title: Comparing the cost-effectiveness of two- and three-dose schedules of human papillomavirus vaccination: a transmission-dynamic modelling study.
abstract: BACKGROUND
  Recent evidence suggests that two doses of HPV vaccines may be as protective as three doses in the short-term. We estimated the incremental cost-effectiveness of two- and three-dose schedules of girls-only and girls & boys HPV vaccination programmes in Canada.
  
  
  METHODS
  We used HPV-ADVISE, an individual-based transmission-dynamic model of multi-type HPV infection and diseases (anogenital warts, and cancers of the cervix, vulva, vagina, anus, penis and oropharynx). We conducted the analysis from the health payer perspective, with a 70-year time horizon and 3% discount rate, and performed extensive sensitivity analyses, including duration of vaccine protection and vaccine cost.
  
  
  RESULTS
  Assuming 80% coverage and a vaccine cost per dose of $85, two-dose girls-only vaccination (vs. no vaccination) produced cost/quality-adjusted life-year (QALY)-gained varying between $7900-24,300. The incremental cost-effectiveness ratio of giving the third dose to girls (vs. two doses) was below $40,000/QALY-gained when: (i) three doses provide longer protection than two doses and (ii) two-dose protection was shorter than 30 years. Vaccinating boys (with two or three doses) was not cost-effective (vs. girls-only vaccination) under most scenarios investigated.
  
  
  CONCLUSIONS
  Two-dose HPV vaccination is likely to be cost-effective if its duration of protection is at least 10 years. A third dose of HPV vaccine is unlikely to be cost-effective if two-dose duration of protection is longer than 30 years. Finally, two-dose girls & boys HPV vaccination is unlikely to be cost-effective unless the cost per dose for boys is substantially lower than the cost for girls.
authors.affiliation: Centre de recherche du CHU de Québec, Québec, Canada.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Laprise
authors.affiliation: Centre de recherche du CHU de Québec, Québec, Canada; Département de médecine sociale et préventive, Université Laval, Québec, Canada.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Drolet
authors.affiliation: Department of Infectious Disease Epidemiology, Imperial College, London, United Kingdom.
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Boily
authors.affiliation: Modelling and Economics Unit, Public Health England, United Kingdom; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Jit
authors.affiliation: Centre de recherche du CHU de Québec, Québec, Canada.
authors.forename: Chantal
authors.initials: C
authors.lastname: Sauvageau
authors.affiliation: Division of Cancer Epidemiology, McGill University, Montreal, Canada.
authors.forename: Eduardo L
authors.initials: EL
authors.lastname: Franco
authors.affiliation: Centre de recherche du CHU de Québec, Québec, Canada; Département de médecine sociale et préventive, Université Laval, Québec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lemieux-Mellouki
authors.affiliation: Centre de recherche du CHU de Québec, Québec, Canada; Département de médecine sociale et préventive, Université Laval, Québec, Canada.
authors.forename: Talía
authors.initials: T
authors.lastname: Malagón
authors.affiliation: Centre de recherche du CHU de Québec, Québec, Canada; Département de médecine sociale et préventive, Université Laval, Québec, Canada; Department of Infectious Disease Epidemiology, Imperial College, London, United Kingdom. Electronic address: marc.brisson@uresp.ulaval.ca.
authors.forename: Marc
authors.initials: M
authors.lastname: Brisson
mesh_terms: D002170:Canada; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007115:Immunization Schedule; D008297:Male; D018803:Models, Economic; D030361:Papillomavirus Infections / Q000191:economics / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D019057:Quality-Adjusted Life Years; D014611:Vaccination / Q000191:economics*
chemical_list: D053918:Papillomavirus Vaccines
keywords: Anogenital warts; Cervical cancer; Cost-effectiveness; Human papillomavirus (HPV); Immunisation; Programme optimisation; Transmission-dynamic modelling; Vaccine schedules