title: The clinical and economic benefits of school-based quadrivalent HPV vaccination in Singapore.
abstract: OBJECTIVE
  To investigate the clinical and economic impacts of school-based administration of the quadrivalent HPV vaccine.
  
  
  METHODS
  A retrospective health-economic analysis was conducted using data collected in Singapore between 2004 and 2005. A dynamic transmission model was adapted for universal vaccination that provided 80% coverage among students aged 11-12 years. Strategy 1 involved only girls, with a 5-year catch-up vaccination to provide 50% coverage among those aged 13-17 years. Strategy 2 included both girls and boys with no catch-up vaccination. Outcomes included the predicted incidence of HPV-related disease over 100 years.
  
  
  RESULTS
  Current coverage was assumed to be 5%. Strategy 1 would reduce cervical intraepithelial neoplasia grade 1 (CIN1) by 63.8%, cervical intraepithelial neoplasia grade 2-3 (CIN2-3) by 62.9%, cervical cancer by 50.9%, and genital warts by 78.0% (female individuals) and 73.6% (male individuals). Strategy 2 would reduce CIN1 by 64.0%, CIN2-3 by 63.1%, cervical cancer by 50.7%, and genital warts by 79.9% (female individuals) and 80.1% (male individuals). The incremental cost-effectiveness ratio was S$12 464 for strategy 1 and $27 837 for Strategy 2. These values decreased to $7477 and $22 574, respectively, if a two-dose regimen was adapted.
  
  
  CONCLUSIONS
  School-based quadrivalent HPV vaccination offered clinical and economic benefits, and is cost-effective in Singapore.
authors.affiliation: Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore.
authors.forename: Sun Kuie
authors.initials: SK
authors.lastname: Tay
authors.affiliation: Medical Affairs, MSD Pharma (Singapore), Singapore.
authors.forename: Tun-Ying
authors.initials: TY
authors.lastname: Hsu
authors.affiliation: Center for Observational and Real World Evidence, Merck, Kenilworth, NJ, USA.
authors.forename: Andrei
authors.initials: A
authors.lastname: Shcheprov
authors.affiliation: Department of Medical Affairs, MSD International (Singapore), Singapore.
authors.forename: Anuj
authors.initials: A
authors.lastname: Walia
authors.affiliation: Center for Observational and Real World Evidence, Merck, Kenilworth, NJ, USA.
authors.forename: Amit S
authors.initials: AS
authors.lastname: Kulkarni
mesh_terms: D002648:Child; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008962:Models, Theoretical; D030361:Papillomavirus Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology; D016896:Treatment Outcome; D014611:Vaccination / Q000191:economics / Q000706:statistics & numerical data; D016387:Women's Health; D002578:Uterine Cervical Dysplasia / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D053918:Papillomavirus Vaccines
keywords: Cervical cancer; Cost-effectiveness; HPV; HPV vaccine; Singapore