title: Cost effectiveness of prophylactic HPV 16/18 vaccination in Finland: results from a modelling exercise.
abstract: OBJECTIVE
  the study aims to estimate the clinical-impact and cost-effectiveness value of adding human papillomavirus 16/18 vaccination against cervical cancer among women currently undergoing organised screening in Finland.
  
  
  METHODS
  A Markov cohort model evaluating high-risk HPV infections and cervical cancer (CC) cases combined with screening has been customised to the Finnish setting. The model outcome for a cohort of 30,000 girls aged 10 years was calibrated to age-specific annual number of Pap smears, CC incidence and mortality.
  
  
  RESULTS
  The observed age-specific incidence and mortality rates of CC closely match the data replicated by the model. The model predicts that with a 90% vaccine coverage rate, CC cases and mortality would be reduced by 70%. In the base-case analysis with a discount rate of 3% the incremental cost per quality-adjusted life-years (QALY) gained, from a healthcare perspective, was €17,294. Without discounting this value is €2,591/QALY gained.
  
  
  CONCLUSIONS
  The analysis suggests that implementing prophylactic CC vaccination within the current screening system would substantially reduce CC cases and deaths, as well as the overall disease burden expressed in pre-cancer lesions averted. Vaccination could be a cost-effective intervention in Finland despite the fact that the number of CC cases and deaths are currently relatively low. Conservative estimates of the cost effectiveness of the vaccination were provided since it was not possible to assess herd protection induced by vaccination using this Markov model.
authors.affiliation: GlaxoSmithKline, Espoo, Finland. saku.torvinen@gmail.com
authors.forename: Saku
authors.initials: S
authors.lastname: Torvinen
authors.forename: Pekka
authors.initials: P
authors.lastname: Nieminen
authors.forename: Matti
authors.initials: M
authors.lastname: Lehtinen
authors.forename: Jorma
authors.initials: J
authors.lastname: Paavonen
authors.forename: Nadia
authors.initials: N
authors.lastname: Demarteau
authors.forename: Jarmo
authors.initials: J
authors.lastname: Hahl
mesh_terms: D000328:Adult; D002648:Child; D003362:Cost-Benefit Analysis; D005260:Female; D005387:Finland; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D065006:Papanicolaou Test; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000191:economics*; D019057:Quality-Adjusted Life Years; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014626:Vaginal Smears / Q000191:economics / Q000706:statistics & numerical data
chemical_list: D053918:Papillomavirus Vaccines