title: Cost-Effectiveness Analysis of Universal Human Papillomavirus Vaccination Using a Dynamic Bayesian Methodology: The BEST II Study.
abstract: BACKGROUND
  Human papillomavirus (HPV) plays a role in the development of benign and malign neoplasms in both sexes. The Italian recommendations for HPV vaccines consider only females. The BEST II study (Bayesian modelling to assess the Effectiveness of a vaccination Strategy to prevent HPV-related diseases) evaluates 1) the cost-effectiveness of immunization strategies targeting universal vaccination compared with cervical cancer screening and female-only vaccination and 2) the economic impact of immunization on various HPV-induced diseases.
  
  
  OBJECTIVE
  The objective of this study was to evaluate whether female-only vaccination or universal vaccination is the most cost-effective intervention against HPV.
  
  
  METHODS
  We present a dynamic Bayesian Markov model to investigate transmission dynamics in cohorts of females and males in a follow-up period of 55 years. We assumed that quadrivalent vaccination (against HPV 16, 18, 6, and 11) is available for 12-year-old individuals. The model accounts for the progression of subjects across HPV-induced health states (cervical, vaginal, vulvar, anal, penile, and head/neck cancer as well as anogenital warts). The sexual mixing is modeled on the basis of age-, sex-, and sexual behavioral-specific matrices to obtain the dynamic force of infection.
  
  
  RESULTS
  In comparison to cervical cancer screening, universal vaccination results in an incremental cost-effectiveness ratio of €1,500. When universal immunization is compared with female-only vaccination, it is cost-effective with an incremental cost-effectiveness ratio of €11,600. Probabilistic sensitivity analysis shows a relatively large amount of parameter uncertainty, which interestingly has, however, no substantial impact on the decision-making process. The intervention being assessed seems to be associated with an attractive cost-effectiveness profile.
  
  
  CONCLUSIONS
  Universal HPV vaccination is found to be a cost-effective choice when compared with either cervical cancer screening or female-only vaccination within the Italian context.
authors.affiliation: Department of Statistical Science, University College London, London, UK. Electronic address: k.haeussler@ucl.ac.uk.
authors.forename: Katrin
authors.initials: K
authors.lastname: Haeussler
authors.affiliation: Economic Evaluation and HTA, Faculty of Economics, University of Rome "Tor Vergata," Rome, Italy; Department of Demography, University of Rome "La Sapienza," Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Marcellusi
authors.affiliation: Economic Evaluation and HTA, Faculty of Economics, University of Rome "Tor Vergata," Rome, Italy; Institute of Leadership and Management in Health, Kingston University London, London, UK.
authors.forename: Francesco Saverio
authors.initials: FS
authors.lastname: Mennini
authors.affiliation: Institute of Leadership and Management in Health, Kingston University London, London, UK.
authors.forename: Giampiero
authors.initials: G
authors.lastname: Favato
authors.affiliation: Laboratory of Cutaneous Pathophysiology, San Gallicano Dermatological Institute (IRCCS), Rome, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Picardo
authors.affiliation: Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Garganese
authors.affiliation: Department of Surgery Pietro Valdoni, University of Rome "La Sapienza," Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Bononi
authors.affiliation: Department of Gynecology and Obstetrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Silvano
authors.initials: S
authors.lastname: Costa
authors.affiliation: Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
authors.affiliation: Socioeconomic Institute, University of Zurich, Zurich, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Zweifel
authors.affiliation: Institute of Leadership and Management in Health, Kingston University London, London, UK.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Capone
authors.affiliation: Department of Statistical Science, University College London, London, UK.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Baio
mesh_terms: D000367:Age Factors; D001499:Bayes Theorem; D002648:Child; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics*; D005260:Female; D005831:Genital Diseases, Female / Q000191:economics / Q000517:prevention & control; D005832:Genital Diseases, Male / Q000191:economics / Q000517:prevention & control; D006258:Head and Neck Neoplasms / Q000191:economics / Q000517:prevention & control; D006801:Humans; D017589:Immunization Programs / Q000191:economics; D007558:Italy; D008297:Male; D008390:Markov Chains; D017059:Models, Econometric; D030361:Papillomavirus Infections / Q000517:prevention & control* / Q000635:transmission; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012737:Sex Factors; D012725:Sexual Behavior; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000191:economics
chemical_list: D053918:Papillomavirus Vaccines
keywords: HPV; cost-effectiveness analysis; dynamic Bayesian model; herd immunity; vaccination programs