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Cost-effectiveness of a tetravalent human papillomavirus vaccine in Germany

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Abstract

Aim

Clinical trials have demonstrated the efficacy of the tetravalent human papillomavirus (HPV) vaccination in the prevention of cervical cancer and genital warts associated with HPV types 6, 11, 16 and 18. We used an empirically calibrated Markov cohort model of the natural history of HPV to assess the cost-effectiveness of the vaccine administered to 12-year-old girls alongside existing cervical screening programmes in Germany.

Subjects and methods

The model estimated cervical cancer (CC), cervical intraepithelial neoplasia (CIN) and genital wart lifetime risks and total lifetime health care costs, life years gained and quality-adjusted life years (QALY) gained. The analysis was conducted from the perspective of the German health care payer.

Results

In the base case (considering a lifetime duration of protection and 100% efficacy) it was estimated that 2,835 cervical cancer cases and 679 deaths could be prevented among a cohort of 400,000, at an incremental cost per QALY gained of 10,530 €. A total of 120 girls needed to be vaccinated to prevent 1 case of CC. Cost-effectiveness is sensitive to a duration of protection of less than 20 years and to the discount rate for costs and benefits.

Conclusion

A policy of vaccinating adolescent girls has been recommended by the German Standing Committee on Vaccinations. This study has demonstrated that such a policy is cost-effective based on thresholds of cost-effectiveness that apply in Germany.

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References

  • Anttila A, Jordan J (2004) Epidemiological guidelines for quality assurance in cervical cancer screening. In: European guidelines for quality assurance in cervical cancer screening, pp 1–70

  • Bergeron C, Largeron N, McAllister R, Mathevet P, Remy V (2008) Cost-effectiveness analysis of the introduction of a quadrivalent human papillomavirus vaccine in France. Int J Technol Assess Health Care 24:10–19

    Article  PubMed  Google Scholar 

  • Bischoff-Everding CH, Reimers W, Hopfenmüller W, Kühn W (2006) Kosten-Nutzen-Effektivitätsanalysen des zytologischen Zervixkarzinomscreenings mittels Markov-Analysen (abstract). 56. Kongress der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe, 2006

  • Bollmann R, Bankfalvi A, Griefingholt H, Trosic A, Speich N, Schmitt C, Bollmann M (2005) Validity of combined cytology and human papillomavirus (HPV) genotyping with adjuvant DNA-cytometry in routine cervical screening: results from 31031 women from the Bonn-region in West Germany. Oncol Rep 13:915–922

    PubMed  CAS  Google Scholar 

  • Brisson M, Van de Velde N, De Wals P, Boily MC (2007a) Estimating the number needed to vaccinate to prevent diseases and death related to human papillomavirus infection. CMAJ 177:464–468

    PubMed  Google Scholar 

  • Brisson M, Van de Velde N, De Wals P, Boily MC (2007b) The potential cost-effectiveness of prophylactic human papillomavirus vaccines in Canada. Vaccine 25:5399–5408

    Article  PubMed  Google Scholar 

  • Brown D (2007) HPV type 6/11/16/18 vaccine: first analysis of cross-protection against persistent infection, cervical intraepithelial neoplasia (CIN), and adenocarcinoma in situ (AIS) caused by oncogenic HPV types in addition to 16/18 (abstract G-1720b). 47th Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, 17–20 September 2007

  • Canfell K, Barnabas R, Patnick J, Beral V (2004) The predicted effect of changes in cervical screening practice in the UK: results from a modelling study. Br J Cancer 91:530–536

    Article  PubMed  CAS  Google Scholar 

  • Chesson HW, Ekwueme D, Sasieni P, Markowitz E (2008) Cost-effectiveness of human papillomavirus vaccination in the United States. Emerg Infect Dis 14:244–251

    Article  PubMed  Google Scholar 

  • Clifford GM, Smith JS, Aguado T, Franceschi S (2003) Comparison of HPV type distribution in high-grade cervical lesions and cervical cancer: a meta-analysis. Br J Cancer 89:101–105

    Article  PubMed  CAS  Google Scholar 

  • Clifford GM, Rana RK, Franceschi S, Smith JS, Gough G, Pimenta JM (2005) Human papillomavirus genotype distribution in low-grade cervical lesions: comparison by geographic region and with cervical cancer. Cancer Epidemiol Biomarkers Prev 14:1157–1164

    Article  PubMed  Google Scholar 

  • Crott R (2007) Economic analysis of HPV-vaccines: not so simple? Vaccine 25:7717

    Article  PubMed  Google Scholar 

  • Dasbach EJ, Elbasha EH, Insinga RP (2006) Mathematical models for predicting the epidemiologic and economic impact of vaccination against human papillomavirus infection and disease. Epidemiol Rev 28:88–100

    Article  PubMed  Google Scholar 

  • Dasbach EJ, Insinga RP, Elbasha EH (2008) The epidemiological and economic impact of a quadrivalent human papillomavirus vaccine (6/11/16/18) in the UK. BJOG 115:947–956

    Article  PubMed  CAS  Google Scholar 

  • Dutch Health Care Insurance Board (2005) Richtlijnen voor farmaco-economisch onderzoek; evaluatie en actualisatie College voor zorgverzekeringen http://www.cvz.nl/resources/rpt0510_richtlijnen_FEO_tcm28–17860.pdf. 27 Oct 2005

  • European Commission (2002) Percentage of women reporting specific preventive examinations. Eurobarometer 43.0 and 59.0

  • Federal Statistical Office Germany Statistics (2004) Population: births and deaths. http://www.destatis.de/presse/deutsch/cal_2004.htm#Explanatory%20note.website. 29 Dec 2004

  • Garland SM, Hernandez-Avila M, Wheeler CM, Perez G, Harper DM, Leodolter S et al (2007) Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. N Engl J Med 356:1928–1943

    Article  PubMed  CAS  Google Scholar 

  • Goldie SJ, Kohli M, Grima D, Weinstein MC, Wright TC, Bosch FX, Franco E (2004) Projected clinical benefits and cost-effectiveness of a human papillomavirus 16/18 vaccine. J Natl Cancer Inst 96:604–615

    Article  PubMed  Google Scholar 

  • Hillemanns P, Breugelmans G, Gieseking F, Bénard S, Lamure E, Littlewood KJ, Petry KU (2008) Estimation of the incidence of genital warts and the cost of illness in Germany: a cross-sectional study. BMC Infect Dis 8:76

    Article  PubMed  Google Scholar 

  • Jit M, Choi YH, Edmunds WJ (2008) Economic evaluation of human papillomavirus vaccination in the United Kingdom. BMJ 337:a769

    Article  PubMed  Google Scholar 

  • Karnon J, Peters J, Platt J, Chilcott J, McGoogan E, Brewer N (2004) Liquid-based cytology in cervical screening: an updated rapid and systematic review and economic analysis. Health Technol Assess 8:iii1–iii78

    Google Scholar 

  • Krebsregister, Saarland (2003) Annual report of the epidemiological cancer register Saarland for the diagnostic years 1998 to 2000. http://www.krebsregister.saarland.de/. 1 Jul 2003

  • Kulasingam SL, Benard S, Barnabas R, Largeron N, Myers ER (2008) Adding a quadrivalent human papillomavirus vaccine to the UK cervical cancer screening programme: a cost-effectiveness analysis. Cost Eff Resour Alloc 6:4

    Article  PubMed  Google Scholar 

  • Lacey C (2008) Continued efficacy of quadrivalent HPV (types 6/11/16/18) L1 VLP vaccine in preventing cervical or external genital disease: 4 years of follow-up. 20th European College of Obstetrics and Gynaecology, Lisbon, 4–8 March 2008

  • Mitchell MF, Schottenfeld D, Tortolero-Luna G, Cantor SB, Richards-Kortum R (1998) Colposcopy for the diagnosis of squamous intraepithelial lesions: a meta-analysis. Obstet Gynecol 91:626–631

    Article  PubMed  CAS  Google Scholar 

  • Mittendorf T, Petry KU, Iftner T, Greiner W, von der Schulenburg JM (2003) Economic evaluation of human papillomavirus screening in Germany. Eur J Health Econ 4:209–215

    Article  PubMed  CAS  Google Scholar 

  • Muñoz N, Castellsagué X, de González AB, Gissmann L (2006) Chapter 1: HPV in the etiology of human cancer. Vaccine 24(Suppl 3):S3/1–S3/10

    Google Scholar 

  • Myers ER, Green S, Lipkus I (2004) Patient preferences for health states related to HPV infection: visual analogue scales vs time trade-off elicitation. Proceedings of the 21st International Papillomavirus Conference, Mexico City, 20–26 February 2004

  • Myers ER, McCrory DC, Nanda K, Bastian L, Matchar DB (2000) Mathematical model for the natural history of human papillomavirus infection and cervical carcinogenesis. Am J Epidemiol 151:1158–1171

    PubMed  CAS  Google Scholar 

  • Olsson SE, Villa LL, Costa RL, Petta CA, Andrade RP, Malm C et al (2007) Induction of immune memory following administration of a prophylactic quadrivalent human papillomavirus (HPV) types 6/11/16/18 L1 virus-like particle (VLP) vaccine. Vaccine 25:4931–4939

    Article  PubMed  CAS  Google Scholar 

  • Paavonen J, Jenkins D, Bosch F, Naud P, Salmeron J, Wheeler C, Chow S, Apter D, Kitchener H, Castellsague X, de Carvalho N, Skinner S, Harper D, Hedrick J, Jaisamrarn U, Limson G, Dionne M, Quint W, Spiessens B, Peeters P, Struyf F, Wieting S, Lehtinen M, Dubin M, HPV PATRICIA study group (2007) Efficacy of a prophylactic adjuvanted bivalent L1 virus-like-particle vaccine against infection with human papillomavirus types 16 and 18 in young women: an interim analysis of a phase III double-blind, randomised controlled trial. Lancet 369:2161–2170

    Article  PubMed  CAS  Google Scholar 

  • Petry KU, Menton S, Menton M, van Loenen-Frosch F, de Carvalho GH, Holz B et al (2003) Inclusion of HPV testing in routine cervical cancer screening for women above 29 years in Germany: results for 8466 patients. Br J Cancer 88:1570–1577

    Article  PubMed  Google Scholar 

  • Petry KU, Breugelmans G, Bénard S, Lamure E, Littlewood KJ, Hillemanns P (2008) Cost of screening and treatment of cervical dyskaryosis in Germany. Eur J Gynaecol Oncol 29:345–349

    PubMed  CAS  Google Scholar 

  • Robert Koch Institute (2007) Statement by the standing committee on vaccinations (STIKO) at the Robert Koch Institute: vaccination against human papilloma virus (HPV) for girls of 12 to 17 years of age—recommendation and explanatory statement. Epidemiology Bulletin 98–103

  • Robert Koch-Institut (2008) Gesellschaft der epidemiologischen Krebsregister in Deutschland e. V. (ed): Krebs in Deutschland 2003–2004. Häufigkeiten und Trends, 6th edn. Berlin

  • Schenck U, Soost HJ (1995) In Referatband der 13. Fortbildungstagung für klinische Zytologie. Befundwiedergabe in der Zytologie: Münchner Nomenklatur II und Bethesda System 1991. Märkl-Druck, Munich, pp 224–233

    Google Scholar 

  • Schenck U, von Karsa L (2000) Cervical cancer screening in Germany. Eur J Cancer 36:2221–2226

    Article  PubMed  CAS  Google Scholar 

  • Sheriff SK, Petry KU, Ikenberg H, Crouse G, Mazonson PD, Santas CC (2007) An economic analysis of human papillomavirus triage for the management of women with atypical and abnormal Pap smear results in Germany. Eur J Health Econ 8:153–160

    Article  PubMed  Google Scholar 

  • Siebert U, Muth C, Sroczynski G, Velasco-Garrido M, Gerhardus A, Gibis B (2004) Institute for Technology Assessment. Liquid-based preparation and computer-assisted examination of cervical smears. Clinical effectiveness, economic evaluation and systematic decision analysis. Health Technology Assessment Vol 35. 1–444. Series of the German Institute for Medical Documentation and Information commissioned by the Federal Ministry of Health and Social Security. Asgard, St. Augustin

  • Siebert U, Sroczynski G, Hillemanns P, Engel J, Stabenow R, Stegmaier C et al (2006) The German cervical cancer screening model: development and validation of a decision-analytic model for cervical cancer screening in Germany. Eur J Public Health 16:185–192

    Article  PubMed  Google Scholar 

  • FUTURE II Study Group (2007) Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med 356:1915–1927

    Article  Google Scholar 

  • von Krogh G (2001) Management of anogenital warts (condylomata acuminata). Eur J Dermatol 11:598–603

    Google Scholar 

Download references

Acknowledgements

The decision to submit this manuscript for publication was taken collectively by all of the authors.

Funding

This study was conducted with the financial support of Sanofi Pasteur MSD, Lyon, France.

Conflict of interest statement

PH and KUP declared that they have received honoraria from Sanofi Pasteur MSD and/or GSK for speaking at several scientific meetings and for acting as scientific consultant. NL is an employee of Sanofi Pasteur MSD, who commercializes Gardasil® in Europe. KB previously worked for Sanofi Pasteur MSD. RMA and KT previously worked for Mapi Values who were contracted by Sanofi Pasteur MSD to conduct the analysis and to write a previous version of this manuscript.

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Authors and Affiliations

  1. Medizinische Hochschule Hannover, Carl-Neubergstr. 1, 30625, Hannover, Germany

    Peter Hillemanns

  2. Frauenklinik im Klinikum der Stadt Wolfsburg, Wolfsburg, Germany

    Karl Ulrich Petry

  3. Sanofi Pasteur MSD, Lyon, France

    Nathalie Largeron

  4. Mapi Values, Bollington, UK

    Ruth McAllister & Keith Tolley

  5. Sanofi Pasteur MSD, Leimen, Germany

    Katharina Büsch

Authors
  1. Peter Hillemanns
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  2. Karl Ulrich Petry
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  3. Nathalie Largeron
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  4. Ruth McAllister
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  5. Keith Tolley
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  6. Katharina Büsch
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Correspondence to Peter Hillemanns.

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Hillemanns, P., Petry, K.U., Largeron, N. et al. Cost-effectiveness of a tetravalent human papillomavirus vaccine in Germany. J Public Health 17, 77–86 (2009). https://doi.org/10.1007/s10389-008-0228-3

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  • DOI: https://doi.org/10.1007/s10389-008-0228-3

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