by Roxanne Nelson
July 2, 2009 — Vaccination against the human papillomavirus (HPV) is not cost-effective in the Netherlands, even under favorable assumptions that include lifelong protection against 70% of all cervical cancers, administration to all women regardless of their risk for cervical cancer, and no adverse effects.
According to a report published online July 1 in the Journal of the National Cancer Institute, in order for the HPV vaccine to become cost-effective among Dutch women, the price would have to be considerably reduced, depending on the long-term effectiveness of the vaccine.
Adding HPV vaccination was not cost-effective, even under favorable assumptions. The authors note that with the current price of €118 per vaccine dose, the addition of the HPV vaccination to the current Dutch screening program had a cost-effectiveness ratio of €53,500 per quality-adjusted life-year (QALY) gained. This cost-effectiveness ratio is considerably higher than the cost-effectiveness threshold of €20,000 per QALY gained, they write, which is the acceptability threshold previously established by the Dutch government for the cervical-cancer screening program. In other words, an intervention with a cost-effectiveness ratio of more than €20,000 per QALY gained was not considered acceptable.
In a favorable situation, where only 1 vaccination round of 3 doses is required for complete lifetime protection against HPV type16/18–related cervical cancer, achieving a cost-effectiveness ratio of €20,000 per QALY gained would require pricing the vaccine at approximately €40 per dose, explain the researchers. If an additional booster vaccination is added, the price per initial vaccination must be €33 per dose, and with 4 booster vaccinations, €16 per dose.
Cost Effectiveness Tied to Declining Incidence
As in many industrialized nations, cervical-cancer–associated mortality has dramatically declined in the Netherlands, due to efficient and widespread screening programs. In 2005 it was 1.6 per 100,000 woman-years [World Standardized Rate (WSR)] in the Netherlands, and this rate is lower than the WSR of 2.5 per 100,000 woman-years in the United States for the period 2001–2005 and 1.9 in the United Kingdom in 2005, according to the authors.
A number of analyses have concluded that HPV vaccination should be cost-effective, but this conclusion is primarily dependent on the incidence and mortality rates of cervical cancer. Low incidence and mortality rates might limit the cost-effectiveness of adding HPV vaccination to a screening program, the researchers comment.
The team, led by Inge M.C.M. de Kok, from the department of public health at Erasmus MC University Medical Center, in Rotterdam, the Netherlands, examined the effect of adding HPV vaccination to the current Dutch cervical-cancer screening program..
Using a microsimulation screening analysis (MISCAN) model, the researchers estimated costs and effects of adding HPV vaccination to the current screening protocol in the Netherlands and examined the impact of changes in the price of vaccination, number of booster vaccinations, vaccination attendance rate, vaccination efficacy, cervical-cancer incidence level, and quality-of-life assumptions on the cost-effectiveness of HPV vaccination.