Home and Community Care Digest
Should a HPV Vaccine be Added to a Cervical Cancer Screening Program? Cost-effective Evidence from 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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