title: Cost-effectiveness analysis of the bivalent compared with the quadrivalent human papillomavirus vaccines in Taiwan.
abstract: OBJECTIVE
  To compare the epidemiological and economic impact of additional cross-protection against oncogenic human papillomavirus (HPV) types beyond 16/18 of the bivalent vaccine (BV) versus protection against nononcogenic HPV types 6/11 of the quadrivalent vaccine (QV) in Taiwan.
  
  
  METHODS
  A lifetime Markov model calibrated to the Taiwanese setting simulated the natural history of low-risk (engendering cervical intraepithelial neoplasia [CIN] 1 and genital warts) and high-risk HPV (engendering CIN1, CIN2/3, and cervical cancer [CC]) infections, screening, and vaccination (100% coverage) for a cohort of 12-year-old girls (N = 153,000). Transition probabilities, costs, and utilities were estimated from published data and expert opinion. Vaccine efficacy was obtained from each vaccine's respective clinical trials. Price-parity and lifelong protection was assumed for both vaccines. The number of CIN lesions, CC cases, CC deaths and genital wart (GW) cases, and quality-adjusted life-years were estimated. Costs and outcomes (discounted at 3% and 1.5%, respectively) were compared from a payer's perspective.
  
  
  RESULTS
  The model estimated that the BV led to an additional, undiscounted, 11,484 CIN1, 1,779 (+34.3% vs. QV) CIN2/3, 188 (+29.0% vs. QV) CC, and 69 (+29.0% vs. QV) CC deaths prevented compared with the QV, while the QV prevented 4,150 GW (+71%). This resulted in an additional 768 quality-adjusted life-years (QALY) and 11.6 million new Taiwan dollars costs saved for the BV versus the QV after discounting.
  
  
  CONCLUSIONS
  Both vaccines have a different epidemiological impact with an increased number of CC-related lesions potentially prevented for the BV because of additional cross-protection. In the Taiwanese setting, HPV mass vaccination using the BV was estimated to dominate vaccination using the QV.
authors.affiliation: GlaxoSmithKline Biologicals, Wavre, Belgium. nadia.x.demarteau@gskbio.com
authors.forename: Nadia
authors.initials: N
authors.lastname: Demarteau
authors.forename: Chao-Hsiun
authors.initials: CH
authors.lastname: Tang
authors.forename: Hui-Chi
authors.initials: HC
authors.lastname: Chen
authors.forename: Chien-Jen
authors.initials: CJ
authors.lastname: Chen
authors.forename: Georges
authors.initials: G
authors.lastname: Van Kriekinge
mesh_terms: D002648:Child; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D052140:Human papillomavirus 11 / Q000276:immunology; D052162:Human papillomavirus 16 / Q000276:immunology; D052161:Human papillomavirus 18 / Q000276:immunology; D052163:Human papillomavirus 6 / Q000276:immunology; D006801:Humans; D008390:Markov Chains; D032541:Mass Vaccination / Q000191:economics* / Q000379:methods; D018803:Models, Economic; D030361:Papillomavirus Infections / Q000191:economics / Q000517:prevention & control* / Q000821:virology; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000191:economics* / Q000276:immunology; D019057:Quality-Adjusted Life Years; D013624:Taiwan / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D002578:Uterine Cervical Dysplasia / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D053918:Papillomavirus Vaccines