Cost-effectiveness of a tetravalent human papillomavirus vaccine in Germany
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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.
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.
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.
KeywordsHuman papillomavirus (HPV) vaccine Cost-effectiveness Germany
The decision to submit this manuscript for publication was taken collectively by all of the authors.
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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