Novel Health Economic Evaluation of a Vaccination Strategy to Prevent HPV-related Diseases The BEST Study

*Department of Accounting and Finance at Kingston University †Department of Statistical Science, University College London, London, UK ‡Biostatistics Unit, Department of Statistics, University of Milano-Bicocca, Milan §CEIS Sanità (CHEM-Centre for Health Economics and Management), Faculty of Economics, University of Tor Vergata, Rome ∥Department of Gynecology and Obstetrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna ¶Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome #Laboratory of Cutaneous Pathophysiology, San Gallicano Dermatological Institute (IRCCS), Rome, Italy **Centre for Health Economics Alcuin A Block, University of York, Heslington, UK ††Stockholm School of Economics, Stockholm, Sweden ‡‡Socioeconomic Institute, University of Zurich, Zurich, Switzerland.
Medical care (Impact Factor: 3.23). 08/2012; 50(12). DOI: 10.1097/MLR.0b013e318269e06d
Source: PubMed


The development of human papillomavirus (HPV)-related diseases is not understood perfectly and uncertainties associated with commonly utilized probabilistic models must be considered. The study assessed the cost-effectiveness of a quadrivalent-based multicohort HPV vaccination strategy within a Bayesian framework.

A full Bayesian multicohort Markov model was used, in which all unknown quantities were associated with suitable probability distributions reflecting the state of currently available knowledge. These distributions were informed by observed data or expert opinion. The model cycle lasted 1 year, whereas the follow-up time horizon was 90 years. Precancerous cervical lesions, cervical cancers, and anogenital warts were considered as outcomes.

The base case scenario (2 cohorts of girls aged 12 and 15 y) and other multicohort vaccination strategies (additional cohorts aged 18 and 25 y) were cost-effective, with a discounted cost per quality-adjusted life-year gained that corresponded to €12,013, €13,232, and €15,890 for vaccination programs based on 2, 3, and 4 cohorts, respectively. With multicohort vaccination strategies, the reduction in the number of HPV-related events occurred earlier (range, 3.8-6.4 y) when compared with a single cohort. The analysis of the expected value of information showed that the results of the model were subject to limited uncertainty (cost per patient = €12.6).

This methodological approach is designed to incorporate the uncertainty associated with HPV vaccination. Modeling the cost-effectiveness of a multicohort vaccination program with Bayesian statistics confirmed the value for money of quadrivalent-based HPV vaccination. The expected value of information gave the most appropriate and feasible representation of the true value of this program.

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