Comparison of two dose and three dose human papillomavirus vaccine schedules: cost effectiveness analysis based on transmission model.
Bottom Line: Costs (from the healthcare provider's perspective), health related utilities, and incremental cost effectiveness ratios.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.Two dose human papillomavirus vaccine schedules are likely to be the most cost effective option provided protection lasts for at least 20 years.
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 firstname.lastname@example.org.Show MeSH
Related in: MedlinePlus
Mentions: Giving the first two doses of human papillomavirus vaccine is clearly cost effective at a threshold of £20 000 to £30 000 per QALY gained, regardless of the duration of protection (within the range examined), existence of cross protection, and discount rate. At 3.5% discounting, giving the third dose is highly unlikely to be cost effective if the first two doses give at least 20 years’ protection. However, if the first two doses only give 10 years’ protection, and the third dose can extend this to lifetime protection, then the third dose becomes cost effective, with a median incremental cost effectiveness ratio of £17 000 (interquartile range £11 700-£25 800) per QALY gained (fig 3 (left, solid lines) and supplementary table D). In terms of threshold costs, the first two doses would be clearly cost effective even if the vaccine costs £300 per dose, well above the list price of £86.50 per dose. The third dose is cost effective if it extends the duration of protection from 10 years to lifelong and costs less than about £147 (£108-188) per dose (including administration costs). However, if two doses give longer than 10 years’ protection, then in all the scenarios explored in this model the threshold price per dose for the third dose remains below £31 (£28-35), and may be substantially less depending on exact assumptions about duration of protection and cross protection (fig 4 (left, solid lines) and supplementary table D). The total costs of vaccination are shown in supplementary table C.
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 email@example.com.