title: Potential cost-effectiveness of the nonavalent human papillomavirus (HPV) vaccine.
abstract: Randomized clinical trials are currently examining the efficacy of a nonavalent human papillomavirus (HPV) vaccine, including HPV-types 6/11/16/18/31/33/45/52/58. Evidence on the cost-effectiveness of the nonavalent is required for timely policy-decisions. We compared the potential cost-effectiveness of the nonavalent and quadrivalent HPV vaccines. We used a multi-type individual-based transmission-dynamic model of HPV infection and diseases, 70-year time-horizon, 3% discount rate and healthcare payer perspective. We calibrated the model to Canadian sexual behavior and epidemiologic data, and estimated Quality-Adjusted Life-Years (QALYs) lost and costs ($CAN 2010) from the literature. Under base-case assumptions (vaccinating 10-year-old girls, 80% coverage, 95$/dose, vaccine-type efficacy = 95%, cross-protection for the quadrivalent vaccine, duration of vaccine-type protection (cross-protection) = 20 (10) years), using the quadrivalent and nonavalent vaccines is estimated to cost $15,528 [12,056; 19,140] and $12,203 [9,331; 17,292] per QALY-gained, respectively. At equal price, the nonavalent vaccine is more cost-effective than the quadrivalent vaccine, even when assuming both shorter duration of protection (nonavalent = 20 years vs. quadrivalent = lifelong) and lower vaccine-type efficacy (nonavalent = 85% vs. quadrivalent = 95%). However, the additional cost per dose of the nonavalent vaccine should not exceed $11 to remain more cost-effective than the quadrivalent vaccine, and $24 to represent a cost-effective alternative to the quadrivalent vaccine (using a $40,000/QALY-gained threshold). The nonavalent vaccine can be a cost-effective alternative to the quadrivalent vaccine, even in scenarios where nonavalent vaccine efficacy is 85%. However, because most cervical cancers are caused by HPV-16/18, it is unlikely that the nonavalent would be used if its efficacy against these types is lower than current HPV vaccines.
authors.affiliation: Centre de recherche du CHU de Québec, Axe Santé des populations et pratiques optimales en santé, Québec, Canada, G1S 4L8; Département de médecine sociale et préventive, Université Laval, Québec, Canada, G1V 0A6.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Drolet
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Laprise
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Boily
authors.forename: Eduardo L
authors.initials: EL
authors.lastname: Franco
authors.forename: Marc
authors.initials: M
authors.lastname: Brisson
mesh_terms: D002170:Canada; D019496:Cancer Vaccines / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D030361:Papillomavirus Infections / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000191:economics*; D019057:Quality-Adjusted Life Years; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*
chemical_list: D019496:Cancer Vaccines; D053918:Papillomavirus Vaccines
keywords: cost-effectiveness; human papillomavirus; immunization; mathematical modeling; nonavalent vaccine