COST UTILITY ANALYSIS OF VACCINATION AGAINST HPV IN ISRAEL

Author(s)

Gary M Ginsberg, DrPH, MSc(Econ), Director, Medical Technology Assessment Sector1, Menachem Fisher, MD, District Health Doctor2, Inbar Ben-Shahar, MD, Senior Physician3, Jacob Bornstein, MD, Professor and Department Head41Ministry of Health, Jerusalem, Israel; 2 Clalit Health Services, Nahariah, Israel; 3 Hadassah Hospital, Jerusalem, Israel; 4 Western Galilee Hospital, Nahariah, Israel

Objective: Determine appropriate scenarios for screening compliance for vervical cancer in Israel. Methods: Generalised cost-effectiveness estimates of screening (PAP, HPV-DNA, VIA at various frequencies) and/or HPV vaccination interventions for cervical cancer in Israel were calculated using WHO-CHOICE standardised methodology, utilising a state transition population model (POPMOD) simulating Israeli population demographics. Results: What single intervention should we currently use? HPV vaccine (three doses, costing $120 per dose at age 12) is not cost-effective as its cost per Quality-Adjusted-Life-Year (QALY) is more than three times the magnitude of the GNP per head. Adoption of a thrice a lifetime PAP screening strategy dominates (ie: costs less and adds more QALYs) the current strategy, which opportunistically gives PAP screens to 12.2% of females annually. However, because of the inevitable future fall in the HPV vaccine price, it is not recommended to abandon the current opportunistic PAP smear strategy for a more systematic thrice a lifetime strategy. When should the HPV vaccination be adopted? Assuming non-waning efficacy, HPV vaccinations become cost effective when cost falls below $97 per dose, become very cost-effective (ie: cost per QALY After HPV vaccination is adopted, should we still have screening programs? Expansion of the PAP program to a penta-annual PAP program would provide the most additional QALYs within cost-effectiveness constraints. Conclusion: PAP compliancy should be increased to 20.0 % per annum, both before and after the vaccination is introduced. An HPV vaccination program should be adopted when the vaccine price drops to a level that it becomes affordable to the Ministry of Health or falls below $20.44 per dose, providing a cost-saving incentive to the health insurance funds.

Conference/Value in Health Info

2008-05, ISPOR 2008, Toronto, Ontario, Canada

Value in Health, Vol. 11, No. 3 (May/June 2008)

Code

PCN33

Topic

Economic Evaluation

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis

Disease

Oncology

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