Skip to main content

Advertisement

SpringerLink
Log in

Economic evaluation of human papilloma virus vaccination in the European Union: a critical review

  • CE - HEALTH TECHNOLOGY ASSESSMENT
  • Published:
Internal and Emergency Medicine Aims and scope Submit manuscript

Abstract

The human papilloma virus (HPV) vaccine is a new and expensive vaccine potentially effective in the prevention of a cancer. We reviewed the economic evaluations (EEs) on the vaccine in the EU to assess their potential contribution to public decision-making in a fairly homogeneous setting where HPV vaccination has been widely adopted. A literature search on PubMed selected EEs on HPV vaccines in the EU for the period 2007–2010 using the terms “HPV vaccines” and “Costs and cost analysis.” Fifteen articles were eventually selected. All studies were based on modelling techniques, either “cohort” or “dynamic transmission”: three were cost utility, three cost-effectiveness, and the remainder included both. The ten studies explicitly assessing one of the two vaccines were all sponsored by their manufacturer, while the five studies unrelated to the vaccine type were funded by public agencies. Apart from two studies, utility estimates were always obtained from three US sources. Direct costs were always vaccination, diagnosis and treatment of related pathologies. Incremental cost-effectiveness ratio (ICER) results were less favourable when life years gained were valued rather than quality-adjusted life years, genital warts were excluded, and booster doses and extension of vaccination to men were included in the base-case analysis. All but one of the sponsored EEs recommend in favour of the vaccination strategy, which is dominant in one English study. The ICER results were very sensitive to discount rates, followed by duration of protection and vaccine price. At such an early stage, when the vaccines’ efficacy have been demonstrated by well-designed studies, it is not possible (and not even reasonable) to wait for several years to measure their effectiveness; public decision-makers might benefit more from EEs designed to indicate sustainable prices using realistic estimates of crucial variables like coverage rates, rather than referring to a large number of assumptions in order to show acceptable cost-effectiveness.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Bosch FX, Lorincz A, Muñoz N et al (2002) The causal relation between human papillomavirus and cervical cancer. J Clin Pathol 55:244–265

    PubMed  CAS  Google Scholar 

  2. Pagliusi SR, Aguado MT (2004) Efficacy and other milestones for human papillomavirus vaccine introduction. Vaccine 23:569–578

    Article  PubMed  Google Scholar 

  3. Myers E, Huh WK, Wright JD et al (2008) The current and the future role of screening in the era of HPV vaccination. Gynecol Oncol 109(2 Suppl):S31–S39

    Article  PubMed  Google Scholar 

  4. WHO (2008) Preparing for the introduction of HPV Vaccine in the WHO European Region: strategy paper. Vaccine-Preventable Diseases and Immunization Programme. World Health Organization, Copenhagen

  5. Anttila A, von Karsa L, Aasmaa A et al (2009) Cervical cancer screening policies and coverage in Europe. Eur J Cancer 45:2649–2658

    Article  PubMed  Google Scholar 

  6. Bosch FX, Castellsagué X, de Sanjosé S (2008) HPV and cervical cancer: screening or vaccination? Br J Cancer 98:15–21

    Article  PubMed  CAS  Google Scholar 

  7. Kim S-Y, Goldie SJ (2008) Cost-effectiveness analyses of vaccination programmes, a focused review of modelling approaches. Pharmacoeconomics 26(3):191–215

    Article  PubMed  Google Scholar 

  8. Marra F, Cloutier K, Oteng B et al (2009) Effectiveness and cost effectiveness of human papillomavirus vaccine. A systematic review. Pharmacoeconomics 27:127–147

    Article  PubMed  Google Scholar 

  9. Cuschieri K (2009) Should boys receive the human papillomavirus vaccine? No. BMJ 339:b4921

    Article  PubMed  Google Scholar 

  10. Techakehakij W, Feldman RD (2008) Cost-effectiveness of HPV vaccination compared with Pap smear screening on a national scale: a literature review. Vaccine 28:6258–6265

    Article  Google Scholar 

  11. Ortega-Sanchez IR, Lee GM, Jacobs RJ et al (2008) Projected cost-effectiveness of new vaccines for adolescents in the United States. Pediatrics 121(Suppl 1):563–578

    Google Scholar 

  12. Newal AT, Beutels P, Wood JG et al (2007) Cost-effectiveness analyses of human papillomavirus vaccination. Lancet Infect Dis 7:289–296

    Article  Google Scholar 

  13. Schiffman M, Castle PE, Jeronimo J et al (2007) Human papillomavirus and cervical cancer. Lancet 370:890–907

    Article  PubMed  CAS  Google Scholar 

  14. Bonati M, Garattini S (2009) Controlling cervical cancer. Pharmacoeconomics 27(2):91–93

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  16. La Torre G, de Waure C, Chiaradia G, Mannocci A, Ricciardi W (2010) HPV vaccine eficacy in preventing persistent cervical HPV infection: a systematic review and meta-analysis. Vaccine 25:8352–8358

    Article  Google Scholar 

  17. De Pouvourville G, Ulmann P, Nixon J et al (2005) The diffusion of health economics knowledge in Europe. The EURONHEED (European Network of Health Economic Evaluation Databases) Project. Pharmacoeconomics 23(2):113–120

    Article  PubMed  Google Scholar 

  18. Usher C, Tilson L, Olsen J et al (2008) Cost-effectiveness of human papillomavirus vaccine in reducing the risk of cervical cancer in Ireland due to HPV types 16 and 18 using a transmission dynamic model. Vaccine 26(44):5654–5661

    Article  PubMed  Google Scholar 

  19. Goldie SJ, Goldhaber-Fiebert JD, Garnett GP (2006) Chapter 18: Public health policy for cervical cancer prevention: The role of decision science, economic evaluation, and mathematical modeling. Vaccine 24(Suppl 3):S155–S163

    Article  Google Scholar 

  20. La Torre G, de Waure C, Chiaradia G et al (2010) The health technology assessment of bivalent HPV vaccine Cervarix® in Italy. Vaccine 28:3379–3384

    Article  PubMed  Google Scholar 

  21. De Kok IM, van Ballegooijen M, Habbema JDF (2009) Cost-effectiveness analysis of human papillomavirus vaccination in The Netherlands. J Natl Cancer Inst 101(15):1083–1092

    Article  PubMed  Google Scholar 

  22. Zechmeister I, de Blasio BF, Garnett G et al (2009) Cost-effectiveness analysis of human papillomavirus—vaccination programs to prevent cervical cancer in Austria. Vaccine 27(37):5133–5141

    Article  PubMed  Google Scholar 

  23. Rogoza RM, Westra TA, Ferko N et al (2009) Cost-effectiveness analysis of prophylactic vaccination against human papillomavirus 16/18 for the prevention of cervical cancer: adaptation of an existing cohort model to the situation in The Netherlands. Vaccine 27(35):4776–4783

    Article  PubMed  CAS  Google Scholar 

  24. Thiry N, De Laet C, Hulstaert F et al (2009) Cost-effectiveness of human papillomavirus vaccination in Belgium: do not forget about cervical cancer screening. Int J Technol Assess Health Care 25(2):161–170

    Article  PubMed  Google Scholar 

  25. Annemans L, Rémy V, Oyee J et al (2009) Cost-effectiveness evaluation of a quadrivalent human papillomavirus vaccine in Belgium. Pharmacoeconomics 27(3):231–245

    Article  PubMed  Google Scholar 

  26. Mennini FS, Giorgi Rossi P, Palazzo F et al (2009) Health and economic impact associated with a quadrivalent HPV vaccine in Italy. GynecolOncol 112(2):370–376

    CAS  Google Scholar 

  27. Coupé VMH, van Ginkel J, de Melker HE et al (2009) HPV vaccination to prevent cervical cancer in The Netherlands: model-based cost-effectiveness. Int J Cancer 124(4):970–978

    Article  PubMed  Google Scholar 

  28. Jit M, Choi YH, Edmunds WJ (2008) Economic evaluation of human papillomavirus vaccination in the United Kingdom. BMJ 337:769. doi:10.11367bmj.a769

  29. 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(8):947–956

    Google Scholar 

  30. Bergeron C, Largeron N, McAllister R et al (2008) Cost-effectiveness analysis of the introduction of a quadrivalent human papilloma vaccine in France. Int J Technol Assess Health Care 24(1):10–19

    Article  PubMed  Google Scholar 

  31. Boot HJ, Wallenburg I, de Melker HE et al (2007) Assessing the introduction of universal human papillomavirus vaccination for preadolescent girls in The Netherlands. Vaccine 25(33):6245–6256

    Article  PubMed  Google Scholar 

  32. Kulasingam SL, Benard S, Barnabas RV et al (2008) Adding a quadrivalent human papillomavirus vaccine to the UK cervical cancer screening programme: a cost-effectiveness analysis. Cost Eff Resour Alloc 6(4):4–15

    Article  PubMed  Google Scholar 

  33. Hillemans P, Petry KU, Largeron N et al (2009) Cost-effectiveness of a tetravalent human papillomavirus vaccine in Germany. J Public Health 17:77–86

    Article  Google Scholar 

  34. Olsen J, Jepsen MR (2010) Human papillomavirus transmission and cost-effectiveness of introducing quadrivalent HPV vaccination in Denmark. Int J Technol Assess Health Care 26(2):183–191

    Article  PubMed  Google Scholar 

  35. Villa LL, Perez G, Kjaer SK et al (2007) Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med 356:1915–1927

    Article  CAS  Google Scholar 

  36. Paavonen J, Naud P, Salmeròn J et al (2009) Efficacy of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA): final analysis of a double-blind, randomised study in young women. Lancet 374:301–314

    Article  PubMed  CAS  Google Scholar 

  37. Harper DM, Franco EL, Wheeler CM et al (2006) Sustained efficacy up to 4–5 years of a bivalent L1 virus like particle vaccine against human papillomavirus 16 and 18: follow-up from a randomised control trial. Lancet 367:1247–1255

    Article  PubMed  CAS  Google Scholar 

  38. Villa LL, Costa RLR, Petta CA et al (2006) High sustained efficacy of a prophylactic quadrivalent human papillomavirus types 6/11/16/18 L1-like-particle vaccine through 5 years of follow-up. Br J Cancer 95:1459–1466

    Article  PubMed  CAS  Google Scholar 

  39. Harper DM, Franco EL, Wheeler C et al (2004) Efficacy of bivalent L1 virus-like particle vaccine in prevention of infection with human papillomavirus types 16 and 18 in young women: a randomised controlled trial. Lancet 364:1757–1765

    Article  PubMed  CAS  Google Scholar 

  40. Villa LL, Costa RLR, Petta CA et al (2005) Prophylactic quadrivalent human papillomavirus (types 6, 11, 16, and 18) L1 virus-like particle vaccine in young women: a randomised double-blind placebo-controlled multicentre phase II efficacy trial. Lancet Oncol 6:271–278

    Article  PubMed  Google Scholar 

  41. Stoykova B, Dowie R (2007) HPV testing matters—findings from a time trade-off survey in England. In: IHEA 2007 6th World Congress: explorations in health economics paper. Available at SSRN http://ssrn.com/abstract=945729

  42. Elbasha EH, Dasbach EJ, Insinga RP (2007) Model for assessing human papillomavirus vaccination strategies. Emerg Infect Dis 13:28–41

    Article  PubMed  Google Scholar 

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

  44. Gold M, Franks P, McCoy KI et al (1998) Towards consistency in cost-utility analyses: using national measures to create condition-specific values. Med Care 36:778–792

    Article  PubMed  CAS  Google Scholar 

  45. Woodman CBJ, Collins SI, Young LS (2007) The natural history of cervical HPV infection: unresolved issues. Nat Rev Cancer 7:11–22

    Article  PubMed  CAS  Google Scholar 

  46. Wolstenholme JL, Whynes DK (1998) Stage-specific treatment costs for cervical cancer in the United Kingdom. Eur J Cancer 34(12):1889–1893

    Article  PubMed  CAS  Google Scholar 

  47. Oostenbrink JB, Bouwmans CA, Koopmanschap MA et al (2004) Richtlijnen voor Kostenschattingen in de Gesondheidszorg Guideline for costinng research, methods and standardized prices for economic evaluations in health care. Health Care Insurance Board, Diemen (Netherlands)

  48. Cleemput I, Van Wilder P, Vrijens F et al (2008) Guidelines for pharmaco-economic evaluations in Belgium. Health Technology Assessment (HTA). In: F.K.v.d.G. (KCE) (ed) KCE reports. Belgian Health Care Knowledge Centre (KCE), Brussels

  49. National Institute for Health and Clinical Excellence (2004) Guide to the methods of technology appraisal (reference N0515). http://www.nice.org.uk/niceMedia/pdf/TAP_Methods.pdf

  50. Haug CJ (2008) Human papillomavirus vaccination—reasons for caution. N Engl J Med 359(8):861–862

    Article  PubMed  CAS  Google Scholar 

  51. Loos AH, Bray F, McCarron P et al (2004) Sheep and goats: separating cervix and corpus uteri from imprecisely coded uterine cancer deaths, for studies of geographical and temporal variations in mortality. Eur J Cancer 40:2794–2803

    Article  PubMed  CAS  Google Scholar 

  52. Knies S, Evers SMAA, Candel MJJM et al (2009) Utilities of the EQ-5D. Transferable or not? Pharmacoeconomics 27(9):767–779

    Article  PubMed  Google Scholar 

  53. Korfage IJ, Essink-Bot ML, Mols F et al (2009) Health-related quality of life in cervical cancer survivors: a population-based survey. Int J Radiat Oncol Biol Phys 73(5):1501–1509

    Article  PubMed  Google Scholar 

  54. Whynes DK, Woolley C, Philips Z, for the TOMBOLA Group (2008) Management of low-grade cervical abnormalities detected at screening: which method do women prefer? Cytopathology 19:355–362

    Google Scholar 

  55. Bell CM, Urbach DR, Ray JG et al (2006) Bias in published cost effectiveness studies: systematic review. BMJ 332:699–703

    Article  PubMed  Google Scholar 

  56. Puig-Junoy J, Lopez-Valcarcel BG (2009) Economic evaluations of massive HPV vaccination: within-study and between study variations in incremental cost per QALY gained. Prev Med 48:444–448

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

No funding to declare.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. CESAV, Centre of Health Economics, Via Camozzi, 3 c/o Villa Camozzi, 24020, Ranica (Bergamo), Italy

    Daniela Koleva, Paola De Compadri, Anna Padula & Livio Garattini

Authors
  1. Daniela Koleva
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paola De Compadri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anna Padula
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Livio Garattini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Livio Garattini.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Koleva, D., De Compadri, P., Padula, A. et al. Economic evaluation of human papilloma virus vaccination in the European Union: a critical review. Intern Emerg Med 6, 163–174 (2011). https://doi.org/10.1007/s11739-011-0529-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11739-011-0529-3

Keywords

Search

Navigation