title: Comparative cost-effectiveness of the quadrivalent and bivalent human papillomavirus vaccines: a transmission-dynamic modeling study.
abstract: BACKGROUND
  The quadrivalent and bivalent human papillomavirus (HPV) vaccines are now licensed in several countries. We compared the cost-effectiveness of the HPV vaccines to provide evidence for policy decisions.
  
  
  METHODS
  We developed HPV-ADVISE, a multi-type individual-based transmission-dynamic model of HPV infection and disease (anogenital warts, and cervical, anogenital and oropharyngeal cancers). We calibrated the model to sexual behavior and epidemiologic data from Canada, and estimated quality-adjusted life-years (QALYs) lost and costs ($CAN 2010) from the literature. Vaccine-type efficacy was based on a systematic literature review. The analysis was performed from the healthcare provider perspective, and costs and benefits were discounted at 3%. Predictions are presented using the median [10th;90th percentiles] of simulations.
  
  
  RESULTS
  Under base-case assumptions (vaccinating 10-year-old girls, 80% coverage, $95/dose), using the quadrivalent and bivalent vaccines is estimated to cost $15,528 [12,056;19,140] and $20,182 [15,531;25,240] per QALY-gained, respectively. At equal price, the quadrivalent vaccine is more cost-effective than bivalent under all scenarios investigated, except when assuming longer duration of protection for the bivalent and minimal anogenital warts burden. Under base-case assumptions, the maximum additional cost per dose for the quadrivalent vaccine to remain more cost-effective than the bivalent is $32 [17;46] (using a $40,000/QALY-gained threshold). Results were most sensitive to discounting, time-horizon, differences in durations of protection and anogenital warts burden.
  
  
  CONCLUSIONS
  Vaccinating pre-adolescent girls against HPV is predicted to be highly cost-effective. If equally priced, the quadrivalent is the most economically desirable vaccine. However, ultimately, the most cost-effective HPV vaccine will be determined by their relative price.
authors.affiliation: SP-POS, Centre de recherche du CHU de Québec, Québec, Canada. marc.brisson@uresp.ulaval.ca
authors.forename: Marc
authors.initials: M
authors.lastname: Brisson
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Laprise
authors.forename: Mélanie
authors.initials: M
authors.lastname: Drolet
authors.forename: Nicolas
authors.initials: N
authors.lastname: Van de Velde
authors.forename: Eduardo L
authors.initials: EL
authors.lastname: Franco
authors.forename: Erich V
authors.initials: EV
authors.lastname: Kliewer
authors.forename: Gina
authors.initials: G
authors.lastname: Ogilvie
authors.forename: Shelley L
authors.initials: SL
authors.lastname: Deeks
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Boily
mesh_terms: D002170:Canada; D002648:Child; D003218:Condylomata Acuminata / Q000191:economics / Q000517:prevention & control / Q000821:virology; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008297:Male; D018803:Models, Economic; D008962:Models, Theoretical; D009959:Oropharyngeal Neoplasms / Q000191:economics / Q000517:prevention & control / Q000821:virology; D030361:Papillomavirus Infections / Q000191:economics / Q000635:transmission*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012725:Sexual Behavior; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000517:prevention & control / Q000821:virology; D014611:Vaccination / Q000191:economics / Q000379:methods
chemical_list: D053918:Papillomavirus Vaccines
keywords: Cervical cancer; Cost-effectiveness; Economic analysis; HPV vaccination; Mathematical modeling