Economic evaluation of human papillomavirus vaccination in the United Kingdom

Abstract

Objective: To assess the cost effectiveness of routine vaccination of 12 year old schoolgirls against human papillomavirus infection in the United Kingdom.

Design: Economic evaluation.

Setting: UK. Population Schoolgirls aged 12 or older.

Main outcome measures: Costs, quality adjusted life years (QALYs), and incremental cost effectiveness ratios for a range of vaccination options.

Results: Vaccinating 12 year old schoolgirls with a quadrivalent vaccine at 80% coverage is likely to be cost effective at a willingness to pay threshold of pound30,000 (euro37,700; $59,163) per QALY gained, if the average duration of protection from the vaccine is more than 10 years. Implementing a catch-up campaign of girls up to age 18 is likely to be cost effective. Vaccination of boys is unlikely to be cost effective. A bivalent vaccine with the same efficacy against human papillomavirus types 16 and 18 costing pound13- pound21 less per dose (depending on the duration of vaccine protection) may be as cost effective as the quadrivalent vaccine although less effective as it does not prevent anogenital warts.

Conclusions: Routine vaccination of 12 year old schoolgirls combined with an initial catch-up campaign up to age 18 is likely to be cost effective in the UK. The results are robust to uncertainty in many parameters and processes. A key influential variable is the duration of vaccine protection.

Fig 1 Cost effectiveness acceptability curves for base case vaccination programme (girls aged 12 years only, quadrivalent vaccine, 80% coverage) under different assumptions about duration of protection from vaccine. Incremental cost effectiveness of vaccination compared with no vaccination option is shown. Region of £20 000- £30 000 per QALY gained is shaded. Thick solid and dashed lines indicate cost effectiveness acceptability curves when considering vaccine type cervical cancers in a screened population, medium solid and dashed lines indicate curves assuming 80% coverage in screened and unscreened populations, and thin solid and dashed lines indicate curves assuming 80% coverage in screened and unscreened populations, protection against non-cervical cancers, and some cross protection against non-vaccine types

Fig 2 Cost effectiveness acceptability curves for vaccination of girls aged 12, 13, or 14 years with a quadrivalent vaccine at 80% coverage, under different assumptions about vaccine duration of protection, based on results of 50 000 meta-scenarios combining epidemiological and economic assumptions. Incremental cost effectiveness of vaccination compared with no vaccination option is shown. Region of £20 000-£30 000 per QALY gained is shaded

Fig 3 Cost effectiveness acceptability curves for vaccination of girls aged 12 years with a quadrivalent vaccine at different levels of three dose coverage, for different assumptions about duration of protection from vaccine. Incremental cost effectiveness of vaccination compared with no vaccination option is shown. Region of £20 000-£30 000 per QALY gained is shaded

Fig 4 Results of sensitivity analysis. Effect of changing each parameter over its range on estimated cost effectiveness of base case programme (estimates derived from regression model). 95% end points of range of each parameter are also shown