Systematic review of the cost-effectiveness of the vaccination against HPV in Brazil

Figures & data

Table 1. Summary of 6 articles selected for the systematic review of cost-effectiveness of vaccination against HPV in Brazil

Study (author, year)	Source (database)	Modeling method	Main strategy tested	Baseline strategy	Clinical outcome	Economic outcome	Currency and base year	Perspective of the paying source	Main result ^£
Goldie et al. (2007)	MEDLINE	Transmission dynamic model	Mass vaccination of pre-adolescents girls against HPV	Population screening with cervical cytology	Years of life saved	$/years of life saved	2006 I$	Brazilian Unified Health System	$ 1,100/year of life saved
Kim et al.(2007)	MEDLINE	Transmission dynamic model	Mass vaccination of pre-adolescent boys and girls against HPV	Mass vaccination of only pre-adolescent girls against HPV	Years of life saved	$/years of life saved	2007 I$	Brazilian Unified Health System	$ 37,720/year of life saved
Colantonio et al.(2009)	MEDLINE	Markov model	Mass vaccination of pre-adolescent girls against HPV	Population screening with cervical cytology	QALY	$/QALY	2008 US$	Brazilian Unified Health System	$ 10,181/QALY
Kawai et al. (2012)	MEDLINE	Transmission dynamic model	Mass quadrivalent vaccination of pre-adolescent girls against HPV	Population screening with cervical cytology	QALY	$/QALY	2012 US$	Brazilian Unified Health System	$ 450/QALY
Vanni et al. (2012)	MEDLINE	Transmission dynamic model	Mass vaccination of pre-adolescents girls against HPV	Population screening with cervical cytology	QALY	$/QALY	2012 US$	Brazilian Unified Health System	$ 5,590/QALY
Fonseca et al. (2013)	MEDLINE	Markov model	Mass vaccination of pre-adolescents girls against HPV in Brazilian Amazonian region	Population screening with cervical cytology	QALY	$/QALY	2012 US$	Brazilian Unified Health System	$ 825/QALY

^£The main result refers to the incremental cost-effectiveness ratio of the main strategy tested in relation to the base strategy, considering the base case described in the article. Legend: I$: international dollar; US$: United States dollar; QALY: quality-adjusted life years; ASC-US: atypical squamous cells of unknown significance.

Table 2. Cost-effectiveness of preventive methods and combinations for Brazil. Strategies estimated for 70% of the population. Study of Goldie et al.¹³

Strategies	Incremental cost-effectiveness ratio (I$/years of life saved)
Cost of vaccination	I$25	I$50	I$75	I$100	I$450	Risk reduction (%)
Pap test (3×)	inferior	Inferior	inferior	inferior	inferior	21.9
HPV-DNA test (3×)	inferior	Inferior	500	500	500	30.7
Vaccine	superior	300	inferior	inferior	inferior	42.7
Vaccine + Pap test (3×)	200	Inferior	inferior	inferior	inferior	55.6
Vaccine + HPV test (3×)	700	1,000	1,100	1,700	9,600	60.8

Legend: Inferior: more costly and less effective than the alternative strategy; Superior: more effective and less costly than the alternative strategy; Pap 3×: Papanicolaou test performed at 35, 40 and 45 years; HPV-DNA: hybrid capture test performed at 35, 40 and 45 years; Vaccine: vaccination of pre-adolescent girls between 9 and 12 y of age.

Source: Goldie et al.¹³

Table 3. Clinical benefits and incremental cost-effectiveness ratios for vaccine coverage and vaccination costa. Study of Kim et al.¹⁶

		Cost per individual vaccinated
Strategy	Reduction in the risk of CC (%)^b	US$25	US$50	US$100	US$400
Coverage
Girls only	14	Superior^c	30	610	3450
Both genders	21	110	810	2.190	9,370
Coverage
Girls only	29	Superior^c	70	540	3210
Both genders	40	660	1,740	3,900	15,120
Coverage
Girls only	45	Superior^c	130	740	3,940
Both genders	57	2,440	2,180	4,860	18,820
Coverage
Girls only	63	Superior^c	170	810	4,180
Both genders	67	9,110	18,650	37,720	136,910

^aValues represent the additional cost divided by the clinical benefit in terms of years of life saved compared to the base strategy of not vaccinating (US$/QALY).

^bPer cent reduction in the risk of CC over a lifetime

^cSuperior means that the vaccine strategy is more efficient and less costly than the alternative.

Source: Kim et al.¹⁶

Table 4. Health and economic outcomes for the addition of vaccination to the 3 scenarios of screening strategy (Pap test) in Brazilian Amazonian region. Study of Fonseca, 2013. [¹⁸]

Preventive Strategies	Cost per individual (US$)	Quality-adjusted life years (QALYs)	Incremental cost (US$)	QALYs saved per individual	ICER (US$/QALY)
Non-screening scenario
Vaccination	270	24.8	−25	0.2	Dominant
No vaccination (natural history)	295	24.6
Scenario of 3 screenings throughout the lifetime (base case)
Vaccination + screening	320	29.6	165	0.2	825
Only screening	155	29.4
Scenario of 10 screenings throughout the lifetime
Vaccination + screening	448	34.5	255	0.2	1,275
Only screening	193	34.3

ICER: incremental cost-effectiveness ratio.

^aDominant means more costly and less effective than the baseline strategy.

Goldie SJ, Kim JJ, Kobus K, Goldhaber-Fiebert JD, Salomon J, O'Shea MK, et al. Cost-effectiveness of HPV 16, 18 vaccination in Brazil. Vaccine 2007; 25(33):6257-70; PMID:17606315; http://dx.doi.org/10.1016/j.vaccine.2007.05.058

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Kim JJ, Andres-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(9):1322-8; PMID:17923869; http://dx.doi.org/10.1038/sj.bjc.6604023

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Fonseca AJ, Ferreira LC, Neto GB. Cost-effectiveness of the vaccine against human papillomavirus in the Brazilian Amazon region. Rev Assoc Med Bras 2013; 59(5):442-51; PMID:24041909; http://dx.doi.org/10.1016/j.ramb.2013.03.004

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