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BMC Public Health
Published in: BMC Public Health 1/2009

Open Access 01-12-2009 | Research article

A cost-utility analysis of cervical cancer vaccination in preadolescent Canadian females

Authors: Andrea M Anonychuk, Chris T Bauch, Maraki Fikre Merid, Georges Van Kriekinge, Nadia Demarteau

Published in: BMC Public Health | Issue 1/2009

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Abstract

Background

Despite the fact that approximately 70% of Canadian women undergo cervical cancer screening at least once every 3 years, approximately 1,300 women were diagnosed with cervical cancer and approximately 380 died from it in 2008. This study estimates the effectiveness and cost-effectiveness of vaccinating 12-year old Canadian females with an AS04-adjuvanted cervical cancer vaccine. The indirect effect of vaccination, via herd immunity, is also estimated.

Methods

A 12-health-state 1-year-cycle Markov model was developed to estimate lifetime HPV related events for a cohort of 12-year old females. Annual transition probabilities between health-states were derived from published literature and Canadian population statistics. The model was calibrated using Canadian cancer statistics. From a healthcare perspective, the cost-effectiveness of introducing a vaccine with efficacy against HPV-16/18 and evidence of cross-protection against other oncogenic HPV types was evaluated in a population undergoing current screening practices. The base-case analysis included 70% screening coverage, 75% vaccination coverage, $135/dose for vaccine, and 3% discount rate on future costs and health effects. Conservative herd immunity effects were taken into account by estimated HPV incidence using a mathematical model parameterized by reported age-stratified sexual mixing data. Sensitivity analyses were performed to address parameter uncertainties.

Results

Vaccinating 12-year old females (n = 100,000) was estimated to prevent between 390-633 undiscounted cervical cancer cases (reduction of 47%-77%) and 168-275 undiscounted deaths (48%-78%) over their lifetime, depending on whether or not herd immunity and cross-protection against other oncogenic HPV types were included. Vaccination was estimated to cost $18,672-$31,687 per QALY-gained, the lower range representing inclusion of cross-protective efficacy and herd immunity. The cost per QALY-gained was most sensitive to duration of vaccine protection, discount rate, and the correlation between probability of screening and probability of vaccination.

Conclusion

In the context of current screening patterns, vaccination of 12-year old Canadian females with an ASO4-ajuvanted cervical cancer vaccine is estimated to significantly reduce cervical cancer and mortality, and is a cost-effective option. However, the economic attractiveness of vaccination is impacted by the vaccine's duration of protection and the discount rate used in the analysis.
Appendix
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Literature
1.
2.
Health Canada: Programmatic Guidelines for Screening for Cancer of the Cervix in Canada. 1998
3.
4.
5.
Bosch FX, Manos MM, Munoz N, Sherman M, Jansen AM, Peto J, Schiffman MH, Moreno V, Kurman R, Shah KV: Prevalence of human papillomavirus in cervical cancer: a worldwide perspective. International biological study on cervical cancer (IBSCC) Study Group. J Natl Cancer Inst. 1995, 87: 796-802. 10.1002/ijc.20244.CrossRefPubMed
6.
Munoz N, Bosch FX, Castellsague X, Diaz M, de SS, Hammouda D, Shah KV, Meijer CJ: Against which human papillomavirus types shall we vaccinate and screen? The international perspective. Int J Cancer. 2004, 111: 278-285. 10.1016/j.vaccine.2007.04.086.CrossRefPubMed
7.
Brisson M, Van dV, De WP, Boily MC: The potential cost-effectiveness of prophylactic human papillomavirus vaccines in Canada. Vaccine. 2007, 25: 5399-5408. 10.1016/S0140-6736(09)61248-4.CrossRefPubMed
8.
Paavonen J, Naud P, Salmeron J, Wheeler C, Chow SN, Apter DL, Kitchener HC: Efficacy of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA): final analysis of a double-blind, randomised study in young women. Lancet. 2009, 374: 301-314. 10.1016/S0140-6736(07)60946-5.CrossRefPubMed
9.
Paavonen J, Jenkins D, Bosch FX, Naud P, Salmeron J, Wheeler CM, Chow SN, Apter DL, Kitchener HC, Castellsague X, et al: Efficacy of a prophylactic adjuvanted bivalent L1 virus-like-particle vaccine against infection with human papillomavirus types 16 and 18 in young women: an interim analysis of a phase III double-blind, randomised controlled trial. Lancet. 2007, 369: 2161-2170. 10.1016/S0140-6736(06)68439-0.CrossRefPubMed
10.
Harper DM, Franco EL, Wheeler CM, Moscicki AB, Romanowski B, Roteli-Martins CM, Jenkins D, Schuind A, Costa Clemens SA, Dubin G: Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised control trial. Lancet. 2006, 367: 1247-1255. 10.1016/S0140-6736(04)17398-4.CrossRefPubMed
11.
Harper DM, Franco EL, Wheeler C, Ferris DG, Jenkins D, Schuind A, Zahaf T, Innis B, Naud P, De Carvalho NS, et al: Efficacy of a bivalent L1 virus-like particle vaccine in prevention of infection with human papillomavirus types 16 and 18 in young women: a randomised controlled trial. Lancet. 2004, 364: 1757-1765. 10.1016/S1470-2045(05)70101-7.CrossRefPubMed
12.
Villa LL, Costa RL, Petta CA, Andrade RP, Ault KA, Giuliano AR, Wheeler CM, Koutsky LA, Malm C, Lehtinen M, et al: Prophylactic quadrivalent human papillomavirus (types 6, 11, 16, and 18) L1 virus-like particle vaccine in young women: a randomised double-blind placebo-controlled multicentre phase II efficacy trial. Lancet Oncol. 2005, 6: 271-278. 10.1056/NEJMoa020586.CrossRefPubMed
13.
Koutsky LA, Ault KA, Wheeler CM, Brown DR, Barr E, Alvarez FB, Chiacchierini LM, Jansen KU: A controlled trial of a human papillomavirus type 16 vaccine. N Engl J Med. 2002, 347: 1645-1651. 10.1056/NEJMoa020586.CrossRefPubMed
14.
Carter JJ, Koutsky LA, Wipf GC, Christensen ND, Lee SK, Kuypers J, Kiviat N, Galloway DA: The natural history of human papillomavirus type 16 capsid antibodies among a cohort of university women. J Infect Dis. 1996, 174: 927-936. 10.1016/j.vaccine.2005.09.002.CrossRefPubMed
15.
Stanley M: Immune responses to human papillomavirus. Vaccine. 2006, 24: S16-S22. 10.1016/j.vaccine.2005.09.002.CrossRefPubMed
16.
Unckell F, Streeck RE, Sapp M: Generation and neutralization of pseudovirions of human papillomavirus type 33. J Virol. 1997, 71: 2934-2939.PubMedPubMedCentral
17.
Wang Z, Christensen N, Schiller JT, Dillner J: A monoclonal antibody against intact human papillomavirus type 16 capsids blocks the serological reactivity of most human sera. J Gen Virol. 1997, 78: 2209-2215. 10.1006/viro.1994.1649.CrossRefPubMed
18.
Christensen ND, Kirnbauer R, Schiller JT, Ghim SJ, Schlegel R, Jenson AB, Kreider JW: Human papillomavirus types 6 and 11 have antigenically distinct strongly immunogenic conformationally dependent neutralizing epitopes. Virology. 1994, 205: 329-335. 10.1177/0272989X02239651.CrossRefPubMed
19.
Brisson M, Edmunds WJ: Economic evaluation of vaccination programs: the impact of herd-immunity. Med Decis Making. 2003, 23: 76-82. 10.1086/425271.CrossRefPubMed
20.
Garnett GP: Role of herd immunity in determining the effect of vaccines against sexually transmitted disease. J Infect Dis. 2005, 191: S97-106. 10.3201/eid1301.060438.CrossRefPubMed
21.
22.
Elbasha EH, Dasbach EJ, Insinga RP: Model for assessing human papillomavirus vaccination strategies. Emerg Infect Dis. 2007, 13: 28-41. 10.1016/j.vaccine.2007.10.056.CrossRefPubMedPubMedCentral
23.
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
24.
25.
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 Cancer Screening Program. Sex Health. 2007, 4: 165-175. 10.1016/j.vaccine.2007.10.001.CrossRefPubMed
26.
Bauch CT, Anonychuk AM, Pham BZ, Gilca V, Duval B, Krahn MD: Cost-utility of universal hepatitis A vaccination in Canada. Vaccine. 2007, 25: 8536-8548. 10.1017/S0266462307080026.CrossRefPubMed
27.
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. 10.1016/j.vaccine.2007.05.061.CrossRefPubMed
28.
Boot HJ, Wallenburg I, de Melker HE, Mangen MJ, Gerritsen AA, Maas van der NA, Berkhof J, Meijer CJ, Kimman TG: Assessing the introduction of universal human papillomavirus vaccination for preadolescent girls in The Netherlands. Vaccine. 2007, 25: 6245-6256. 10.3201/eid1402.070499.CrossRefPubMed
29.
Chesson HW, Ekwueme DU, Saraiya M, Markowitz LE: Cost-effectiveness of human papillomavirus vaccination in the United States. Emerg Infect Dis. 2008, 14: 244-251. 10.1016/j.vaccine.2006.05.116.CrossRefPubMedPubMedCentral
30.
Garnett GP, Kim JJ, French K, Goldie SJ: Chapter 21: Modelling the impact of HPV vaccines on cervical cancer and screening programmes. Vaccine. 2006, 24 Suppl 3: S3/178-S3/186. 10.1016/j.vaccine.2007.07.018.
31.
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
32.
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. 10.1016/j.vaccine.2007.05.058.CrossRefPubMed
33.
Goldie SJ, Kim JJ, Kobus K, Goldhaber-Fiebert JD, Salomon J, O'shea MK, Xavier BF, de SS, Franco EL: Cost-effectiveness of HPV 16, 18 vaccination in Brazil. Vaccine. 2007, 25: 6257-6270. 10.1016/j.vaccine.2007.05.058.CrossRefPubMed
34.
35.
Kim JJ, ndres-Beck B, Goldie SJ: The value of including boys in an HPV vaccination programme: a cost-effectiveness analysis in a low-resource setting. Br J Cancer. 2007, 97: 1322-1328. 10.1186/1478-7547-6-4.CrossRefPubMedPubMedCentral
36.
Kulasingam SL, Benard S, Barnabas RV, Largeron N, Myers ER: Adding a quadrivalent human papillomavirus vaccine to the UK cervical cancer screening programme: A cost-effectiveness analysis. Cost Eff Resour Alloc. 2008, 6: 4-10.1016/j.vaccine.2008.02.040.CrossRefPubMedPubMedCentral
37.
Debicki D, Ferko N, Demarteau N, Gallivan S, Bauch C, Anonychuk A, Mantovani L, Capri S, Chou CY, Standaert B, et al: Comparison of detailed and succinct cohort modelling approaches in a multi-regional evaluation of cervical cancer vaccination. Vaccine. 2008, 26: F16-F28. 10.1038/sj.bjc.6603501.CrossRefPubMed
38.
Kohli M, Ferko N, Martin A, Franco EL, Jenkins D, Gallivan S, Sherlaw-Johnson C, Drummond M: Estimating the long-term impact of a prophylactic human papillomavirus 16/18 vaccine on the burden of cervical cancer in the UK. Br J Cancer. 2007, 96: 143-150. 10.1038/sj.bjc.6603501.CrossRefPubMed
39.
Statistics Canada: Pap smear, by age group, women aged 18 to 69 years, Canada, provinces, territories, health regions (January 2000 boundaries) and peer groups, every 2 years. Canadian Community Health Survey: . 2000
40.
Mitchell MF, Tortolero-Luna G, Wright T, Sarkar A, Richards-Kortum R, Hong WK, Schottenfeld D: Cervical human papillomavirus infection and intraepithelial neoplasia: a review. J Natl Cancer Inst Monogr. 1996, 17-25.
41.
Canadian Cancer Registry, Public Health Agency of Canada, 1990-2001. 2009
42.
De Carvalho NS, Roteli-Martins CM, Teixeira J, Naud P, de Borba P, Zahaf T, Sanchez N, Schuind A: Immunogenicity and safety of HPV-16/18 AS04-Adjuvanted vaccine up to 7.3Y. 25th International papillomavirus conference; 8. 2009, May
43.
David MP, Van HK, Hardt K, Tibaldi F, Dubin G, Descamps D, Van DP: 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.
44.
Hethcote HW, Lewis MA, van den Driessche P: An epidemiological model with a delay and a nonlinear incidence rate. J Math Biol. 1989, 27: 49-64.CrossRefPubMed
45.
Barnabas RV, Laukkanen P, Koskela P, Kontula O, Lehtinen M, Garnett GP: Epidemiology of HPV 16 and cervical cancer in Finland and the potential impact of vaccination: mathematical modelling analyses. PLoS Med. 2006, 3: e138-10.1371/journal.pmed.0030138.CrossRefPubMedPubMedCentral
46.
Anderson RM, May RM, Anderson B: Infectious diseases of humans: dynamics and control. 1992, New York, USA: Oxford University Press
47.
Bauch CT, Anonychuk AM, Effelterre TV, Pham BZ, Merid MF: Incorporating Herd Immunity Effects into Cohort Models of Vaccine Cost-Effectiveness. Med Decis Making. 2009
48.
49.
50.
Colucci R, Hryniuk W, Savage C: HPV vaccination programs in Canada: Are we hitting the mark?. Report Card on Cancer in Canada. 2008, 7-10. 10.2165/00019053-200422180-00002.
51.
52.
Sauvageau C, Duval B, Gilca V, Lavoie F, Ouakki M: Human papilloma virus vaccine and cervical cancer screening acceptability among adults in Quebec, Canada. BMC Public Health. 2007, 7: 304-10.1016/j.vaccine.2007.09.003.CrossRefPubMedPubMedCentral
53.
54.
Beutels P, Edmunds WJ, Antonanzas F, De Wit GA, Evans D, Feilden R, Fendrick AM, Ginsberg GM, Glick HA, Mast E, et al: Economic evaluation of vaccination programmes: a consensus statement focusing on viral hepatitis. Pharmacoeconomics. 2002, 20: 1-7. 10.1056/NEJMoa071430.CrossRefPubMed
55.
Bos JM, Beutels P, Annemans L, Postma MJ: Valuing prevention through economic evaluation: some considerations regarding the choice of discount model for health effects with focus on infectious diseases. Pharmacoeconomics. 2004, 22: 1171-1179. 10.2165/00019053-199915040-00004.CrossRefPubMed
56.
Crott R: Economic analysis of HPV-vaccines: not so simple?. Vaccine. 2007, 25: 7717-10.1016/j.vaccine.2007.09.003.CrossRefPubMed
57.
Mayrand MH, Duarte-Franco E, Rodrigues I, Walter SD, Hanley J, Ferenczy A, Ratnam S, Coutlee F, Franco EL: Human papillomavirus DNA versus Papanicolaou screening tests for cervical cancer. N Engl J Med. 2007, 357: 1579-1588. 10.1056/NEJMoa071430.CrossRefPubMed
58.
Mittmann N, Trakas K, Risebrough N, Liu BA: Utility scores for chronic conditions in a community-dwelling population. Pharmacoeconomics. 1999, 15: 369-376. 10.2165/00019053-199915040-00004.CrossRefPubMed
59.
60.
Insinga R: Health State transitions following an abnormal pap smear: implications for health utility assessment in cost-effectiveness analyses. 22nd International Papillomavirus Conference and Clinical Workshop. 2005
61.
Appendix 11: Human Papillomavirus. Vaccines for the 21st century: a tool for decisionmaking. Edited by: Stratton KR, Durch JS, Lawrence S. 2000, Washington D.C.: National Academy Press, 213-221.
Metadata
Title
A cost-utility analysis of cervical cancer vaccination in preadolescent Canadian females
Authors
Andrea M Anonychuk
Chris T Bauch
Maraki Fikre Merid
Georges Van Kriekinge
Nadia Demarteau
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2009
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-9-401

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