title: The cost effectiveness of a quadrivalent human papillomavirus vaccine (6/11/16/18) in Hungary.
abstract: OBJECTIVE
  A transmission dynamic model was used to assess the epidemiological and economic impact of a quadrivalent human papillomavirus (HPV) (6/11/16/18) vaccine in preventing cervical cancer, cervical intraepithelial neoplasia grades 2 and 3 (CIN 2/3), CIN 1 and genital warts in Hungary.
  
  
  METHODS
  The routine vaccination of 12-year-old girls and the routine vaccination of 12-year-old girls plus a temporary catch-up programme for girls and women aged 12-24 years was evaluated.
  
  
  RESULTS
  The model projected that at year 100, both strategies could reduce the incidence of HPV 6/11/16/18-related cervical cancer, CIN 2/3, CIN 1 and genital warts cases among Hungarian women by 90%, 90%, 85% and 93%, respectively. Twenty-five years after the introduction of HPV vaccination in the population, routine vaccination of girls by the age of 12 reduced the cumulative number of cases of cervical cancer, CIN 2/3, CIN 1 and genital warts by 685, 13,473, 3,423 and 163,987, respectively. The incremental cost-effectiveness ratios of the two vaccination strategies were €9,577 and €10,646 per quality-adjusted life-year (QALY) gained over a time horizon of 100 years.
  
  
  CONCLUSIONS
  The model did not account for the health and economic impact of other HPV diseases which may result from HPV 16, 18, 6, and 11 infections such as vaginal, vulvar, penile, anal and head-neck cancers, and recurrent respiratory papillomatosis. Epidemiological data from Hungary on these other HPV diseases as well genital warts are needed.
  
  
  CONCLUSIONS
  A quadrivalent HPV vaccination programme can reduce the incidence of cervical cancer, CIN and genital warts in Hungary at a cost-per-QALY ratio within the range defined as cost effective.
authors.affiliation: Health Economic Statistics, Biostatistics and Research Decision Sciences, Merck Research Laboratories, North Wales, PA 19454-1099, USA. erik_dasbach@merck.com
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Dasbach
authors.forename: Laszlo
authors.initials: L
authors.lastname: Nagy
authors.forename: Agnes
authors.initials: A
authors.lastname: Brandtmüller
authors.forename: Elamin H
authors.initials: EH
authors.lastname: Elbasha
mesh_terms: D000293:Adolescent; D002648:Child; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D017589:Immunization Programs / Q000191:economics / Q000706:statistics & numerical data; D015994:Incidence; D018803:Models, Economic; D008962:Models, Theoretical; D030361:Papillomavirus Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000191:economics*; D019057:Quality-Adjusted Life Years; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D014611:Vaccination / Q000191:economics / Q000706:statistics & numerical data; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D053918:Papillomavirus Vaccines