Mind the gaps: what's missing from current economic evaluations of universal HPV vaccination?
BACKGROUND
Since the original licensing of human papilloma virus (HPV) vaccination for women, evidence is accumulating of its effectiveness in preventing HPV-related conditions in men, and universal vaccination (vaccinating men and women) is now recommended in some countries. Several models of the cost-effectiveness of universal HPV vaccination have been published, but results have been mixed. This article assesses the extent to which economic studies have captured the range of values associated with universal HPV vaccination, and how this influences estimates of its cost-effectiveness.


METHODS
Eight published economic evaluations of universal HPV vaccination were reviewed to identify which of the values associated with universal HPV vaccination were included in each analysis.


RESULTS
Studies of the cost-effectiveness of universal HPV vaccination capture only a fraction of the values generated. Most studies focused on impacts on health and health system cost, and only captured these partially. A range of values is excluded from most studies, including impacts on productivity, patient time and costs, carers and family costs, and broader social values such as the right to access treatment. Further, those studies that attempted to capture these values only did so partially.


CONCLUSIONS
Decisions to invest in universal HPV vaccination need to be based on a complete assessment of the value that it generates. This is not provided by existing economic evaluations. Further work is required to understand this value. First, research is required to understand how HPV-related health outcomes impact on society including, for instance, their impact on productivity. Second, consideration should be given to alternative approaches to capture this broader set of values in a manner useful to decisions-makers, such as multi-criteria decision analysis.
Evidera, Metro Building, 6th Floor, 1 Butterwick, London W6 8DL, United Kingdom.
Kevin
K
Marsh
Evidera, Metro Building, 6th Floor, 1 Butterwick, London W6 8DL, United Kingdom.
Ruth
R
Chapman
London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E HT, United Kingdom.
Rebecca F
RF
Baggaley
Sanofi Pasteur MSD, 8, rue Jonas Salk, 69367 Lyon Cedex 07, France. Electronic address: NLargeron@spmsd.com.
Nathalie
N
Largeron
Sanofi Pasteur MSD, 8, rue Jonas Salk, 69367 Lyon Cedex 07, France.
Xavier
X
Bresse
D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D008297:Male; D030361:Papillomavirus Infections / Q000191:economics / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000191:economics*; D019057:Quality-Adjusted Life Years
D053918:Papillomavirus Vaccines
Cost-effectiveness; Health economics; Human papilloma virus; Vaccine