Cost-effectiveness of human papillomavirus (HPV) vaccination in Norway( 28/04/2008 )
1-page key messages
HPV vaccination is highly efficacious against the development of high risk HPV 16/18 type related infections, the most common cause of cervical cancer. In Norway, the current screening strategy (since 1995) is to screen every 3 years, woman aged 25 to 69. How effective and cost-effective HPV vaccination alongside screening would be over the long-term remain key issues for decision makers considering programme introduction.
The objective of this report was to estimate the potential cost-effectiveness of an HPV 16/18 type vaccination alongside screening compared to screening alone. A dynamic model of HPV transmission was used to predict cases of cervical dysplasia, cervical cancers and deaths and the results compared against age-specific Norwegian data representing a situation without vaccination. We then explored the potential impact of a vaccine given to 12-year-old girls under a base case assumption of 90% efficacy and 90% coverage for a hypothetical time period of 2008-2060. Model outputs (e.g. reductions in cancers and cancer deaths) together with screening programme data were used to perform cost-effectiveness calculations from the health care sector perspective and society. Analyses used available Norwegian data on resource consumption patterns and published unit costs. Cost-effectiveness was measured as the incremental cost per life year gained (LYG) and quality-adjusted life year (QALY) gained.
Introduction of vaccination, and maintaining the screening programme unchanged yielded a base case incremental cost-effectiveness ratio (ICER) that varied from NOK 477,000/LY (NOK 399,00/ QALY) to NOK 141,000/ LY (NOK 118,000/QALY) from the healthcare sector and societal perspectives respectively. Estimates were sensitive to alternative assumptions relating to efficacy, coverage, vaccine cost, discount rate, and time horizon of the analysis.
Under several plausible assumptions, our economic evaluation suggest that introduction of HPV 16/18 type vaccination to current screening in Norway may be a cost-effective strategy for further reductions in cervical cancer incidence and mortality. However, the estimates were susceptible to both the perspective adopted, and assumptions used in the modelling analyses.
>1-page key messages
3-page executive summary
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