A comparative analysis of the epidemiological impact and disease cost-savings of HPV vaccines in France

Abstract

The aim was to compare the epidemiological and economic impact of 16/18 bivalent and 6/11/16/18 quadrivalent HPV vaccination in France, considering differences in licensed outcomes, protection against non-vaccine HPV types and prevention of HPV-6/11-related diseases. The differential impact of the two vaccines was evaluated using a published model adapted to the French setting. The target population was females aged 14-23 y and the time horizon was 100 y. A total of eight different scenarios compared vaccination impact in terms of reduction in HPV-16/18-associated carcinomas (cervical, vulvar, vaginal, anal, penile and head and neck), HPV-6/11-related genital warts and recurrent respiratory papillomatosis, and incremental reduction in cervical cancer due to potential cross-protection. Quadrivalent vaccine was associated with total discounted cost savings ranging from EUR 544-1,020 million vs. EUR 177-538 million with the bivalent vaccination (100-y time horizon). Genital wart prevention thanks to quadrivalent HPV vaccination accounted for EUR 306-380 million savings (37-56% of costs saved). In contrast, the maximal assumed cross-protection against cervical cancer resulted in EUR 13-33 million savings (4%). Prevention of vulvar, vaginal and anal cancers accounted for additional EUR 71-89 million savings (13%). In France, the quadrivalent HPV vaccination would result in significant incremental epidemiological and economic benefits vs. the bivalent vaccination, driven primarily by prevention of genital. The present analysis is the first in the French setting to consider the impact of HPV vaccination on all HPV diseases and non-vaccine types.

Keywords: France; HPV vaccine; cost-consequence; human papillomavirus.

Figure 1. Comparison of annual number of cancer cases avoided at steady-state (100 y) depending on vaccination strategy.AC, anal cancer; CC, cervical cancer, H and N, head and neck cancers; P, penile cancer; VaC, vaginal cancers; VT, vaccine-types; VuC, vulvar cancers. Twelve Non-vaccine HPV types for bivalent vaccine (HPV 31, 33, 45 driven) and 10 non vaccine types for quadrivalent vaccine (HPV 31-driven)

Figure 2. Discounted healthcare cost savings over 100 (2012–2112) years and early benefit analysis over first 15 y. A, anal cancer; CC, cervical cancer; GW, genital warts; Va, vaginal cancer; Vu, vulvar cancer; VT, vaccine types; non VT, non-vaccine types. Health cost savings breakdown attributable per type of HPV-related disease: vaccine type HPV-related diseases (HPV16/18/6/11 for the quadrivalent vaccine and HPV 16/18 for the bivalent vaccine) vs. non vaccine type HPV-related diseases. Lifetime duration of protection for HPV-vaccine types and 20-y duration of protection for non-vaccine HPV types were assumed, 4% discount rate (costs).Vaccine efficacy based on scenario E.

Figure 3. Scenario analysis summary: discounted direct medical costs avoided over 100 y, including costs associated with genital warts, cervical cancer (vaccine and non-vaccine types) and other HPV 6/11/16/18 conditions.AC, anal cancer; CC, cervical cancer; H and N, head and neck cancers; P, penile cancer; VaC, vaginal cancers; VT, vaccine-types; VuC, vulvar cancers 12 Non vaccine HPV types for bivalent vaccine = HPV 31, 33 and 45-driven; 10 non vaccine HPV types for quadrivalent vaccine = HPV 31-driven, for cervical cancer

Figure 4. Tornado diagram showing total incremental savings due to quadrivalent vs. bivalent vaccination over the period 2012–2112 (Scenario E). Sensitivity analyses were conducted with the effect on the cost saving calculated. The dotted line represents the baseline cost saving (EUR 478 million). Bars extending to the left of the chart represent scenarios were cost savings were increased, while bars extending to the right represent reduced cost savings. Results were most sensitive to changes in the discount rate. Quadrivalent vaccination was found to be cost saving over bivalent vaccination in all analyses RRP, recurrent respiratory papillomatosis