OBJECTIVES: To assess cost-effectiveness of Danish childhood vaccination strategies for preventing invasive cervical cancer by comparing the bivalent HPV-vaccine (2V HPV-vaccine), the quadrivalent HPV-vaccine (4V HPV-vaccine), and the nonavalent HPV-vaccine (9V HPV-vaccine).

METHODS: A Markov decision analytical model is developed for the natural history of invasive cervical cancer in women aged 12 to 35 years. The analysis uses a health sector perspective and quality adjusted life years (QALY) as measure of effect. The states correspond to the natural history of disease progression and include the following states; well, CIN (I-III), FIGO (I-IV), cervical cancer survivor, relapse, and death. The effectiveness of protection against invasive cervical cancer is 70 % for the 2V HPV-vaccine and the 4V HPV-vaccine, and 90 % for the 9V HPV-vaccine. Difference in the protection profile between the vaccines is incorporated in the transition from CIN I to CIN II. Vaccine costs and costs related to treatment of CIN (I-III) and FIGO (I-IV) are included for all vaccines. The 2V HPV-vaccine and the 4V HPV-vaccine follows a 2-dosage programme, and the 9V HPV-vaccine follows a 3-dosage programme. Initial treatment costs and utility decrements related to genital warts are added to the 2V HPV-vaccine, as the 4V HPV-vaccine and the 9V HPV-vaccine protect against these. 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 HPV-vaccine, 4V HPV-vaccine, and the 9V HPV-vaccine is estimated to £5909, 14.63 QALY, £3724, 14.71 QALY, and £1819, 17.78 QALY, respectively. The 9V HPV-vaccine is dominant as it has the lowest cost and highest effect.

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