DOES IT MATTER? DISCOUNTING AND ITS ROLE IN ANALYSING THE COST-EFFECTIVENESS OF PREVENTATIVE INTERVENTIONS
Author(s)
Starkie Camejo HJ*1;Van Kriekinge G2, Li X3 1GlaxoSmithKline, Uxbridge, United Kingdom, 2GlaxoSmithKline Vaccines, 1300 Wavre, Belgium, 3GlaxoSmithKline Vaccines, Wavre, Belgium
OBJECTIVES: The UK runs a human papillomavirus (HPV) vaccination programme for girls aged 12-13 years to protect them from cervical cancer (CC). When long-term health benefits such as these occur, with costs occurring at the outset, cost-effectiveness analyses are very sensitive to the discount rate used. In view of this, the National Institute for Health and Care Excellence (NICE) will consider analyses with discount rates of 1.5% for costs and outcomes. Therefore, we modelled the cost-effectiveness of vaccination with the AS04-adjuvanted HVP-16/18 vaccine (BV) compared with HPV-6/11/16/18 (QV) with discount rates of 1.5%. METHODS: A published lifetime Markov cohort model replicating the natural history of oncogenic and low-risk HPV infection was adapted to the UK and run for a cohort of 100,000 girls aged 12. Vaccine efficacy against vaccine-type and non-vaccine type HPV was obtained from each vaccine’s respective clinical trials. Lifetime protection was assumed for both vaccines. Input data were obtained from the literature, public databases and expert opinion. All costs were updated to 2012 values and reflected an NHS perspective. The incremental cost effectiveness ratio (ICER) of vaccinating with the BV vs. the QV was evaluated. Sensitivity analyses were performed on key variables. RESULTS: The model estimated that compared with QV, BV saved an additional 277 CIN1 cases, 1,460 CIN2/3 cases, 53 CC cases and 23 deaths, but did not protect against 7,747 GW cases. Discounting at 1.5% results in +54 QALYs gained and £2.4 million saved. However, applying a discount rate of 3.5% results in -52 QALYs and £1.1 million saved. Sensitivity analyses showed results were robust. CONCLUSIONS: Applying a discount rate of 1.5% for both costs and outcomes focuses the appraisal on the long-term outcomes, such as CC and CC-death, of the vaccination programme, and to the finding that the BV was shown to dominate QV.
Conference/Value in Health Info
2013-11, ISPOR Europe 2013, The Convention Centre Dublin
Value in Health, Vol. 16, No. 7 (November 2013)
Code
PRM60
Topic
Methodological & Statistical Research
Topic Subcategory
Modeling and simulation
Disease
Oncology