The cost effectiveness of a quadrivalent human papillomavirus vaccine (6/11/16/18) in Hungary

Abstract

Objective: A transmission dynamic model was used to assess the epidemiological and economic impact of a quadrivalent human papillomavirus (HPV) (6/11/16/18) vaccine in preventing cervical cancer, cervical intraepithelial neoplasia grades 2 and 3 (CIN 2/3), CIN 1 and genital warts in Hungary.

Methods: The routine vaccination of 12-year-old girls and the routine vaccination of 12-year-old girls plus a temporary catch-up programme for girls and women aged 12–24 years was evaluated.

Results: The model projected that at year 100, both strategies could reduce the incidence of HPV 6/11/16/18-related cervical cancer, CIN 2/3, CIN 1 and genital warts cases among Hungarian women by 90%, 90%, 85% and 93%, respectively. Twenty-five years after the introduction of HPV vaccination in the population, routine vaccination of girls by the age of 12 reduced the cumulative number of cases of cervical cancer, CIN 2/3, CIN 1 and genital warts by 685, 13,473, 3,423 and 163,987, respectively. The incremental cost-effectiveness ratios of the two vaccination strategies were €9,577 and €10,646 per quality-adjusted life-year (QALY) gained over a time horizon of 100 years.

Key limitations: The model did not account for the health and economic impact of other HPV diseases which may result from HPV 16, 18, 6, and 11 infections such as vaginal, vulvar, penile, anal and head-neck cancers, and recurrent respiratory papillomatosis. Epidemiological data from Hungary on these other HPV diseases as well genital warts are needed.

Conclusion: A quadrivalent HPV vaccination programme can reduce the incidence of cervical cancer, CIN and genital warts in Hungary at a cost-per-QALY ratio within the range defined as cost effective.

Keywords::

• cervical intraepithelial neoplasia
• cost-effectiveness analysis
• epidemiology
• human papillomavirus
• uterine cervical neoplasms
• vaccines

Transparency

Declaration of funding: This study was funded by Merck, North Wales, Pennsylvania, USA.

Declaration of financial/ other relationships:

E.J.D. and E.H.E. are employees of Merck and own Merck stock. LN is an employee of MSD, Budapest, Hungary and owns MSD stock. AB works as a paid consultant for MSD, Budapest, Hungary.

Some peer reviewers receive honoraria from JME for their review work. Peer reviewers 1 and 2 have disclosed that they have no relevant financial relationships.

Acknowledgement

The authors wish to thank Ralph P. Insinga from Merck for his helpful comments on the manuscript, and Karen Collins, BS, of JK Associates, Inc., for assistance with manuscript preparation.