Cost-effectiveness analysis of universal human papillomavirus vaccination using a dynamic Bayesian methodology: The BEST II study


Objectives. Human papillomavirus (HPV) plays a role in the development of benign and malign neoplasms in both sexes. The Italian recommendations for HPV vaccines only consider females. The BEST II study (Bayesian modelling to assess the Effectiveness of a vaccination Strategy To prevent HPV-related diseases) evaluates: i) the cost-effectiveness of immunization strategies targeting universal vaccination compared to cervical cancer screening and female-only vaccination; and ii) the economic impact of immunization on a variety of HPV-induced diseases. Methods. We present a dynamic Bayesian Markov model to investigate transmission dynamics in cohorts of females and males in a follow-up of 55 years. We assume that quadrivalent vaccination (against HPV 16, 18, 6 and 11) is available for 12 year old individuals. The model accounts for the progression of subjects across HPV-induced health states (cervical, vaginal, vulvar, anal, penile and head/neck cancer as well as anogenital warts). The sexual mixing is modelled on the basis of age-, gender-, and sexual behavioural-specific matrices to obtain the dynamic force of infection. Results. In comparison to cervical cancer screening, universal vaccination results in an ICER of €1,500. When universal immunization is compared to female-only vaccination, it is cost-effective with an ICER of €11,600. Probabilistic sensitivity analysis shows a relatively large amount of parameter uncertainty, which interestingly has however no substantial impact on the decision-making process. The intervention being assessed seems to be associated with an attractive cost-effectiveness profile. Conclusions. Universal HPV vaccination is found to be a cost-effective choice when compared to either cervical cancer screening or female-only vaccination within the Italian context.

Value in Health
Gianluca Baio
Gianluca Baio
Professor of Statistics and Health Economics