Cost-effectiveness of human papillomavirus vaccination in Germany
Abstract Background 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. Methods Based on a mathematical model simulating the transmission dyn...
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| Format: | Article |
| Language: | English |
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BMC
2017-09-01
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| Series: | Cost Effectiveness and Resource Allocation |
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| Online Access: | http://link.springer.com/article/10.1186/s12962-017-0080-9 |
| _version_ | 1819263272748056576 |
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| author | Oliver Damm Johannes Horn Rafael T. Mikolajczyk Mirjam E. E. Kretzschmar Andreas M. Kaufmann Yvonne Deleré Bernhard Ultsch Ole Wichmann Alexander Krämer Wolfgang Greiner |
| author_facet | Oliver Damm Johannes Horn Rafael T. Mikolajczyk Mirjam E. E. Kretzschmar Andreas M. Kaufmann Yvonne Deleré Bernhard Ultsch Ole Wichmann Alexander Krämer Wolfgang Greiner |
| author_sort | Oliver Damm |
| collection | DOAJ |
| description | Abstract Background 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. Methods 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. Results 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. Conclusions 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. |
| first_indexed | 2024-12-23T20:10:57Z |
| format | Article |
| id | doaj.art-0db43fbf30a847c6a673a38359cf17b6 |
| institution | Directory Open Access Journal |
| issn | 1478-7547 |
| language | English |
| last_indexed | 2024-12-23T20:10:57Z |
| publishDate | 2017-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Cost Effectiveness and Resource Allocation |
| spelling | doaj.art-0db43fbf30a847c6a673a38359cf17b62022-12-21T17:32:48ZengBMCCost Effectiveness and Resource Allocation1478-75472017-09-0115111910.1186/s12962-017-0080-9Cost-effectiveness of human papillomavirus vaccination in GermanyOliver Damm0Johannes Horn1Rafael T. Mikolajczyk2Mirjam E. E. Kretzschmar3Andreas M. Kaufmann4Yvonne Deleré5Bernhard Ultsch6Ole Wichmann7Alexander Krämer8Wolfgang Greiner9Department of Health Economics and Health Care Management, School of Public Health, Bielefeld UniversityEpidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection ResearchEpidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection ResearchJulius Center for Health Sciences and Primary Care, University Medical Center UtrechtGynecologic Tumor Immunology, Clinic for Gynecology, Charité-Universitätsmedizin BerlinPraxis Löser/Kaden/Deleré/KnappeImmunisation Unit, Robert Koch InstituteImmunisation Unit, Robert Koch InstituteDepartment of Public Health Medicine, School of Public Health, Bielefeld UniversityDepartment of Health Economics and Health Care Management, School of Public Health, Bielefeld UniversityAbstract Background 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. Methods 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. Results 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. Conclusions 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.http://link.springer.com/article/10.1186/s12962-017-0080-9HPVVaccinationEconomic evaluationCost-effectivenessDynamic transmission modelGermany |
| spellingShingle | Oliver Damm Johannes Horn Rafael T. Mikolajczyk Mirjam E. E. Kretzschmar Andreas M. Kaufmann Yvonne Deleré Bernhard Ultsch Ole Wichmann Alexander Krämer Wolfgang Greiner Cost-effectiveness of human papillomavirus vaccination in Germany Cost Effectiveness and Resource Allocation HPV Vaccination Economic evaluation Cost-effectiveness Dynamic transmission model Germany |
| title | Cost-effectiveness of human papillomavirus vaccination in Germany |
| title_full | Cost-effectiveness of human papillomavirus vaccination in Germany |
| title_fullStr | Cost-effectiveness of human papillomavirus vaccination in Germany |
| title_full_unstemmed | Cost-effectiveness of human papillomavirus vaccination in Germany |
| title_short | Cost-effectiveness of human papillomavirus vaccination in Germany |
| title_sort | cost effectiveness of human papillomavirus vaccination in germany |
| topic | HPV Vaccination Economic evaluation Cost-effectiveness Dynamic transmission model Germany |
| url | http://link.springer.com/article/10.1186/s12962-017-0080-9 |
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