Cost-Effectiveness of a Potential Vaccine for Human papillomavirus

Gillian D. Sanders, Al V. Taira


Emerging Infectious Diseases. 2003;9(1) 

In This Article

Abstract and Introduction

Human papillomavirus (HPV) infection, usually a sexually transmitted disease, is a risk factor for cervical cancer. Given the substantial disease and death associated with HPV and cervical cancer, development of a prophylactic HPV vaccine is a public health priority. We evaluated the cost-effectiveness of vaccinating adolescent girls for high-risk HPV infections relative to current practice. A vaccine with a 75% probability of immunity against high-risk HPV infection resulted in a life-expectancy gain of 2.8 days or 4.0 quality-adjusted life days at a cost of $246 relative to current practice (incremental cost effectiveness of $22,755/quality-adjusted life year [QALY]). If all 12-year-old girls currently living in the United States were vaccinated, >1,300 deaths from cervical cancer would be averted during their lifetimes. Vaccination of girls against high-risk HPV is relatively cost effective even when vaccine efficacy is low. If the vaccine efficacy rate is 35%, the cost effectiveness increases to $52,398/QALY. Although gains in life expectancy may be modest at the individual level, population benefits are substantial.

Cervical cancer is one of the most common malignancies in women: this year in the United States, approximately 13,000 new cases will be diagnosed, and >4,000 women will die of the disease. Fortunately, cervical cancer is highly preventable with regular Papanicolaou (Pap) testing. Between 1973 and 1995, the Surveillance, Epidemiology, and End Results (SEER) Program (sponsored by the National Cancer Institute) documented a 43% decrease in incidence and a 46% decrease in death from cervical cancer. Such reductions, however, have not been observed in locations or countries where cytologic testing is not widely available. Epidemiologic research strongly implicates Human papillomavirus (HPV) as the major risk factor for cervical cancer. Therefore, methods of prevention, diagnosis, and treatment of HPV infection have been pinpointed as a means of reducing the incidence of cervical cancer.

HPV comprises >100 different types of viruses; approximately 40 of these are transmitted sexually. Although most HPV infections proceed and resolve without symptoms, some types of HPV (such as 6 and 11) may cause genital warts, whereas other types (such as 16 and 18) are associated with certain types of cancer. HPV infections are recognized as the major cause of cervical cancer: >90% of women who have cervical cancer also have been infected with HPV[1,2,3,4,5,6,7]. HPV types that are correlated with the development of cancer are referred to as high-risk. Although no medical means currently exist to eliminate HPV infection, precancerous lesions and warts caused by these viruses can be treated.

Given the substantial disease and death associated with HPV and cervical cancer, research to develop a prophylactic HPV vaccine is ongoing[8]. Vaccines for HPV-16 and HPV-18 are currently being studied in clinical trials; the Phase I trial results are encouraging[9,10]. The cost effectiveness of such vaccines, however, has not been studied sufficiently. Therefore, we evaluated the effectiveness and cost effectiveness of a prophylactic vaccine.


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