Cost-effectiveness of human papillomavirus vaccination in Germany
Identifieur interne : 000665 ( Main/Exploration ); précédent : 000664; suivant : 000666Cost-effectiveness of human papillomavirus vaccination in Germany
Auteurs : Oliver Damm [Allemagne] ; Johannes Horn [Allemagne] ; Rafael T. Mikolajczyk [Allemagne] ; Mirjam E. E. Kretzschmar [Pays-Bas] ; Andreas M. Kaufmann [Allemagne] ; Yvonne Deleré [Allemagne] ; Bernhard Ultsch [Allemagne] ; Ole Wichmann [Allemagne] ; Alexander Kr Mer [Allemagne] ; Wolfgang Greiner [Allemagne]Source :
- Cost Effectiveness and Resource Allocation : C/E [ 1478-7547 ] ; 2017.
Abstract
The aim of this study was to assess the cost-effectiveness of human papillomavirus (HPV) vaccination in addition to the current cervical cancer screening programme in Germany using a dynamic transmission model.
Based on a mathematical model simulating the transmission dynamics and the natural history of HPV infection and associated diseases (cervical intraepithelial neoplasia, cervical cancer, and genital warts), we estimated the epidemiological and economic consequences of HPV vaccination with both the quadrivalent and bivalent vaccines. In our base case analysis, we assessed the cost-effectiveness of vaccinating 12-year-old girls with a 3-dose schedule. In sensitivity analysis, we also evaluated the use of a 2-dose schedule and assessed the impact of vaccinating boys.
From a health care payer perspective, incremental cost-effectiveness ratios (ICERs) of a 3-dose schedule were €34,249 per quality-adjusted life year (QALY) for the bivalent and €14,711 per QALY for the quadrivalent vaccine. Inclusion of indirect costs decreased ICERs by up to 40%. When adopting a health care payer perspective, ICERs of a 2-dose approach decreased to €19,450 per QALY for the bivalent and to €3645 per QALY for the quadrivalent vaccine. From a societal perspective, a 2-dose approach using the quadrivalent vaccine was a cost-saving strategy while using the bivalent vaccine resulted in an ICER of €13,248 per QALY. Irrespective of the perspective adopted, additional vaccination of boys resulted in ICERs exceeding €50,000 per QALY, except for scenarios with low coverage (20%) in girls.
Our model results suggest that routine HPV vaccination of 12-year-old girls with three doses is likely to be cost-effective in Germany. Due to the additional impact on genital warts, the quadrivalent vaccine appeared to be more cost-effective than the bivalent vaccine. A 2-dose schedule of the quadrivalent vaccine might even lead to cost savings when adopting a societal perspective. The cost-effectiveness of additional vaccination of boys was highly dependent on the coverage in girls.
Url:
DOI: 10.1186/s12962-017-0080-9
PubMed: 28878573
PubMed Central: 5583986
Affiliations:
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type="main">Cost-effectiveness of human papillomavirus vaccination in Germany</title><author><name sortKey="Damm, Oliver" sort="Damm, Oliver" uniqKey="Damm O" first="Oliver" last="Damm">Oliver Damm</name><affiliation wicri:level="1"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0944 9128</institution-id><institution-id institution-id-type="GRID">grid.7491.b</institution-id><institution>Department of Health Economics and Health Care Management, School of Public Health,</institution><institution>Bielefeld University,</institution></institution-wrap>Universitätsstraße 25, 33615 Bielefeld, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Universitätsstraße 25, 33615 Bielefeld</wicri:regionArea><wicri:noRegion>33615 Bielefeld</wicri:noRegion><wicri:noRegion>33615 Bielefeld</wicri:noRegion><wicri:noRegion>33615 Bielefeld</wicri:noRegion></affiliation></author><author><name sortKey="Horn, Johannes" sort="Horn, Johannes" uniqKey="Horn J" first="Johannes" last="Horn">Johannes Horn</name><affiliation wicri:level="1"><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="GRID">grid.7490.a</institution-id><institution>Epidemiological and Statistical Methods Research Group,</institution><institution>Helmholtz Centre for Infection Research,</institution></institution-wrap>Braunschweig, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Braunschweig</wicri:regionArea></affiliation></author><author><name sortKey="Mikolajczyk, Rafael T" sort="Mikolajczyk, Rafael T" uniqKey="Mikolajczyk R" first="Rafael T." last="Mikolajczyk">Rafael T. 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E." last="Kretzschmar">Mirjam E. E. Kretzschmar</name><affiliation wicri:level="1"><nlm:aff id="Aff5"><institution-wrap><institution-id institution-id-type="ISNI">0000000090126352</institution-id><institution-id institution-id-type="GRID">grid.7692.a</institution-id><institution>Julius Center for Health Sciences and Primary Care,</institution><institution>University Medical Center Utrecht,</institution></institution-wrap>Utrecht, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Utrecht</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff6"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2208 0118</institution-id><institution-id institution-id-type="GRID">grid.31147.30</institution-id><institution>Centre for Infectious Disease Control,</institution><institution>RIVM,</institution></institution-wrap>Bilthoven, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Bilthoven</wicri:regionArea></affiliation></author><author><name sortKey="Kaufmann, Andreas M" sort="Kaufmann, Andreas M" uniqKey="Kaufmann A" first="Andreas M." last="Kaufmann">Andreas M. Kaufmann</name><affiliation wicri:level="1"><nlm:aff id="Aff7"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2218 4662</institution-id><institution-id institution-id-type="GRID">grid.6363.0</institution-id><institution>Gynecologic Tumor Immunology, Clinic for Gynecology,</institution><institution>Charité-Universitätsmedizin Berlin,</institution></institution-wrap>Berlin, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Berlin</wicri:regionArea></affiliation></author><author><name sortKey="Delere, Yvonne" sort="Delere, Yvonne" uniqKey="Delere Y" first="Yvonne" last="Deleré">Yvonne Deleré</name><affiliation wicri:level="3"><nlm:aff id="Aff8">Praxis Löser/Kaden/Deleré/Knappe, Berlin, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Praxis Löser/Kaden/Deleré/Knappe, Berlin</wicri:regionArea><placeName><region type="land" nuts="3">Berlin</region><settlement type="city">Berlin</settlement></placeName></affiliation></author><author><name sortKey="Ultsch, Bernhard" sort="Ultsch, Bernhard" uniqKey="Ultsch B" first="Bernhard" last="Ultsch">Bernhard Ultsch</name><affiliation wicri:level="1"><nlm:aff id="Aff9"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0940 3744</institution-id><institution-id institution-id-type="GRID">grid.13652.33</institution-id><institution>Immunisation Unit,</institution><institution>Robert Koch Institute,</institution></institution-wrap>Berlin, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Berlin</wicri:regionArea></affiliation></author><author><name sortKey="Wichmann, Ole" sort="Wichmann, Ole" uniqKey="Wichmann O" first="Ole" last="Wichmann">Ole Wichmann</name><affiliation wicri:level="1"><nlm:aff id="Aff9"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0940 3744</institution-id><institution-id institution-id-type="GRID">grid.13652.33</institution-id><institution>Immunisation Unit,</institution><institution>Robert Koch Institute,</institution></institution-wrap>Berlin, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Berlin</wicri:regionArea></affiliation></author><author><name sortKey="Kr Mer, Alexander" sort="Kr Mer, Alexander" uniqKey="Kr Mer A" first="Alexander" last="Kr Mer">Alexander Kr Mer</name><affiliation wicri:level="1"><nlm:aff id="Aff10"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0944 9128</institution-id><institution-id institution-id-type="GRID">grid.7491.b</institution-id><institution>Department of Public Health Medicine, School of Public Health,</institution><institution>Bielefeld University,</institution></institution-wrap>Bielefeld, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Bielefeld</wicri:regionArea></affiliation></author><author><name sortKey="Greiner, Wolfgang" sort="Greiner, Wolfgang" uniqKey="Greiner W" first="Wolfgang" last="Greiner">Wolfgang Greiner</name><affiliation wicri:level="1"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0944 9128</institution-id><institution-id institution-id-type="GRID">grid.7491.b</institution-id><institution>Department of Health Economics and Health Care Management, School of Public Health,</institution><institution>Bielefeld University,</institution></institution-wrap>Universitätsstraße 25, 33615 Bielefeld, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Universitätsstraße 25, 33615 Bielefeld</wicri:regionArea><wicri:noRegion>33615 Bielefeld</wicri:noRegion><wicri:noRegion>33615 Bielefeld</wicri:noRegion><wicri:noRegion>33615 Bielefeld</wicri:noRegion></affiliation></author></analytic><series><title level="j">Cost Effectiveness and Resource Allocation : C/E</title><idno type="eISSN">1478-7547</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p id="Par1">The aim of this study was to assess the cost-effectiveness of human papillomavirus (HPV) vaccination in addition to the current cervical cancer screening programme in Germany using a dynamic transmission model.</p></sec><sec><title>Methods</title><p id="Par2">Based on a mathematical model simulating the transmission dynamics and the natural history of HPV infection and associated diseases (cervical intraepithelial neoplasia, cervical cancer, and genital warts), we estimated the epidemiological and economic consequences of HPV vaccination with both the quadrivalent and bivalent vaccines. In our base case analysis, we assessed the cost-effectiveness of vaccinating 12-year-old girls with a 3-dose schedule. In sensitivity analysis, we also evaluated the use of a 2-dose schedule and assessed the impact of vaccinating boys.</p></sec><sec><title>Results</title><p id="Par3">From a health care payer perspective, incremental cost-effectiveness ratios (ICERs) of a 3-dose schedule were €34,249 per quality-adjusted life year (QALY) for the bivalent and €14,711 per QALY for the quadrivalent vaccine. Inclusion of indirect costs decreased ICERs by up to 40%. When adopting a health care payer perspective, ICERs of a 2-dose approach decreased to €19,450 per QALY for the bivalent and to €3645 per QALY for the quadrivalent vaccine. From a societal perspective, a 2-dose approach using the quadrivalent vaccine was a cost-saving strategy while using the bivalent vaccine resulted in an ICER of €13,248 per QALY. Irrespective of the perspective adopted, additional vaccination of boys resulted in ICERs exceeding €50,000 per QALY, except for scenarios with low coverage (20%) in girls.</p></sec><sec><title>Conclusions</title><p id="Par4">Our model results suggest that routine HPV vaccination of 12-year-old girls with three doses is likely to be cost-effective in Germany. Due to the additional impact on genital warts, the quadrivalent vaccine appeared to be more cost-effective than the bivalent vaccine. A 2-dose schedule of the quadrivalent vaccine might even lead to cost savings when adopting a societal perspective. The cost-effectiveness of additional vaccination of boys was highly dependent on the coverage in girls.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Bosch, Fx" uniqKey="Bosch F">FX Bosch</name></author><author><name sortKey="Lorincz, A" uniqKey="Lorincz A">A Lorincz</name></author><author><name sortKey="Mu Oz, N" uniqKey="Mu Oz N">N Muñoz</name></author><author><name sortKey="Meijer, Cjlm" uniqKey="Meijer C">CJLM Meijer</name></author><author><name sortKey="Shah, Kv" uniqKey="Shah K">KV Shah</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gillison, Ml" uniqKey="Gillison M">ML Gillison</name></author><author><name sortKey="Chaturvedi, Ak" uniqKey="Chaturvedi A">AK Chaturvedi</name></author><author><name sortKey="Lowy, Dr" uniqKey="Lowy D">DR Lowy</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Grulich, Ae" uniqKey="Grulich A">AE 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Kohli</name></author><author><name sortKey="Grima, D" uniqKey="Grima D">D Grima</name></author><author><name sortKey="Weinstein, Mc" uniqKey="Weinstein M">MC Weinstein</name></author><author><name sortKey="Wright, Tc" uniqKey="Wright T">TC Wright</name></author><author><name sortKey="Bosch, Fx" uniqKey="Bosch F">FX Bosch</name></author><author><name sortKey="Franco, E" uniqKey="Franco E">E Franco</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gold, Mr" uniqKey="Gold M">MR Gold</name></author><author><name sortKey="Franks, P" uniqKey="Franks P">P Franks</name></author><author><name sortKey="Mccoy, Ki" uniqKey="Mccoy K">KI McCoy</name></author><author><name sortKey="Fryback, Dg" uniqKey="Fryback D">DG Fryback</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="De Kok, Imcm" uniqKey="De Kok I">IMCM de Kok</name></author><author><name sortKey="Van Ballegooijen, M" uniqKey="Van Ballegooijen M">M van Ballegooijen</name></author><author><name sortKey="Habbema, Jdf" uniqKey="Habbema J">JDF Habbema</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Allemagne</li><li>Pays-Bas</li></country><region><li>Berlin</li></region><settlement><li>Berlin</li></settlement></list><tree><country name="Allemagne"><noRegion><name sortKey="Damm, Oliver" sort="Damm, Oliver" uniqKey="Damm O" first="Oliver" last="Damm">Oliver Damm</name></noRegion><name sortKey="Delere, Yvonne" sort="Delere, Yvonne" uniqKey="Delere Y" first="Yvonne" last="Deleré">Yvonne Deleré</name><name sortKey="Greiner, Wolfgang" sort="Greiner, Wolfgang" uniqKey="Greiner W" first="Wolfgang" last="Greiner">Wolfgang Greiner</name><name sortKey="Horn, Johannes" sort="Horn, Johannes" uniqKey="Horn J" first="Johannes" last="Horn">Johannes Horn</name><name sortKey="Kaufmann, Andreas M" sort="Kaufmann, Andreas M" uniqKey="Kaufmann A" first="Andreas M." last="Kaufmann">Andreas M. Kaufmann</name><name sortKey="Kr Mer, Alexander" sort="Kr Mer, Alexander" uniqKey="Kr Mer A" first="Alexander" last="Kr Mer">Alexander Kr Mer</name><name sortKey="Mikolajczyk, Rafael T" sort="Mikolajczyk, Rafael T" uniqKey="Mikolajczyk R" first="Rafael T." last="Mikolajczyk">Rafael T. Mikolajczyk</name><name sortKey="Mikolajczyk, Rafael T" sort="Mikolajczyk, Rafael T" uniqKey="Mikolajczyk R" first="Rafael T." last="Mikolajczyk">Rafael T. Mikolajczyk</name><name sortKey="Mikolajczyk, Rafael T" sort="Mikolajczyk, Rafael T" uniqKey="Mikolajczyk R" first="Rafael T." last="Mikolajczyk">Rafael T. Mikolajczyk</name><name sortKey="Ultsch, Bernhard" sort="Ultsch, Bernhard" uniqKey="Ultsch B" first="Bernhard" last="Ultsch">Bernhard Ultsch</name><name sortKey="Wichmann, Ole" sort="Wichmann, Ole" uniqKey="Wichmann O" first="Ole" last="Wichmann">Ole Wichmann</name></country><country name="Pays-Bas"><noRegion><name sortKey="Kretzschmar, Mirjam E E" sort="Kretzschmar, Mirjam E E" uniqKey="Kretzschmar M" first="Mirjam E. E." last="Kretzschmar">Mirjam E. E. Kretzschmar</name></noRegion><name sortKey="Kretzschmar, Mirjam E E" sort="Kretzschmar, Mirjam E E" uniqKey="Kretzschmar M" first="Mirjam E. E." last="Kretzschmar">Mirjam E. E. Kretzschmar</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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