Home and Community Care Digest

Home and Community Care Digest 7(3) September 2008

Should a HPV Vaccine be Added to a Cervical Cancer Screening Program? Cost-effective Evidence from France


This study supports the cost-effectiveness of adding a vaccine for types 6, 11, 16 and 18 of the Human Papillomavirus (HPV) for French adolescent females to the current cervical cancer screening program. The vaccine in this study is the same as the one currently used in Ontario. The analysis was conducted from multiple perspectives and underwent a range of sensitivity analysis. In their base case, the incremental costs cost per quality-adjusted life year (QALY) associated with the introduction of a HPV vaccine was €8,408, or approximately $12,612 Canadian dollars.
Background: The Human Papillovirus (HPV) has been identified as the primary cause of cervical cancer. In France, the National Agency for Accreditation and Evaluation of Health (ANAES) recommends screening women for cervical cancer between the ages of 25 and 65 every three years. In addition, the prophylactic quadrivalent HPV (types 6, 11, 16, 18) recombinant vaccine was recommended by the French Technical Committee for Vaccination (CTV) for all girls aged 14 years. This study shows the cost-effectiveness of implementing a HPV vaccine along with the existing cervical screening program in France.

Methods: A cohort of women aged from 14 years to 85 years were assessed from two perspectives: a direct health care cost perspective (DCP), which included all direct medical costs linked to the vaccination and management of diseases; and a third party payer perspective (TPP), which included only direct costs reimbursed by the public insurance system. Costs were converted to 2005 Euros. Efficacy of the HPV vaccine was 100%, as shown in the clinical trials. Duration of protection was assumed to be life-long without the need for a booster. The coverage of the vaccination program was assumed to be 80% of the eligible population. In the analysis, costs and outcomes were discounted at 3.5% and 1.5%, respectively. A sensitivity analysis was conducted around most of these assumptions.

Results: Based on the above assumptions, the incremental cost per quality-adjusted life year (QALY) for the introduction of HPV vaccination was €8,408, or approximately $12,612 CAD (TPP) when all direct costs (and savings) were considered and €13,809 or approximately $20,713 CAD (DCP) when only costs (and savings) borne by the public insurance sector were considered. Sensitivity analysis demonstrated that the cost-effectiveness ratio was relatively insensitive to the changes in vaccine efficacy; however, it was sensitive to changes in the discount rate, with higher discount rates for costs and benefits yielding a larger cost-effectiveness ratio. If the discount rate increased to 5 percent, the incremental cost per QALY would have risen to €35,652 per QALY for TPP. Nevertheless, this ratio is still below commonly accepted threshold for cost-effectiveness in France (€50,000 per QALY).

Conclusions: The study provides evidence to support the cost-effectiveness of adding HPV vaccine (that is currently available in Ontario) to the current cervical cancer screening program in France. Consequently, this study should be of interest to decision makers contemplating similar additions to cervical screening programs in Ontario.

Reference: Bergeron, C., Lageron, N., McAllister, R.., Mathevet, P., Remy, V. Cost-effectiveness Analysis of the Introduction of a Quadrivalent Human Papillomavius Vaccine in France. International Journal of Technology Assessment in Health Care.2008; 24(1): 10-19.


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