Structural differences among cost–effectiveness models of human papillomavirus vaccines

Abstract

In this article we compare previously published cost–effectiveness studies of human papillomavirus (HPV) vaccines along a defined subset of key model structural assumptions relating to HPV infection and disease, cervical cancer screening and HPV vaccination. For each structural aspect examined, we summarize assumptions from each study, provide a critical review and discuss the impact upon results. Considerable variation was observed across HPV vaccine cost–effectiveness models in a number of influential assumptions. Holding constant factors for which current data are lacking, the combined impact of assumptions made for the remaining parameters examined would appear to tend toward underestimation of the cost–effectiveness of HPV vaccination within existing studies. However, uncertainty concerning parameters, such as the duration of vaccine protection and acquired immunity following HPV infection, and the relationship between age and HPV virulence, complicates precise estimation of the cost–effectiveness of HPV vaccination and rigorous evaluation of the validity of existing modeling results.

Keywords::

• cost–effectiveness analysis
• cost–utility analysis
• human papillomavirus
• vaccine

Financial & competing interests disclosures

The authors are employees of Merck & Co., Inc., which has developed a quadrivalent HPV vaccine, and have participated in the development and publication of two of the HPV vaccine cost–effectiveness analyses reviewed in this paper [14,18]. They have endeavored to be consistent and factually accurate in describing their own work as well as that of others. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.