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. 2011 Apr;56(2):153-62.
doi: 10.1007/s00038-010-0216-6. Epub 2010 Nov 26.

A generally applicable cost-effectiveness model for the evaluation of vaccines against cervical cancer

Nadia Demarteau  1 , Bruno Detournay, Bertrand Tehard, Abdelkader El Hasnaoui, Baudouin Standaert
Affiliations

A generally applicable cost-effectiveness model for the evaluation of vaccines against cervical cancer

Nadia Demarteau et al. Int J Public Health. 2011 Apr.

Abstract

Objective: This study aimed at evaluating the cost-effectiveness of human papillomavirus virus (HPV) vaccination in France, using a generally applicable succinct cohort model.

Methods: A lifetime Markov cohort model, adapted to the French setting, simulate the natural history of oncogenic HPV infection towards cervical cancer (CC). Additional modules account for the effects of screening and vaccination. The girls' cohort is vaccinated at age 12 and follows current screening. Costs and outcomes (discounted at 3 and 1.5%, respectively) were compared with a cohort receiving screening alone.

Results: The model results agreed well with real-life data. Vaccination in addition to screening would substantially reduce the incidence of and mortality from CC, compared with screening alone, at an estimated cost-effectiveness of <euro>9,706 per quality-adjusted-life-year. Sensitivity analysis showed that the discount rate and the parameters related to the disease history have the largest impact on the results.

Conclusion: This succinct cohort model indicated that HPV vaccination would be a cost-effective policy option in France. It uses readily available data and should be generally applicable to the evaluation of HPV vaccination in a variety of countries and settings.

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Figures

Fig. 1
Fig. 1
Incidence (top) and mortality (bottom) of invasive cervical cancer in France predicted by the model (squares) and observed by the French national cancer registry (Exbrayat 2002) (diamonds)
Fig. 2
Fig. 2
Effect of age at vaccination on incremental cost-effectiveness ratio (ICER) both discounted (DISC) and non discounted (NDISC) (top) and number of life-years (LY) saved and number of cervical cancer cases (CC) prevented (bottom) with vaccination compared to without
Fig. 3
Fig. 3
One-way sensitivity analysis on discounted ICER (€/QALY). CC cervical cancer; CIN cervical intraepithelial neoplasia; HPV human papillomavirus
Fig. 4
Fig. 4
Regression coefficient obtained from multivariate stepwise regression analysis against discounted ICER (R 2 = 82%). CC cervical cancer; CIN cervical intraepithelial neoplasia; HPV human papillomavirus
See this image and copyright information in PMC

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