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Showing content from https://pubmed.ncbi.nlm.nih.gov/26438574/ below:

Health and Economic Impact of Switching from a 4-Valent to a 9-Valent HPV Vaccination Program in the United States

Affiliations

• ¹ Centre de recherche du CHU de Québec, Axe Santé des populations et pratiques optimales en santé, Québec, Canada (MB, JFL, MD, TM); Département de médecine sociale et préventive, Université Laval, Québec, Canada (MB, MD, TM); Department of Infectious Disease Epidemiology, Imperial College, London, UK (MB, MCB); National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA (HWC, LEM). marc.brisson@crchudequebec.ulaval.ca.
• ² Centre de recherche du CHU de Québec, Axe Santé des populations et pratiques optimales en santé, Québec, Canada (MB, JFL, MD, TM); Département de médecine sociale et préventive, Université Laval, Québec, Canada (MB, MD, TM); Department of Infectious Disease Epidemiology, Imperial College, London, UK (MB, MCB); National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA (HWC, LEM).

• PMID: 26438574
• PMCID: PMC6745694
• DOI: 10.1093/jnci/djv282

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Marc Brisson et al. J Natl Cancer Inst. 2015.

• ¹ Centre de recherche du CHU de Québec, Axe Santé des populations et pratiques optimales en santé, Québec, Canada (MB, JFL, MD, TM); Département de médecine sociale et préventive, Université Laval, Québec, Canada (MB, MD, TM); Department of Infectious Disease Epidemiology, Imperial College, London, UK (MB, MCB); National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA (HWC, LEM). marc.brisson@crchudequebec.ulaval.ca.
• ² Centre de recherche du CHU de Québec, Axe Santé des populations et pratiques optimales en santé, Québec, Canada (MB, JFL, MD, TM); Département de médecine sociale et préventive, Université Laval, Québec, Canada (MB, MD, TM); Department of Infectious Disease Epidemiology, Imperial College, London, UK (MB, MCB); National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA (HWC, LEM).

• PMID: 26438574
• PMCID: PMC6745694
• DOI: 10.1093/jnci/djv282

Item in Clipboard

Background: Randomized clinical trials have shown the 9-valent human papillomavirus (HPV) vaccine to be highly effective against types 31/33/45/52/58 compared with the 4-valent. Evidence on the added health and economic benefit of the 9-valent is required for policy decisions. We compare population-level effectiveness and cost-effectiveness of 9- and 4-valent HPV vaccination in the United States.

Methods: We used a multitype individual-based transmission-dynamic model of HPV infection and disease (anogenital warts and cervical, anogenital, and oropharyngeal cancers), 3% discount rate, and societal perspective. The model was calibrated to sexual behavior and epidemiologic data from the United States. In our base-case, we assumed 95% vaccine-type efficacy, lifelong protection, and a cost/dose of $145 and $158 for the 4- and 9-valent vaccine, respectively. Predictions are presented using the mean (80% uncertainty interval [UI] = 10(th)-90(th) percentiles) of simulations.

Results: Under base-case assumptions, the 4-valent gender-neutral vaccination program is estimated to cost $5500 (80% UI = 2400-9400) and $7300 (80% UI = 4300-11 000)/quality-adjusted life-year (QALY) gained with and without cross-protection, respectively. Switching to a 9-valent gender-neutral program is estimated to be cost-saving irrespective of cross-protection assumptions. Finally, the incremental cost/QALY gained of switching to a 9-valent gender-neutral program (vs 9-valent girls/4-valent boys) is estimated to be $140 200 (80% UI = 4200->1 million) and $31 100 (80% UI = 2100->1 million) with and without cross-protection, respectively. Results are robust to assumptions about HPV natural history, screening methods, duration of protection, and healthcare costs.

Conclusions: Switching to a 9-valent gender-neutral HPV vaccination program is likely to be cost-saving if the additional cost/dose of the 9-valent is less than $13. Giving females the 9-valent vaccine provides the majority of benefits of a gender-neutral strategy.

© The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

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Estimated population-level impact of 4-…

Estimated population-level impact of 4- and 9-valent vaccination strategies in the United States.…

Estimated population-level impact of 4- and 9-valent vaccination strategies in the United States. Estimated percentage change following vaccination in the incidence of (A) diagnosed cervical intraepithelial neoplasia grade 2 and 3 (CIN2/3) and (B) cervical cancer. C–D) Number of human papillomavirus (HPV)-attributable cancers and deaths averted in females and males over the first 70 years of 4- or 9-valent vaccination programs. Base-case: vaccine duration = lifetime, vaccine-type efficacy = 95%, cross-protective vaccine efficacy presented in Supplementary Table 3 (available online), 4-valent cost per dose = $145, 9-valent cost per dose = $158. Predictions: mean estimate generated by the 50 best-fitting parameter sets. Mean prevaccination incidence rate of diagnosed CIN2/3 = 123 per 100 000 women-years, and cervical cancer = 8 per 100 000 women-years. HPV-attributable cancers: cervix, oropharynx, anus, vulva, vagina, and penis. CIN2/3 = cervical intraepithelial neoplasia of grade 2 or 3.

Incremental (A) quality-adjusted life-years (QALYs)…

Incremental (A) quality-adjusted life-years (QALYs) gained and (B) medical costs averted of 4-…

Incremental (A) quality-adjusted life-years (QALYs) gained and (B) medical costs averted of 4- and 9-valent vaccination strategies in the United States (discounted at 3% over 70 years). Base-case: vaccine duration = lifetime, vaccine-type efficacy = 95%, cross-protective vaccine efficacy presented in Supplementary Table 3 (available online). Predictions: mean estimate generated by the 50 best-fitting parameter sets. AGW = anogenital warts; HPV = human papillomavirus; QALY = quality-adjusted life-year; vacc = vaccination.

Sensitivity analysis. Cost per dose…

Sensitivity analysis. Cost per dose of the 9-valent vaccine (gender-neutral vaccination) compared with…

Sensitivity analysis. Cost per dose of the 9-valent vaccine (gender-neutral vaccination) compared with the 4-valent. A) No cross-protection for 4-valent vaccine. B) With cross-protection for 4-valent vaccine. Note: The maximum additional cost per dose for the 9-valent vaccine to remain cost-saving compared with the 4-valent is the value at which the incremental cost-effectiveness ratio is equal to $0. Base-case: vaccine duration = lifetime, vaccine-type efficacy = 95%, cross-protective vaccine efficacy presented in Supplementary Table 3 (available online), 4-valent cost per dose = $145, 9-valent cost per dose = $158. Predictions: mean, and 10th and 90th percentile of model results based on the 50 best-fitting parameter sets (20 runs per parameter set). The 10th and 90th percentiles reflect the uncertainty in the natural history parameters. QALY = quality-adjusted life-year.

• Comparative cost-effectiveness of the quadrivalent and bivalent human papillomavirus vaccines: a transmission-dynamic modeling study.

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