title: Comparison of two dose and three dose human papillomavirus vaccine schedules: cost effectiveness analysis based on transmission model.
abstract: OBJECTIVE
  To investigate the incremental cost effectiveness of two dose human papillomavirus vaccination and of additionally giving a third dose.
  
  
  METHODS
  Cost effectiveness study based on a transmission dynamic model of human papillomavirus vaccination. Two dose schedules for bivalent or quadrivalent human papillomavirus vaccines were assumed to provide 10, 20, or 30 years' vaccine type protection and cross protection or lifelong vaccine type protection without cross protection. Three dose schedules were assumed to give lifelong vaccine type and cross protection.
  
  
  METHODS
  United Kingdom.
  
  
  METHODS
  Males and females aged 12-74 years.
  
  
  METHODS
  No, two, or three doses of human papillomavirus vaccine given routinely to 12 year old girls, with an initial catch-up campaign to 18 years.
  
  
  METHODS
  Costs (from the healthcare provider's perspective), health related utilities, and incremental cost effectiveness ratios.
  
  
  RESULTS
  Giving at least two doses of vaccine seems to be highly cost effective across the entire range of scenarios considered at the quadrivalent vaccine list price of £86.50 (€109.23; $136.00) per dose. If two doses give only 10 years' protection but adding a third dose extends this to lifetime protection, then the third dose also seems to be cost effective at £86.50 per dose (median incremental cost effectiveness ratio £17,000, interquartile range £11,700-£25,800). If two doses protect for more than 20 years, then the third dose will have to be priced substantially lower (median threshold price £31, interquartile range £28-£35) to be cost effective. Results are similar for a bivalent vaccine priced at £80.50 per dose and when the same scenarios are explored by parameterising a Canadian model (HPV-ADVISE) with economic data from the United Kingdom.
  
  
  CONCLUSIONS
  Two dose human papillomavirus vaccine schedules are likely to be the most cost effective option provided protection lasts for at least 20 years. As the precise duration of two dose schedules may not be known for decades, cohorts given two doses should be closely monitored.
authors.affiliation: Modelling and Economics Unit, Public Health England, London NW9 5EQ, UK Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London mark.jit@phe.gov.uk.
authors.forename: Mark
authors.initials: M
authors.lastname: Jit
authors.affiliation: SP-POS, Centre de recherche du CHU de Québec, 1050 Chemin Sainte-Foy, Québec, Canada Department of Infectious Disease Epidemiology, Imperial College, London Département de médecine sociale et préventive, Université Laval, Québec.
authors.forename: Marc
authors.initials: M
authors.lastname: Brisson
authors.affiliation: SP-POS, Centre de recherche du CHU de Québec, 1050 Chemin Sainte-Foy, Québec, Canada.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Laprise
authors.affiliation: Modelling and Economics Unit, Public Health England, London NW9 5EQ, UK Immunisation, Hepatitis and Blood Safety Department, Public Health England, London.
authors.forename: Yoon Hong
authors.initials: YH
authors.lastname: Choi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003362:Cost-Benefit Analysis; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007115:Immunization Schedule; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D030361:Papillomavirus Infections / Q000150:complications / Q000191:economics* / Q000517:prevention & control* / Q000635:transmission; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000191:economics*; D019057:Quality-Adjusted Life Years; D006113:United Kingdom / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014611:Vaccination / Q000191:economics / Q000379:methods
chemical_list: D053918:Papillomavirus Vaccines