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Cost-effectiveness analysis of human papillomavirus vaccination in the Netherlands.
J Natl Cancer Inst. 2009 Aug 05; 101(15):1083-92.JNCI

Abstract

BACKGROUND

In the Netherlands, low cervical cancer incidence and mortality rates might limit the cost-effectiveness of vaccination against the human papillomavirus (HPV). We examined the effect on cervical cancer incidence and mortality of adding HPV vaccination to the current Dutch cervical cancer screening situation and calculated the cost-effectiveness.

METHODS

Costs and effects were estimated under favorable assumptions (ie, that HPV vaccination provides lifelong protection against 70% of all cervical cancers, has no side effects, and is administered to all women regardless of their risk of cervical cancer) by using the microsimulation screening analysis (MISCAN) model. The impact of changes in the price of vaccination, number of booster vaccinations, vaccination attendance rate, vaccination efficacy, cervical cancer incidence level, and quality-of-life assumptions was investigated in sensitivity analyses.

RESULTS

Using the current price of euro118 per vaccine dose and with discounting of costs and effects at an annual rate of 3%, adding HPV vaccination to the current Dutch screening situation had a cost-effectiveness ratio of euro53 500 per quality-adjusted life-year (QALY) gained. The threshold price per vaccine dose at which the cost-effectiveness of vaccination would correspond to an acceptability threshold of euro20 000 per QALY gained was euro40. With the addition of one or more (up to four) booster vaccinations during a lifetime, this threshold price decreased to euro33 for one booster (to euro16 for four boosters). With a doubling of the cervical cancer incidence level, the cost-effectiveness ratio was euro24 400 per QALY gained and the maximum price per dose at threshold of euro20 000 was euro97. All threshold prices were lower under less favorable effectiveness assumptions.

CONCLUSIONS

In the Netherlands, HPV vaccination is not cost-effective even under favorable assumptions. To become cost-effective, the vaccine price would have to be decreased considerably, depending on the effectiveness of the vaccine.

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Authors+Show Affiliations

de Kok IM
Department of Public Health, Erasmus MC, University Medical Center, 3000 CA Rotterdam, the Netherlands. i.dekok@erasmusmc.nl
van Ballegooijen M
No affiliation info available
Habbema JD
No affiliation info available

MeSH

AdultCost-Benefit AnalysisDrug CostsFemaleHumansMiddle AgedNetherlandsPapillomavirus InfectionsPapillomavirus VaccinesQuality-Adjusted Life YearsTumor Virus InfectionsUterine Cervical Neoplasms

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19571256

Citation

de Kok, Inge M C M., et al. "Cost-effectiveness Analysis of Human Papillomavirus Vaccination in the Netherlands." Journal of the National Cancer Institute, vol. 101, no. 15, 2009, pp. 1083-92.
de Kok IM, van Ballegooijen M, Habbema JD. Cost-effectiveness analysis of human papillomavirus vaccination in the Netherlands. J Natl Cancer Inst. 2009;101(15):1083-92.
de Kok, I. M., van Ballegooijen, M., & Habbema, J. D. (2009). Cost-effectiveness analysis of human papillomavirus vaccination in the Netherlands. Journal of the National Cancer Institute, 101(15), 1083-92. https://doi.org/10.1093/jnci/djp183
de Kok IM, van Ballegooijen M, Habbema JD. Cost-effectiveness Analysis of Human Papillomavirus Vaccination in the Netherlands. J Natl Cancer Inst. 2009 Aug 5;101(15):1083-92. PubMed PMID: 19571256.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness analysis of human papillomavirus vaccination in the Netherlands. AU - de Kok,Inge M C M, AU - van Ballegooijen,Marjolein, AU - Habbema,J Dik F, Y1 - 2009/07/01/ PY - 2009/7/3/entrez PY - 2009/7/3/pubmed PY - 2009/8/11/medline SP - 1083 EP - 92 JF - Journal of the National Cancer Institute JO - J Natl Cancer Inst VL - 101 IS - 15 N2 - BACKGROUND: In the Netherlands, low cervical cancer incidence and mortality rates might limit the cost-effectiveness of vaccination against the human papillomavirus (HPV). We examined the effect on cervical cancer incidence and mortality of adding HPV vaccination to the current Dutch cervical cancer screening situation and calculated the cost-effectiveness. METHODS: Costs and effects were estimated under favorable assumptions (ie, that HPV vaccination provides lifelong protection against 70% of all cervical cancers, has no side effects, and is administered to all women regardless of their risk of cervical cancer) by using the microsimulation screening analysis (MISCAN) model. The impact of changes in the price of vaccination, number of booster vaccinations, vaccination attendance rate, vaccination efficacy, cervical cancer incidence level, and quality-of-life assumptions was investigated in sensitivity analyses. RESULTS: Using the current price of euro118 per vaccine dose and with discounting of costs and effects at an annual rate of 3%, adding HPV vaccination to the current Dutch screening situation had a cost-effectiveness ratio of euro53 500 per quality-adjusted life-year (QALY) gained. The threshold price per vaccine dose at which the cost-effectiveness of vaccination would correspond to an acceptability threshold of euro20 000 per QALY gained was euro40. With the addition of one or more (up to four) booster vaccinations during a lifetime, this threshold price decreased to euro33 for one booster (to euro16 for four boosters). With a doubling of the cervical cancer incidence level, the cost-effectiveness ratio was euro24 400 per QALY gained and the maximum price per dose at threshold of euro20 000 was euro97. All threshold prices were lower under less favorable effectiveness assumptions. CONCLUSIONS: In the Netherlands, HPV vaccination is not cost-effective even under favorable assumptions. To become cost-effective, the vaccine price would have to be decreased considerably, depending on the effectiveness of the vaccine. SN - 1460-2105 UR - https://www.unboundmedicine.com/medline/citation/19571256/Cost_effectiveness_analysis_of_human_papillomavirus_vaccination_in_the_Netherlands_ L2 - https://academic.oup.com/jnci/article-lookup/doi/10.1093/jnci/djp183 DB - PRIME DP - Unbound Medicine ER -