Helseøkonomen.com

Foredragsholder: Emily A. Burger
(Joint work with S Sy, M Nygaard, IS Kristiansen, JJ Kim)

Tid og sted:
Tirsdag 15. oktober 14.15 til 15.30 (kaffe/te fra 14.00)
Møterom (OBS STED): Store møterom HELED, 2 etg., Forskninsveien 3A,
Harald Schjelderups hus

Abstract

Purpose: Increasingly, countries have introduced vaccination against
human papillomavirus (HPV), causally linked to several cancers and
genital warts, targeted to young girls, but few have recommended routine
vaccination of boys. Declining vaccine prices and the growing evidence
of vaccine impact on reducing HPV-related conditions in both women and
men prompts countries, such as Norway, to decide whether HPV vaccination
of boys is warranted.

Methods: A previously-published dynamic model of HPV transmission was
updated to integrate recent evidence of gender- and type-specific
natural history of HPV infections and empirically calibrated to observed
HPV prevalence and cervical cancer incidence in Norway. Reductions in
the incidence of HPV, which include both the direct and indirect
benefits of vaccination, were applied to a microsimulation model of the
natural history of cervical cancer in the presence of status quo
screening, and to incidence-based models for other non-cervical
HPV-related diseases among both men and women. We adopted a societal
perspective and compared the incremental costs and benefits (discounted
4% annually) of a scenario reflecting the current 3-dose coverage level
of pre-adolescent girls (71%) with and without similar coverage in boys
in a school-based delivery program. Multiple good-fitting parameter sets
from the dynamic model were used to explore the impact of parameter
uncertainty on reductions in HPV incidence. Sensitivity analyses were
conducted on vaccine cost and properties, and differential uptake among
boys.

Results Assuming 71% vaccine coverage, high, lifelong vaccine efficacy,
and the assumed tender price (half the current market price and not
publicly available) we found vaccinating both girls and boys fell below
one commonly cited Norwegian willingness-to-pay threshold, $83,000/QALY
when including all presumably HPV-induced diseases. For a lower
willingness-to-pay threshold (i.e., $30,000/QALY), it would not be
considered cost-effective to expand the current programme, unless the
vaccine price was less than $36 per dose. Alternatively, increasing
vaccine coverage to 90% among girls was more effective and less costly
than the benefits achieved by vaccinating both genders with 71% coverage.

Conclusions At Norway’s current tender price and high willingness-to-pay
threshold, expanding the HPV vaccination programme to boys may be
cost-effective and may warrant a change in the current female-only
vaccination policy. However, if feasible, it is more effective and
cost-effective to increase coverage among girls, than to vaccinate boys.

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