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BMC Public Health
Published in: BMC Public Health 1/2012

Open Access 01-12-2012 | Research article

Cost-effectiveness of adding vaccination with the AS04-adjuvanted human papillomavirus 16/18 vaccine to cervical cancer screening in Hungary

Authors: Zoltán Vokó, László Nagyjánosi, Zoltán Kaló

Published in: BMC Public Health | Issue 1/2012

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Abstract

Background

The cervical cancer screening program implemented in Hungary to date has not been successful. Along with screening, vaccination is an effective intervention to prevent cervical cancer. The aim of this study was to assess the cost-effectiveness of adding vaccination with the human papillomavirus 16/18 vaccine to the current cervical cancer screening program in Hungary.

Methods

We developed a cohort simulation state-transition Markov model to model the life course of 12-year-old girls. Eighty percent participation in the HPV vaccination program at 12 years of age was assumed. Transitional probabilities were estimated using data from the literature. Local data were used regarding screening participation rates, and the costs were estimated in US $. We applied the purchasing power parity exchange rate of 129 HUF/$ to the cost data. Only direct health care costs were considered. We used a 3.7% discount rate for both the cost and quality-adjusted life years (QALYs). The time horizon was 88 years.

Results

Inclusion of HPV vaccination at age 12 in the cervical cancer prevention program was predicted to be cost-effective. The incremental cost-effectiveness ratio (ICER) of adding HPV vaccination to the current national cancer screening program was estimated to be 27 588 $/QALY. The results were sensitive to the price of the vaccine, the discount rate, the screening participation rate and whether herd immunity was taken into account.

Conclusions

Our modeling analysis showed that the vaccination of 12-year-old adolescent girls against cervical cancer with the AS04-adjuvanted human papillomavirus 16/18 vaccine would be a cost-effective strategy to prevent cervical cancer in Hungary.
Appendix
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Literature
1.
2.
Saslow D, Castle PE, Cox JT, Davey DD, Einstein MH, Ferris DG, Goldie SJ, Harper DM, Kinney W, Moscicki AB, Noller KL, Wheeler CM, Ades T, Andrews KS, Doroshenk MK, Kahn KG, Schmidt C, Shafey O, Smith RA: Partridge EE; Gynecologic Cancer Advisory Group, Garcia F: American Cancer Society Guideline for human papillomavirus (HPV) vaccine use to prevent cervical cancer and its precursors. CA Cancer J Clin. 2007, 57: 7-28. 10.3322/canjclin.57.1.7.CrossRefPubMed
3.
American College of Obstetricians and Gynecologists (ACOG): Cervical cytology screening. ACOG Practice Bull. 2009, 109:
4.
World Health Organization: Cervical cancer, human papillomavirus (HPV), and HPV vaccines - Key points for policy-makers and health professionals. 2010, Geneva: WHO
5.
Boncz I, Sebestyén A, Ember I: Organized, nationwide cervical screening programme in Hungary. Gynecol Oncol. 2007, 106: 272-273. 10.1016/j.ygyno.2007.03.017.CrossRefPubMed
6.
Kovács A, Döbrössy L, Budai A, Boncz I, Cornides A: Cervical screening in Hungary: why does the "English model" work but the "Hungarian model" does not?. Eur J Gynaecol Oncol. 2008, 29: 5-9.PubMed
7.
Vokó Z, Nagyjánosi L, Margitai B, Kövi R, Tóth Z, László D, Kaló Z: Modeling cost-effectiveness of different scenarios of cervical screening in Hungary. Value Health. 2012, 15: 39-45. 10.1016/j.jval.2011.10.003.CrossRefPubMed
8.
Goldhaber-Fiebert JD, Stout NK, Ortendahl J, Kuntz KM, Goldie SJ, Salomon JA: Modeling human papillomavirus and cervical cancer in the United States for analyses of screening and vaccination. Popul Health Metr. 2007, 5: 11-10.1186/1478-7954-5-11.CrossRefPubMedPubMedCentral
9.
Goldhaber-Fiebert JD, Stout NK, Ortendahl J, Kuntz KM, Goldie SJ, Salomon JA: An individual-based stochastic microsimulation of human papillomavirus and cervical cancer in the United States. 2009, Model structure, parameterization, calibration, evaluation, screening and vaccination strategies: Supplemental technical information, Available from: http://​www.​pophealthmetrics​.​com/​content/​5/​1/​11/​additional/​. [Accessed March 3, 2009]
10.
Szende A, Mogyorósy Z, Muszbek N, Nagy J, Pallos G, Dózsa C: Methodological guidelines for conducting economic evaluation of healthcare interventions in Hungary: a Hungarian proposal for methodology standards. Eur J Health Econ. 2002, 3: 196-206. 10.1007/s10198-002-0109-6.CrossRef
11.
Boncz I, Sebestyén A, Döbrössy L, Kovács A, Budai A, Székely T: A méhnyakszűrés részvételi mutatói Magyarországon (in Hungarian) [The coverage of cervical screening in Hungary]. Orv Hetil. 2007, 148 (46): 2177-82. 10.1556/OH.2007.28956.CrossRefPubMed
12.
Munoz N, Bosch FX, Castellsagué X, Díaz M, de Sanjose S, Hammouda D, Shah KV, Meijer CJ: Against which human papillomavirus types shall we vaccinate and screen? The international perspective. Int J Cancer. 2004, 11: 278-285.CrossRef
13.
14.
Ault KA: Long-term efficacy of human papillomavirus vaccination. Gynecol Oncol. 2007, 107 (2 Suppl 1): 27-30.CrossRef
15.
Romanowski B, de Borba PC, Naud PS, Roteli-Martins CM, De Carvalho NS, Teixeira JC, Aoki F, Ramjattan B, Shier RM, Somani R, Barbier S, Blatter MM, Chambers C, Ferris D, Gall SA, Guerra FA, Harper DM, Hedrick JA, Henry DC, Korn AP, Kroll R, Moscicki AB, Rosenfeld WD, Sullivan BJ, Thoming CS, Tyring SK, Wheeler CM, Dubin G, Schuind A, Zahaf T, Greenacre M, Sgriobhadair A, GlaxoSmithKline Vaccine HPV-007 Study Group: Sustained efficacy and immunogenicity of the human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine: analysis of a randomised placebo-controlled trial up to 6.4 years. Lancet. 2009, 374: 1975-1985.CrossRefPubMed
16.
Fraser C, Tomassini JE, Xi L, Golm G, Watson M, Giuliano AR, Barr E, Ault KA: Modeling the long-term antibody response of a human papillomavirus (HPV) virus-like particle (VLP) type 16 prophylactic vaccine. Vaccine. 2007, 25: 4324-4333. 10.1016/j.vaccine.2007.02.069.CrossRefPubMed
17.
David MP, Van Herck K, Hardt K, Tibaldi F, Dubin G, Descamps D, Van Damme P: Long-term persistence of anti-HPV-16 and −18 antibodies induced by vaccination with the AS04-adjuvanted cervical cancer vaccine: modeling of sustained antibody responses. Gynecol Oncol. 2009, 115 (3 Suppl): S1-6.CrossRefPubMed
18.
19.
La Torre G, de Waure C, Chiaradia G, Mannocci A, Capri S, Ricciardi W: The Health Technology Assessment of bivalent HPV vaccine Cervarix in Italy. Vaccine. 2010, 28: 3379-3384. 10.1016/j.vaccine.2010.02.080.CrossRefPubMed
20.
Coupé VM, van Ginkel J, de Melker HE, Snijders PJ, Meijer CJ, Berkhof J: HPV16/18 vaccination to prevent cervical cancer in The Netherlands: model-based cost-effectiveness. Int J Cancer. 2009, 124: 970-978. 10.1002/ijc.24000.CrossRefPubMed
21.
de Kok IM, van Ballegooijen M, Habbema JD: Cost-effectiveness analysis of human papillomavirus vaccination in the Netherlands. J Natl Cancer Inst. 2009, 101: 1083-1092. 10.1093/jnci/djp183.CrossRefPubMed
22.
Goldie SJ, Kohli M, Grima D, Weinstein MC, Wright TC, Bosch FX, Franco E: Projected clinical benefits and cost-effectiveness of a human papillomavirus 16/18 vaccine. J Natl Cancer Inst. 2004, 96: 604-615. 10.1093/jnci/djh104.CrossRefPubMed
23.
Torvinen S, Nieminen P, Lehtinen M, Paavonen J, Demarteau N, Hahl J: Cost effectiveness of prophylactic HPV 16/18 vaccination in Finland: results from a modelling exercise. J Med Econ. 2010, 13: 284-294. 10.3111/13696998.2010.485951.CrossRefPubMed
24.
25.
Obradovic M, Mrhar A, Kos M: Cost-effectiveness analysis of HPV vaccination alongside cervical screening programme in Slovenia. Eur J Public Health. 2010, 20: 415-421. 10.1093/eurpub/ckp208.CrossRefPubMed
26.
Taira AV, Neukermans CP, Sanders GD: Evaluating human papillomavirus vaccination programs. Emerg Infect Dis. 2004, 10: 1915-1923. 10.3201/eid1011.040222.CrossRefPubMedPubMedCentral
27.
Insinga RP, Dasbach EJ, Elbasha EH, Puig A, Reynales-Shigematsu LM: Cost-effectiveness of quadrivalent human papillomavirus (HPV) vaccination in Mexico: a transmission dynamic model-based evaluation. Vaccine. 2007, 26: 128-139. 10.1016/j.vaccine.2007.10.056.CrossRefPubMed
28.
Bergeron C, Largeron N, McAllister R, Mathevet P, Remy V: Cost-effectiveness analysis of the introduction of a quadrivalent human papillomavirus vaccine in France. Int J Technol Assess Health Care. 2008, 24: 10-19.CrossRefPubMed
29.
Brisson M, Van de Velde N, De Wals P, Boily MC: The potential cost-effectiveness of prophylactic human papillomavirus vaccines in Canada. Vaccine. 2007, 25: 5399-5408. 10.1016/j.vaccine.2007.04.086.CrossRefPubMed
30.
Szucs TD, Largeron N, Dedes KJ, Rafia R, Bénard S: Cost-effectiveness analysis of adding a quadrivalent HPV vaccine to the cervical screening programme in Switzerland. Curr Med Res Opin. 2008, 24: 1473-1483. 10.1185/030079908X297826.CrossRefPubMed
31.
Kulasingam S, Connelly L, Conway E, Hocking JS, Myers E, Regan DG, Roder D, Ross J, Wain G: A cost-effectiveness analysis of adding a human papillomavirus vaccine to the Australian National Cervical screening Program. Sex Health. 2007, 4: 165-175. 10.1071/SH07043.CrossRefPubMed
32.
Ginsberg GM, Fisher M, Ben-Shahar I, Bornstein J: Cost-utility analysis of vaccination against HPV in Israel. Vaccine. 2007, 25: 6677-6691. 10.1016/j.vaccine.2007.07.018.CrossRefPubMed
33.
Olsen J, Jepsen MR: Human papillomavirus transmission and cost-effectiveness of introducing quadrivalent HPV vaccination in Denmark. Int J Technol Assess Health Care. 2010, 26: 183-191. 10.1017/S0266462310000085.CrossRefPubMed
34.
Dasbach EJ, Largeron N, Elbasha EH: Assessment of the cost-effectiveness of a quadrivalent HPV vaccine in Norway using a dynamic transmission model. Expert Rev Pharmacoecon Outcomes Res. 2008, 8: 491-500. 10.1586/14737167.8.5.491.CrossRefPubMed
35.
Kulasingam SL, Benard S, Barnabas RV, Largeron N, Myers ER: Adding a quadrivalent human papillomavirus vaccine to the UK cervical screening programme: A cost-effectiveness analysis. Cost Eff Resour Alloc. 2008, 6: 4-10.1186/1478-7547-6-4.CrossRefPubMedPubMedCentral
36.
Dee A, Howell F: A cost-utility analysis of adding a bivalent or quadrivalent HPV vaccine to the Irish cervical screening programme. Eur J Public Health. 2010, 20: 213-9. 10.1093/eurpub/ckp141.CrossRefPubMed
37.
Newall AT, Beutels P, Wood JG, Edmunds WJ, MacIntyre CR: Cost-effectiveness analyses of human papillomavirus vaccination. Lancet Infect Dis. 2007, 7: 289-96. 10.1016/S1473-3099(07)70083-X.CrossRefPubMed
38.
Insinga RP, Dasbach EJ, Elbasha EH: Structural differences among cost-effectiveness models of human papillomavirus vaccines. Expert Rev Vaccines. 2008, 7: 895-913. 10.1586/14760584.7.7.895.CrossRefPubMed
39.
40.
Van de Velde N, Brisson M, Boily MC: Understanding differences in predictions of HPV vaccine effectiveness: A comparative model-based analysis. Vaccine. 2010, 28: 5473-5484. 10.1016/j.vaccine.2010.05.056.CrossRefPubMed
41.
Postma MJ: Cost-effectiveness analysis of Human Papillomavirus (HPV) vaccination in the Netherlands: recent publication reinforces favorable cost-effectiveness despite misleading conclusion. Vaccine. 2010, 28: 873-874. 10.1016/j.vaccine.2009.10.109.CrossRefPubMed
42.
Drummond M, Barbieri M, Cook J, Glick HA, Lis J, Malik F, Reed SD, Rutten F, Sculpher M, Severens J: Transferability of economic evaluations across jurisdictions: ISPOR Good Research Practices Task Force report. Value Health. 2009, 12: 409-418. 10.1111/j.1524-4733.2008.00489.x.CrossRefPubMed
43.
Dasbach EJ, Nagy L, Brandtmüller A, Elbasha EH: The cost effectiveness of a quadrivalent human papillomavirus vaccine (6/11/16/18) in Hungary. J Med Econ. 2010, 13: 110-118. 10.3111/13696990903546013.CrossRefPubMed
Metadata
Title
Cost-effectiveness of adding vaccination with the AS04-adjuvanted human papillomavirus 16/18 vaccine to cervical cancer screening in Hungary
Authors
Zoltán Vokó
László Nagyjánosi
Zoltán Kaló
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2012
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-12-924

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