Elsevier

Vaccine

Volume 26, Issue 1, 21 December 2007, Pages 128-139
Vaccine

Cost-effectiveness of quadrivalent human papillomavirus (HPV) vaccination in Mexico: A transmission dynamic model-based evaluation

https://doi.org/10.1016/j.vaccine.2007.10.056Get rights and content

Summary

We examined the potential health outcomes and cost-effectiveness of quadrivalent human papillomavirus (HPV) 6/11/16/18 vaccination strategies in the Mexican population using a multi-HPV type dynamic transmission model. Assuming similar cervical screening practices, with or without vaccination, we examined the incremental cost-effectiveness of vaccination strategies for 12 year-old females, with or without male vaccination, and temporary age 12–24 catch-up vaccination for females or both sexes. The most effective strategy therein was vaccination of 12-year-olds, plus a temporary 12–24-year-old catch-up program covering both sexes; whereby HPV 6/11/16/18-related cervical cancer, high-grade cervical precancer, and genital wart incidence was reduced by 84–98% during year 50 following vaccine introduction. Incremental cost-effectiveness ratios in the primary analyses ranged from ∼$3000 (U.S.) per quality-adjusted life year (QALY) gained for female vaccination strategies to ∼$16000/QALY for adding male vaccination with catch-up.

Section snippets

Background

Cervical cancer is the second most common cancer among women worldwide [1]. In Mexico, a national cervical cancer screening program was initiated in 1974 [2]. However, the disease remains the country's leading cause of female cancer-related mortality [3] and resulted in 4241 deaths in 2004 [4]. Human papillomavirus (HPV) infections are the primary cause of cervical, [5] anal, penile, vaginal and vulvar cancers, [6] anogenital warts [7] and recurrent respiratory papillomatoses [8], [9] and also

Methods

A full description of the development, structure and selection of inputs for the dynamic transmission model is reported elsewhere [12], [13]. Here, we briefly describe the model structure and selection of inputs relevant to the population in Mexico (Table 1).

Health outcomes

For each of the six vaccination strategies, Figure 1, Figure 2, Figure 3, Figure 4 depict the model projected HPV 6, 11, 16 and 18-related incidence of clinically diagnosed CIN 2/3 and cervical cancer for females, and genital warts for males and females (among individuals ages 12 and over), during the 100 years following the introduction of HPV vaccination.

For all disease endpoints examined, we found the most clinically effective strategy to be vaccination of 12-year-old females and males

Discussion

Consistent with our prior results reported for the U.S. population, [12] data from this analysis suggest that a quadrivalent HPV 6/11/16/18 vaccine can yield substantial benefits in reducing the incidence of cervical cancer, CIN and genital warts in Mexico. In fact, the per capita incremental projected health benefits associated with each vaccination strategy, in terms of quality-adjusted life years gained, were estimated to be approximately twice as large for Mexico as for the United States

Acknowledgments

The authors thank Dr. Eduardo Lazcano-Ponce of the Instituto Nacional de Salud Pública in Mexico for helpful comments on a draft version of this manuscript.

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    This study was supported by Merck & Co., Inc., where authors Insinga, Dasbach and Elbasha are currently employed.

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