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RESEARCH ARTICLE
Contents Vol 4(3)

A cost-effectiveness analysis of adding a human papillomavirus vaccine to the Australian National Cervical Cancer Screening Program

Shalini Kulasingam A J , Luke Connelly B , Elizabeth Conway C , Jane S. Hocking D , Evan Myers E , David G. Regan F , David Roder G , Jayne Ross H and Gerard Wain I
+ Author Affiliations
- Author Affiliations

A Duke University, Center for Clinical Health Policy Research, Durham, NC 27710, USA.

B The University of Queensland, Mayne Medical School, Herston, Qld 4006, Australia.

C CSL Limited, Parkville, Vic. 3052, Australia.

D The University of Melbourne, Parkville, Vic. 3010, Australia.

E Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA.

F National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Darlinghurst, NSW 2010, Australia.

G Group Executive, Research and Information Science, The Cancer Council South Australia, Unley, SA 5061, Australia.

H Jayne Ross & Associates, Cheltenham, NSW 2118, Australia.

I Department of Gynaecological Oncology, Westmead Hospital, Westmead, NSW 2145, Australia.

J Corresponding author. Email: kulas002@mc.duke.edu

Sexual Health 4(3) 165-175 https://doi.org/10.1071/SH07043
Submitted: 19 June 2007  Accepted: 22 June 2007   Published: 23 August 2007

Abstract

Background: The cost-effectiveness of adding a human papillomavirus (HPV) vaccine to the Australian National Cervical Screening Program compared to screening alone was examined. Methods: A Markov model of the natural history of HPV infection that incorporates screening and vaccination was developed. A vaccine that prevents 100% of HPV 16/18-associated disease, with a lifetime duration of efficacy and 80% coverage offered through a school program to girls aged 12 years, in conjunction with current screening was compared with screening alone using cost (in Australian dollars) per life-year (LY) saved and quality-adjusted life-year (QALY) saved. Sensitivity analyses included determining the cost-effectiveness of offering a catch-up vaccination program to 14–26-year-olds and accounting for the benefits of herd immunity. Results: Vaccination with screening compared with screening alone was associated with an incremental cost-effectiveness ratio (ICER) of $51 103 per LY and $18 735 per QALY, assuming a cost per vaccine dose of $115. Results were sensitive to assumptions about the duration of vaccine efficacy, including the need for a booster ($68 158 per LY and $24 988 per QALY) to produce lifetime immunity. Accounting for herd immunity resulted in a more attractive ICER ($36 343 per LY and $13 316 per QALY) for girls only. The cost per LY of vaccinating boys and girls was $92 052 and the cost per QALY was $33 644. The cost per LY of implementing a catch-up vaccination program ranged from $45 652 ($16 727 per QALY) for extending vaccination to 14-year-olds to $78 702 ($34 536 per QALY) for 26-year-olds. Conclusions: These results suggest that adding an HPV vaccine to Australia’s current screening regimen is a potentially cost-effective way to reduce cervical cancer and the clinical interventions that are currently associated with its prevention via screening alone.


References


[1] Department of Health and Aging Australian Government. The National Cervical Screening Program. Facts and key statistics. 2007. Available from: http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/facts [accessed 8 June, 2007]

[2] Australian Institute of Health and Welfare (AIHW). Cervical screening in Australia 2002–3. Cancer Series No. 31, Canberra: AIHW; 2005.

[3] Report of the Evaluation Steering Committee. The interim evaluation of the organised approach to preventing cancer of the cervix 1991–95. Report No. 27. Canberra: Australian Government Publishing Service; 1995.

[4] Bosch FX,  Manos MM,  Munoz N,  Sherman M,  Jansen AM,  Peto J, et al. Prevalence of human papillomavirus in cervical cancer: a worldwide perspective. International biological study on cervical cancer (IBSCC) study group. J Natl Cancer Inst 1995; 87 796–802.
| Crossref | GoogleScholarGoogle Scholar | PubMed | [accessed 8 June, 2007]

[12] Clifford GM,  Rana RK,  Franceschi S,  Smith JS,  Gough G,  Pimenta JM. Human papillomavirus genotype distribution in low-grade cervical lesions: comparison by geographic region and with cervical cancer. Cancer Epidemiol Biomarkers Prev 2005; 14 1157–64.
| Crossref | GoogleScholarGoogle Scholar | PubMed | [accessed 8 June, 2007]

[35] Australian Institute of Health and Welfare (AIHW). Separation, patient day and average length of stay statistics by Australian Refined Diagnosis Related Group (AR-DRG) Version 5.0/5.1. Australia, 1998–99 to 2004–05. Canberra: AIHW; 2005.

[36] South Australian Cancer Registry. Epidemiology of cancer in South Australia. Incidence, mortality and survival 1977 to 1999. Incidence and mortality 1999. Adelaide: Openbook Publishers; 2000.

[37] Davy MLJ,  Dodd TJ,  Luke CJ,  Roder DM. Cervical cancer: effect of glandular cell type on prognosis, treatment, and survival. Obstet Gynecol 2003; 101 38–45.
| Crossref | GoogleScholarGoogle Scholar | PubMed | [accessed 8 June, 2007]

[48] Department of Health and Aging Australian Government. Medicare statistics – March quarter 2006. Group B Tables – selected statistics by broad type of service. 2006. Available from: http://www.health.gov.au/internet/wcms/publishing.nsf/Content/medstat-mar06-analysis-b [accessed 8 June, 2007]

[49] Municipal Association of Victoria. Cost of Victorian local government immunisation services; Melbourne: MAV; 2004.

[50] Myers ER , Green S , Lipkus I . Patient preferences for health states related to HPV infection. Visual analog scales versus time trade-off elicitation. Proceedings of the 21st International Papillomavirus Conference, 2004 February 20–27; Mexico City, Mexico.

[51] Pharmaceutical Benefits Advisory Committee. Guidelines for preparing submissions to the Pharmaceutical Benefits Advisory Committee (PBAC). Version 41. Canberra: PBAC; 2006

[52] Goldie SJ,  Kohli M,  Grima D,  Weinstein MC,  Wright TC,  Bosch FX, et al. Projected clinical benefits and cost-effectiveness of a human papillomavirus 16/18 vaccine. J Natl Cancer Inst 2004; 96 604–15.
| PubMed | [accessed 8 June 2007]

[57] National Institute for Clinical Excellence. Guide to the methods of technology appraisal. London: National Institute for Clinical Excellence; 2004.

[58] Gold MR , Siegel JE , Russell LB , Weinstein MC , eds. Cost-effectiveness in health and medicine. New York: Oxford University Press; 1996.

[59] Dasbach EJ,  Elbasha EH,  Insinga RP. Mathematical models for predicting the epidemiologic and economic impact of vaccination against human papillomavirus infection and disease. Epidemiol Rev 2006; 28 88–100.
| Crossref | GoogleScholarGoogle Scholar | PubMed |

[60] Elbasha EH,  Dasbach EJ,  Insinga RP. Model for assessing human papillomavirus vaccination strategies. Emerg Infect Dis 2007; 13 28–41.
| PubMed |

[61] Taira AV,  Neukermans CP,  Sanders GD. Evaluating human papillomavirus vaccination programs. Emerg Infect Dis 2004; 10 1915–23.
| PubMed |