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Cost-effectiveness of sex-neutral HPV-vaccination in Sweden, accounting for herd-immunity and sexual behaviour

Artikel i vetenskaplig tidskrift
Författare Ellen Wolff
K. M. Elfstrom
Hedda Haugen
Sofie Larsson
H. Englund
P. Sparen
A. Roth
Publicerad i Vaccine
Volym 36
Nummer/häfte 34
Sidor 5160-5165
ISSN 0264-410X
Publiceringsår 2018
Publicerad vid Institutionen för medicin
Sidor 5160-5165
Språk en
Länkar dx.doi.org/10.1016/j.vaccine.2018.0...
Ämnesord Human papillomavirus, HPV, Vaccination, Dynamic modelling, Cost effectiveness, Health economic evaluation, human-papillomavirus vaccination, cancer incidence, health states, united-states, population, impact, quadrivalent, transmission, trends, valuations, Immunology, Research & Experimental Medicine, T-NET, 2015, FESTA Handbook
Ämneskategorier Reproduktionsmedicin och gynekologi

Sammanfattning

Introduction: The aim was to assess cost-effectiveness of expanding the Swedish HPV-vaccination program to include preadolescent boys, by comparing health-effects and costs of HPV-related disease, with a sex-neutral vaccination program versus only vaccinating girls. Methods: We used a dynamic compartmental model to simulate the burden of HPV16/18-related disease in Sweden, accounting for indirect effects of vaccination through herd-immunity. The model accounted for sexual behaviour, such as age preferences and men who have sex with men. The main outcome was number of individuals with HPV-related cancers (cervical, genital, anal and oropharyngeal cancer) and cervical intraepithelial neoplasia (CIN). Costs included in the analysis were those incurred when treating HPV-related cancer and CIN, production losses during sick-leave, and acquisition and administration of vaccine. Health effects were measured as quality-adjusted life years (QALY). The time horizon was set to 100 years, and both effects and costs were discounted by 3% annually. Health effects and costs were accumulated over the time horizon and used to create an incremental cost-effectiveness ratio. Results: A sex-neutral vaccination program would reduce HPV-related cancer and CIN, both due to direct effects among vaccinated as well as through herd-immunity, further decreasing HPV-related cancer burden annually by around 60 cases among men and women respectively in steady-state. The cost per gained QALY was estimated to 40,000 euro. Applying the procurement price of 2017, sex-neutral vaccination was dominant. Conclusion: Introducing a sex-neutral HPV-vaccination program would be good value for money also in Sweden where there this 80% coverage in the current HPV-vaccination program for preadolescent girls. The cost-effectiveness of a sex-neutral program is highly dependent on the price of the vaccine, the lower the price the more favourable it is to also vaccinate boys. (C) 2018 The Author(s). Published by Elsevier Ltd.

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