title: The cost efficiency of HPV vaccines is significantly underestimated due to omission of conisation-associated prematurity with neonatal mortality and morbidity.
abstract: BACKGROUND
  Cervical intraepithelial neoplasia (CIN) represents the precursor of invasive cervical cancer and is associated with human papillomavirus infection (HPV) against which two vaccines have been approved in the last years. Standard treatments of high-grade CIN are conisation procedures, which are associated with an increased risk of subsequent pregnancy complications like premature delivery and possible subsequent life-long disability. HPV vaccination has therefore the potential to decrease neonatal morbidity and mortality. This has not been taken into account in published cost-effectiveness models.
  
  
  METHODS
  We calculated the possible reduction rate of conisations for different vaccination strategies for Germany. Using this rate, we computed the reduction of conisation-associated preterm deliveries, life-long disability and neonatal death due to prematurity. The number of life-years saved (LYS) and gain in quality-adjusted life-years (QALYs) was estimated. The incremental costs per LYS / additional QALY were calculated.
  
  
  RESULTS
  The reduction of conisation procedures was highest in scenario I (vaccination coverage 90% prior to HPV exposition) with about 50%. The costs per LYS or additional QALY were lowest in scenario I, II and III with 45,101 € or 43,505-47,855 € and rose up to 60,544 € or 58,401-64,240 € in scenario V (50% vaccinated prior to sexual activity + additional 20% catch-up at a mean age of 20 y).
  
  
  CONCLUSIONS
  Regarding the HPV 16 / 18 vaccines as "vaccines against conisation-related neonatal morbidity and mortality" alone, they already have the potential to be cost-effective. This effect adds up to reduction of cervical cancer cases and decreased costs of screening for CIN. Further studies on cost-effectiveness of HPV vaccination should take the significant amount of neonatal morbidity and mortality into account.
authors.affiliation: University Women's Hospital, Hannover Medical School, Hannover, Germany. soergel.philipp@mh-hannover.de
authors.forename: Philipp
authors.initials: P
authors.lastname: Soergel
authors.forename: Lars
authors.initials: L
authors.lastname: Makowski
authors.forename: Cordula
authors.initials: C
authors.lastname: Schippert
authors.forename: Ismini
authors.initials: I
authors.lastname: Staboulidou
authors.forename: Ursula
authors.initials: U
authors.lastname: Hille
authors.forename: Peter
authors.initials: P
authors.lastname: Hillemanns
mesh_terms: D019092:Conization / Q000009:adverse effects; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D032541:Mass Vaccination; D053918:Papillomavirus Vaccines / Q000191:economics* / Q000276:immunology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control; D047928:Premature Birth / Q000191:economics / Q000209:etiology / Q000517:prevention & control; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000517:prevention & control* / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000517:prevention & control* / Q000821:virology
chemical_list: D053918:Papillomavirus Vaccines