THE COST-EFFECTIVENESS OF QUADRIVALENT HPV VACCINATION STRATEGIES IN TAIWAN

Author(s): 
EJ DASBACH 1,RP INSINGA 1, EH ELBASHA 1, J PWU 2, C LAC 3
1 Merck Research Laboratories., USA, 2iStat, Taiwan, 3 Merck Sharp & Dohme, Taiwan
Text: 
AIM: The objective of this study was to assess the cost-effectiveness of alternative quadrivalent human papillomavirus (HPV) vaccination strategies in Taiwan.
METHODS: A non-linear, deterministic, age-structured, mathematical model of the transmission dynamics of HPV infection (6,11,16,18) and disease development in the population was developed and integrated with an economic model. Inputs for the model were obtained from public data sources, published literature, and clinical trials. We assumed a vaccine uptake of 85%. We varied duration of protection from 10 years to lifetime and the cost of vaccination from $US 300-500.
RESULTS: Compared with current screening practice, vaccinating females before the age of 12 augmented by a female-only 12-24-year olds temporary 5-year catch-up program was the most effective strategy examined, reducing the incidence of HPV 6/11/16/18-related genital warts, cervical intraepithelial neoplasia (CIN), and cervical cancer by 93%, 89%, and 84%, respectively fifty years following vaccine introduction. The cost-effectiveness ratio of this strategy when compared with screening without vaccination was $US 12,297 per quality adjusted life year (QALY) gained. The following parameters were most influential on the results: degree and duration of vaccine-derived protection, vaccine coverage and costs, and preference weights.
CONCLUSION: A quadrivalent HPV vaccination program can reduce the incidence of cervical cancer, CIN, and genital warts and provide survival benefits and quality of life improvements at a cost-effectiveness ratio within the range accepted as cost-effective for a reasonably wide range of model input values.