Vaccination Programme against the human papillomavirus (HPV) to prevent cervical cancer is by no means cost-effective per QALY said Dutch researchers at the Erasmus medical centre Rotterdam. The costs exceed many times the threshold of € 20,000 per QALY officially for cost-efectiviteit at screening programmes. Article update 1 February 2012
Update 30 March 2010:
Strange that the media coverage of study on cost-effectiveness of vaccination against the HPV virus and thus indirectly against cervical cancer not take away in the coverage about the new vaccination round. But still, but equally also highlighted seen these posts about confidentiality of report on recruitment methods of producer of gardasil: http://forum.www.trosradar.nl/viewtopic.php?f=45&t=80442
6 July 2009: source: Meds cape and j. NAT. Cancer Institute online
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2 July 2009 – the vaccination against the human papillomavirus (HPV) is not cost-effective in Netherlands. Even under the most favourable assumptions that vaccination lifetime protection against 70% of all cervical cancer that would give to all women, irrespective of their administration would be at risk of cervical cancer, and assumed that there would be no adverse effects than the vaccination programme has yet taken a huge amount of money and definitely not cost effective. These are the conclusions from a study report of the Erasmus medical centre Rotterdam that on July 1, 2009 has been published in the Journal of the National Cancer Institute. To be cost effective to make HPV vaccine dosing for Dutch women, strong price would have to be reduced, depending on the long-term effectiveness of the vaccine. The authors note that, with the current price of € 118 per dose of vaccine, the addition of the HPV vaccination to the current Dutch screening programme cost-benefit ratio of quality adjusted life expectancy € 20.900 per year (QALY) is fixed. This cost-benefit ratio is significantly higher than the threshold of € 20,000 per QALY cost-effectiveness as it is drawn up by the Dutch Government aanvaardbaarheidsgrnes for cervical cancer screening program. In other words, an intervention with a cost/benefit ratio of more than € 20,000 per QALY was not deemed acceptable. In a very favourable situation, where only 1 round vaccination of 3 doses would be needed for protection during its entire lifespan type16 against HPV-related cervical cancer would be a/18, of € 20,000 per QALY cost-benefit ratio to be achieved if the price of the vaccine at around € 40 per dose was coming, explain the researchers. If an additional repeat vaccination should be added, should the price of the first vaccination and be complemented with 4 € 33 per dose of € 16 per dose extra donor loads vaccinations. Cost effectiveness in decreasing Incidence As in many industrialized countries, the mortality related to cervical cancer have dropped dramatically in Netherlands. This is thanks to efficient and large-scale screening programs. The mortality rate In 2005 was 1.6 per year per 100,000 women in Netherlands (WSR)], and this percentage is lower than the WSR of 2.5 per 100,000 women in the United States deaths for the period 2001-2005 and 1.9 in the United Kingdom in 2005, according to the authors. A number of analyses |
The team, led by Inge M.C.M. the public health department to the Cook, Erasmus MC University Medical Center in Rotterdam, examined the effect of adding HPV vaccination to the current Dutch cervical cancer screening programme ...
Using a micro simulation analysis (MISCAN) model screenden the screening, the researchers estimated costs and effects of the addition of HPV vaccination on the current screening protocol in Netherlands and examined the impact of changes in the price of vaccination, number of vaccinations, vaccination, vaccination efficacy, cervical cancer incidence rate attendance level, and the quality of the life of assumptions about the cost-effectiveness of HPV vaccination.
Lower cost efficacy under less favourable assumptions
Under favourable assumptions, the vaccine is not cost-effective. In comparison, the researchers have also the cost-benefit ratio and threshold price calculated per dose vaccine among many less favourable assumptions; 5 vaccinations (4 boosters after the first round) during a lifetime for total protection, 50% presence rate (assuming that 10% of the persistent nonattenders for screening, which were supposed to have a 3-times higher risk of cervical cancer than the attenders, a vacinatie will not visit), and 50% efficacy of the vaccine for cervical cancer.
Under less favourable conditions, researchers have no kostenefectiviteit against any prize from the vaccine can find. When the HPV vaccination is added to the current screening protocol this less favourable assumptions. Then the researchers came out on a cost-benefit ratio of 362.100 € per QALY. Using these parameters, the price per dose of vaccine than would be € 8,--must be to a cost-benefit ratio of € 20,000 per QALY would be reached. In other words even if the price per dose would not yet the vaccine would be € 0 cost effective.
There are limitations to the analysis, the researchers note. E.g. the impact of livestock or community immunity was underestimated, and the impact of the vaccine on other types of HPV-related diseases was also not taken into account.
Although the long-term adverse effects are not yet known and only a small number of adverse reactions have been reported in women over the age of 15 to 26 years, most countries ofplan to vaccinate all 12-year-old girls. Both the safety and efficacy are not tested in this age group brands since cervical cancer researchers and a relatively rare disease has become in the Netherlands as a result of vaccination side effects will also affect the risk/benefit ratio of the vaccination. This underlines the importance of future studies that will examine the side effects vaccinated at 12-year-old girls, especially important for safety and also for estimates of cost-effectiveness.
"In short, there are still many uncertainties about the effects of HPV vaccination on HPV-related diseases," write the authors "from our cost-benefit analysis shows that in Netherlands, a country with a low cervical cancer incidence and mortality, HPV vaccination is not cost-effective."
GlaxoSmithKline financing provided for the study, at the Department of Public Health of the Erasmus University Medical Centre. The authors have no interests.
J. Natl. Cancer Inst. Published online 1 July 2009.
