by Strategies 3 and 4. Considering a life-time horizon, the incremental cost-effectiveness ratio of Intervention 4 over Intervention 3 was I$1,895, I$6,800 and I$11,000 at a CpW of I$150, I$300 and I$420, respectively. At CpW lesser than I$75, the Strategy 3 was dominated. CONCLUSIONS: The sensibility analysis showed that CpW is by far the most important variable for the model. At CpW lesser than I$300, strategy 4 could be cost-effective. In that case, budgetary impact should be analyzed. In Colombia, the cost of current screening program is very expensive, and alternative programs should be considered.