OBJECTIVES

: To assess the cost-effectiveness of the Danish HPV-vaccination strategies for preventing invasive cervical cancer by comparing the bi-valent HPV-vaccine (2V-vaccine), the quadri-valent HPV-vaccine (4V-vaccine), and the nona-valent HPV-vaccine (9V-vaccine).

METHODS

: A Markov model is developed to estimate expected values of costs and effects for the three alternatives. The analysis applies a health sector perspective, and the effect is measured in quality adjusted life years (QALY). Vaccine- and treatment costs are included for all vaccines. The structure of the decision model reflects the natural history of cellular disease progression to invasive cervical cancer, thus the included health states are; well, CIN (I-III), FIGO (I-IV), cervical cancer survivor, relapse, and death. The effectiveness of the vaccine to protect against cervical intraepithelial neoplasia is 70 % for the 2V-vaccine and the 4V-vaccine, and 90 % for the 9V-vaccine. The difference in protection profile is incorporated into the transition from CIN I to CIN II. The 2V-vaccine and the 4V-vaccine follows a 2-dosage programme, while the 9V-vaccine follows a 3-dosage programme. Initial treatment costs and utility decrements related to genital warts are added to the 2V-vaccine, as this vaccine does not protect against these, unlike the 4V-vaccine and the 9V-vaccine. Costs and effects are discounted using a 3,5 % rate. To assess cost-effectiveness, a threshold value of £20,000 is applied.

RESULTS

: Expected values for the 2V-vaccine, 4V-vaccine, and the 9V-vaccine is estimated to £5909, 14.63 QALY, £3724, 14.71 QALY, and £1819, 17.78 QALY, respectively. The 9V-vaccine is dominant as it has the lowest cost and highest effect.

CONCLUSIONS

: The results show that the 9V-vaccine is a cost-effective vaccine for preventing invasive cervical cancer in women aged 12 to 35 years compared to the 2V-vaccine and 4V-vaccine