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Journal of the National Cancer Institute Advance Access originally published online on July 1, 2009
JNCI Journal of the National Cancer Institute 2009 101(15):1083-1092; doi:10.1093/jnci/djp183
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Published by Oxford University Press 2009.

ARTICLES

Cost-Effectiveness Analysis of Human Papillomavirus Vaccination in the Netherlands

Inge M. C. M. de Kok, Marjolein van Ballegooijen, J. Dik F. Habbema

Affiliation of authors: Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands

Correspondence to: Inge M. C. M. de Kok, MSc, Department of Public Health, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands (e-mail: i.dekok{at}erasmusmc.nl).

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 {euro}118 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 {euro}53 500 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 {euro}20 000 per QALY gained was {euro}40. With the addition of one or more (up to four) booster vaccinations during a lifetime, this threshold price decreased to {euro}33 for one booster (to {euro}16 for four boosters). With a doubling of the cervical cancer incidence level, the cost-effectiveness ratio was {euro}24 400 per QALY gained and the maximum price per dose at threshold of {euro}20 000 was {euro}97. 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.


CONTEXT AND CAVEATS

Prior knowledge

Cervical cancer incidence and mortality rates in the Netherlands are low, which could limit the cost-effectiveness of human papillomavirus (HPV) vaccination.

Study design

A simulation model was used to estimate costs and effects of adding HPV vaccination to the current screening situation in the Netherlands and to examine 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 on the cost-effectiveness of HPV vaccination.

Contribution

HPV vaccination is not cost-effective, even under favorable assumptions, in the Netherlands.

Implications

To become cost-effective, the vaccine price would have to be decreased considerably, depending on the long-term effectiveness of the vaccine.

Limitations

The impact of herd (or community) immunity was underestimated because viral transmission was not included in the model. The impact of vaccination on other HPV-related diseases was not taken into account.

From the Editors

 
Manuscript received November 27, 2008; revised May 8, 2009; accepted May 26, 2009.


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Re: Cost-Effectiveness Analysis of Human Papillomavirus Vaccination in the Netherlands
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