title: Economic evaluations of massive HPV vaccination: within-study and between study variations in incremental cost per QALY gained.
abstract: OBJECTIVE
  We describe the heterogeneity of the estimates of the incremental cost per quality-adjusted year of life (QALY) within and between cost-utility studies of the human papillomavirus (HPV) vaccine.
  
  
  METHODS
  We searched for articles in English published in peer-reviewed journals that perform cost-utility analyses to evaluate the addition of HPV vaccine to 12-year-old girls to existing cervical cancer screening practices. Fifteen studies were selected according to our inclusion and exclusion criteria.
  
  
  RESULTS
  There are large within-study variations in estimates of the cost per QALY gained. The most influential source of uncertainty is the duration of the vaccine protection. Between-study variations are mainly due to three causes: methodological differences, assumptions, and local conditions in the application area. We find large variations between studies for a given country.
  
  
  CONCLUSIONS
  Economic evaluation models are increasingly sophisticated, but scientific treatment of epidemiological and market uncertainty does not compensate for the lack of basic information.
  
  
  CONCLUSIONS
  The large disparities in cost per QALY estimates of massive vaccination programs around the world may be attributed to several critical sources (unavoidable and avoidable) of uncertainty. An asset of economic evaluation is the ability to highlight the areas of research that could be undertaken to reduce uncertainty.
authors.affiliation: University Pompeu Fabra, Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Puig-Junoy
authors.forename: Beatriz G
authors.initials: BG
authors.lastname: Lopez-Valcarcel
mesh_terms: D002648:Child; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008403:Mass Screening; D032541:Mass Vaccination / Q000191:economics*; D053918:Papillomavirus Vaccines / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D012196:Review Literature as Topic; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control
chemical_list: D053918:Papillomavirus Vaccines