title: A cost-effectiveness analysis of adding a human papillomavirus vaccine to the Australian National Cervical Cancer Screening Program.
abstract: BACKGROUND
  The cost-effectiveness of adding a human papillomavirus (HPV) vaccine to the Australian National Cervical Screening Program compared to screening alone was examined.
  
  
  METHODS
  A Markov model of the natural history of HPV infection that incorporates screening and vaccination was developed. A vaccine that prevents 100% of HPV 16/18-associated disease, with a lifetime duration of efficacy and 80% coverage offered through a school program to girls aged 12 years, in conjunction with current screening was compared with screening alone using cost (in Australian dollars) per life-year (LY) saved and quality-adjusted life-year (QALY) saved. Sensitivity analyses included determining the cost-effectiveness of offering a catch-up vaccination program to 14-26-year-olds and accounting for the benefits of herd immunity.
  
  
  RESULTS
  Vaccination with screening compared with screening alone was associated with an incremental cost-effectiveness ratio (ICER) of $51 103 per LY and $18 735 per QALY, assuming a cost per vaccine dose of $115. Results were sensitive to assumptions about the duration of vaccine efficacy, including the need for a booster ($68 158 per LY and $24 988 per QALY) to produce lifetime immunity. Accounting for herd immunity resulted in a more attractive ICER ($36 343 per LY and $13 316 per QALY) for girls only. The cost per LY of vaccinating boys and girls was $92 052 and the cost per QALY was $33 644. The cost per LY of implementing a catch-up vaccination program ranged from $45 652 ($16 727 per QALY) for extending vaccination to 14-year-olds to $78 702 ($34 536 per QALY) for 26-year-olds.
  
  
  CONCLUSIONS
  These results suggest that adding an HPV vaccine to Australia's current screening regimen is a potentially cost-effective way to reduce cervical cancer and the clinical interventions that are currently associated with its prevention via screening alone.
authors.affiliation: Duke University, Center for Clinical Health Policy Research, Durham, NC 27710, USA. kulas002@mc.duke.edu
authors.forename: Shalini
authors.initials: S
authors.lastname: Kulasingam
authors.forename: Luke
authors.initials: L
authors.lastname: Connelly
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Conway
authors.forename: Jane S
authors.initials: JS
authors.lastname: Hocking
authors.forename: Evan
authors.initials: E
authors.lastname: Myers
authors.forename: David G
authors.initials: DG
authors.lastname: Regan
authors.forename: David
authors.initials: D
authors.lastname: Roder
authors.forename: Jayne
authors.initials: J
authors.lastname: Ross
authors.forename: Gerard
authors.initials: G
authors.lastname: Wain
mesh_terms: D000293:Adolescent; D001315:Australia / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D052162:Human papillomavirus 16; D006801:Humans; D008390:Markov Chains; D032541:Mass Vaccination / Q000191:economics* / Q000706:statistics & numerical data; D009313:National Health Programs / Q000191:economics; D030361:Papillomavirus Infections / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000191:economics* / Q000627:therapeutic use; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D002583:Uterine Cervical Neoplasms / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D053918:Papillomavirus Vaccines