title: Modelling the economic value of cross- and sustained-protection in vaccines against cervical cancer.
abstract: OBJECTIVE
  Two human papillomavirus (HPV) vaccines are on the market. Based on expected differences in sustained- and cross-protection between the two vaccines, their long-term economic value is modelled and compared for France, Ireland and Italy.
  
  
  METHODS
  A Markov cohort model reproducing the natural history of HPV infections, screening and vaccination, is adapted to country-specific data. Two hypothetical HPV vaccines (VA and VB) are compared. At baseline VA provides lifetime protection against HPV-16 and 10-year protection against HPV-18 before waning. VB is the same as VA with a 10-year protection against HPV-6 and 11. Sustained- and cross-protection is varied over wide ranges in VA to define the levels that could make VA cost-effective or dominant compared with VB.
  
  
  RESULTS
  Under baseline conditions VB dominates VA. VA becomes cost-effective when the difference in cross-protection alone reaches 13-15% (undiscounted), and 22-44% (discounted). A combination of sustained- and cross-protection is required for VA to dominate VB (discounted). The results are dependent upon country, the base-case value and the discount applied.
  
  
  CONCLUSIONS
  Realistic additional sustained- and cross-protection in one HPV vaccine may confer benefits that offset the economic value of protection against low-risk HPV in the other. The results are country specific.
authors.affiliation: Health Economics, GlaxoSmithKline Biologicals, Av. Fleming 20, Wavre, Belgium. nadia.x.demarteau@gskbio.com
authors.forename: Nadia
authors.initials: N
authors.lastname: Demarteau
authors.forename: Baudouin
authors.initials: B
authors.lastname: Standaert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003218:Condylomata Acuminata / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D053918:Papillomavirus Vaccines / Q000191:economics*; D019057:Quality-Adjusted Life Years; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines