title: Comparing bivalent and quadrivalent human papillomavirus vaccines: economic evaluation based on transmission model.
abstract: OBJECTIVE
  To compare the effect and cost effectiveness of bivalent and quadrivalent human papillomavirus (HPV) vaccination, taking into account differences in licensure indications, protection against non-vaccine type disease, protection against disease related to HPV types 6 and 11, and reported long term immunogenicity.
  
  
  METHODS
  A model of HPV transmission and disease previously used to inform UK vaccination policy, updated with recent evidence and expanded to include scenarios where the two vaccines differ in duration of protection, cross protection, and end points prevented.
  
  
  METHODS
  United Kingdom. Population Males and females aged 12-75 years.
  
  
  METHODS
  Incremental cost effectiveness ratios for both vaccines and additional cost per dose for the quadrivalent vaccine to be equally cost effective as the bivalent vaccine.
  
  
  RESULTS
  The bivalent vaccine needs to be cheaper than the quadrivalent vaccine to be equally cost effective, mainly because of its lack of protection against anogenital warts. The price difference per dose ranges from a median of £19 (interquartile range £12-£27) to £35 (£27-£44) across scenarios about vaccine duration, cross protection, and end points prevented (assuming one quality adjusted life year (QALY) is valued at £30,000 and both vaccines can prevent all types of HPV related cancers).
  
  
  CONCLUSIONS
  The quadrivalent vaccine may have an advantage over the bivalent vaccine in reducing healthcare costs and QALYs lost. The bivalent vaccine may have an advantage in preventing death due to cancer. However, considerable uncertainty remains about the differential benefit of the two vaccines.
authors.affiliation: Health Protection Agency, London NW9 6BT, UK. mark.jit@hpa.org.uk
authors.forename: Mark
authors.initials: M
authors.lastname: Jit
authors.forename: Ruth
authors.initials: R
authors.lastname: Chapman
authors.forename: Owain
authors.initials: O
authors.lastname: Hughes
authors.forename: Yoon Hong
authors.initials: YH
authors.lastname: Choi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003218:Condylomata Acuminata / Q000191:economics* / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D005260:Female; D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18; D052140:Human papillomavirus 11; D052163:Human papillomavirus 6; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D030361:Papillomavirus Infections / Q000191:economics* / Q000517:prevention & control* / Q000635:transmission; D053918:Papillomavirus Vaccines / Q000191:economics* / Q000276:immunology*; D055815:Young Adult
chemical_list: D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18; D053918:Papillomavirus Vaccines; C510352:human papillomavirus vaccine, L1 type 16, 18