Cost-effectiveness of sex-neutral HPV-vaccination in Sweden, accounting for herd-immunity and sexual behaviour
(2018) In Vaccine 36(34). p.5160-5165- Abstract
Introduction: The aim was to assess cost-effectiveness of expanding the Swedish HPV-vaccination program to include preadolescent boys, by comparing health-effects and costs of HPV-related disease, with a sex-neutral vaccination program versus only vaccinating girls. Methods: We used a dynamic compartmental model to simulate the burden of HPV16/18-related disease in Sweden, accounting for indirect effects of vaccination through herd-immunity. The model accounted for sexual behaviour, such as age preferences and men who have sex with men. The main outcome was number of individuals with HPV-related cancers (cervical, genital, anal and oropharyngeal cancer) and cervical intraepithelial neoplasia (CIN). Costs included in the analysis were... (More)
Introduction: The aim was to assess cost-effectiveness of expanding the Swedish HPV-vaccination program to include preadolescent boys, by comparing health-effects and costs of HPV-related disease, with a sex-neutral vaccination program versus only vaccinating girls. Methods: We used a dynamic compartmental model to simulate the burden of HPV16/18-related disease in Sweden, accounting for indirect effects of vaccination through herd-immunity. The model accounted for sexual behaviour, such as age preferences and men who have sex with men. The main outcome was number of individuals with HPV-related cancers (cervical, genital, anal and oropharyngeal cancer) and cervical intraepithelial neoplasia (CIN). Costs included in the analysis were those incurred when treating HPV-related cancer and CIN, production losses during sick-leave, and acquisition and administration of vaccine. Health effects were measured as quality-adjusted life years (QALY). The time horizon was set to 100 years, and both effects and costs were discounted by 3% annually. Health effects and costs were accumulated over the time horizon and used to create an incremental cost-effectiveness ratio. Results: A sex-neutral vaccination program would reduce HPV-related cancer and CIN, both due to direct effects among vaccinated as well as through herd-immunity, further decreasing HPV-related cancer burden annually by around 60 cases among men and women respectively in steady-state. The cost per gained QALY was estimated to 40,000 euro. Applying the procurement price of 2017, sex-neutral vaccination was dominant. Conclusion: Introducing a sex-neutral HPV-vaccination program would be good value for money also in Sweden where there this 80% coverage in the current HPV-vaccination program for preadolescent girls. The cost-effectiveness of a sex-neutral program is highly dependent on the price of the vaccine, the lower the price the more favourable it is to also vaccinate boys.
(Less)
- author
- Wolff, Ellen ; Elfström, K. Miriam ; Haugen Cange, Hedda ; Larsson, Sofie ; Englund, Helene ; Sparén, Pär and Roth, Adam LU
- organization
- publishing date
- 2018-08-16
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Cost effectiveness, Dynamic modelling, Health economic evaluation, HPV, Human papillomavirus, Vaccination
- in
- Vaccine
- volume
- 36
- issue
- 34
- pages
- 6 pages
- publisher
- Elsevier
- external identifiers
-
- scopus:85049798714
- pmid:30017146
- ISSN
- 0264-410X
- DOI
- 10.1016/j.vaccine.2018.07.018
- language
- English
- LU publication?
- yes
- id
- 04e4d447-5561-45a4-8bd5-718d9225ead9
- date added to LUP
- 2018-09-26 15:35:47
- date last changed
- 2024-04-15 13:16:36
@article{04e4d447-5561-45a4-8bd5-718d9225ead9,
abstract = {{<p>Introduction: The aim was to assess cost-effectiveness of expanding the Swedish HPV-vaccination program to include preadolescent boys, by comparing health-effects and costs of HPV-related disease, with a sex-neutral vaccination program versus only vaccinating girls. Methods: We used a dynamic compartmental model to simulate the burden of HPV16/18-related disease in Sweden, accounting for indirect effects of vaccination through herd-immunity. The model accounted for sexual behaviour, such as age preferences and men who have sex with men. The main outcome was number of individuals with HPV-related cancers (cervical, genital, anal and oropharyngeal cancer) and cervical intraepithelial neoplasia (CIN). Costs included in the analysis were those incurred when treating HPV-related cancer and CIN, production losses during sick-leave, and acquisition and administration of vaccine. Health effects were measured as quality-adjusted life years (QALY). The time horizon was set to 100 years, and both effects and costs were discounted by 3% annually. Health effects and costs were accumulated over the time horizon and used to create an incremental cost-effectiveness ratio. Results: A sex-neutral vaccination program would reduce HPV-related cancer and CIN, both due to direct effects among vaccinated as well as through herd-immunity, further decreasing HPV-related cancer burden annually by around 60 cases among men and women respectively in steady-state. The cost per gained QALY was estimated to 40,000 euro. Applying the procurement price of 2017, sex-neutral vaccination was dominant. Conclusion: Introducing a sex-neutral HPV-vaccination program would be good value for money also in Sweden where there this 80% coverage in the current HPV-vaccination program for preadolescent girls. The cost-effectiveness of a sex-neutral program is highly dependent on the price of the vaccine, the lower the price the more favourable it is to also vaccinate boys.</p>}},
author = {{Wolff, Ellen and Elfström, K. Miriam and Haugen Cange, Hedda and Larsson, Sofie and Englund, Helene and Sparén, Pär and Roth, Adam}},
issn = {{0264-410X}},
keywords = {{Cost effectiveness; Dynamic modelling; Health economic evaluation; HPV; Human papillomavirus; Vaccination}},
language = {{eng}},
month = {{08}},
number = {{34}},
pages = {{5160--5165}},
publisher = {{Elsevier}},
series = {{Vaccine}},
title = {{Cost-effectiveness of sex-neutral HPV-vaccination in Sweden, accounting for herd-immunity and sexual behaviour}},
url = {{http://dx.doi.org/10.1016/j.vaccine.2018.07.018}},
doi = {{10.1016/j.vaccine.2018.07.018}},
volume = {{36}},
year = {{2018}},
}