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Cost-effectiveness analysis of the introduction of a quadrivalent human papillomavirus vaccine in France

Published online by Cambridge University Press:  24 January 2008

Christine Bergeron
Affiliation:
Laboratoire Pasteur Cerba
Nathalie Largeron
Affiliation:
Sanofi Pasteur MSD
Ruth McAllister
Affiliation:
Mapi Values Limited
Patrice Mathevet
Affiliation:
Hôpital Edouard Herriot
Vanessa Remy
Affiliation:
Sanofi Pasteur MSD

Abstract

Objectives: A vaccine to prevent diseases due to human papillomavirus (HPV) types 6, 11, 16, and 18 is now available in France. The objective of this study was to assess the health and economic impact in France of implementing a quadrivalent HPV vaccine alongside existing screening practices versus screening alone.

Methods: A Markov model of the natural history of HPV infection incorporating screening and vaccination, was adapted to the French context. A vaccine that would prevent 100 percent of HPV 6, 11, 16, and 18-associated diseases, with lifetime duration and 80 percent coverage, given to girls at age 14 in conjunction with current screening was compared with screening alone. Results were analyzed from both a direct healthcare cost perspective (DCP) and a third-party payer perspective (TPP). Indirect costs such as productivity loss were not taken into account in this analysis.

Results: The incremental cost per life-year gained from vaccination was €12,429 (TPP) and €20,455 (DCP). The incremental cost per quality-adjusted life-year (QALY) for the introduction of HPV vaccination alongside the French cervical cancer screening program was €8,408 (TPP) and €13,809 (DCP). Sensitivity analyses demonstrated that cost-effectiveness was stable, but was most sensitive to the discount rate used for costs and benefits.

Conclusions: Considering the commonly accepted threshold of €50,000 per QALY, these analyses support the fact that adding a quadrivalent HPV vaccine to the current screening program in France is a cost-effective strategy for reducing the burden of cervical cancer, precancerous lesions, and genital warts caused by HPV types 6, 11, 16, and 18.

Type
GENERAL ESSAYS
Copyright
Copyright © Cambridge University Press 2008

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References

REFERENCES

1. Avis du Comité Technique des Vaccinations et du Conseil Supérieur d'Hygiène Publique de France, Section des maladies transmissibles, relatif à la vaccination contre les papillomavirus humains 6, 11, 16 et 18 (séance du 9 mars 2007). 2007Google Scholar
2. Agence Nationale pour le Développement de l'Evaluation Médicale (ANDEM). Pratique des frottis cervicaux pour le dépistage du cancer du col. Paris: ANDEM; 1995.Google Scholar
3. Arbyn, M, Buntinx, F, Van Ranst, M, et al. Virologic versus cytologic triage of women with equivocal Pap smears: A meta-analysis of the accuracy to detect high-grade intraepithelial neoplasia. J Natl Cancer Inst. 2004;18:280293.CrossRefGoogle Scholar
4. Arveux, P, Breugelmans, G, Cravello, L, et al. Invasive cervical cancer treatment costs in France. Bull Cancer. 2007;94:219224.Google ScholarPubMed
5. Auquier, P, Auray, J, Berdeaux, G, et al. French guidelines for the economic evaluation of health care technologies: Methodological recommendations. Paris: Collège des Economistes de la Santé (French Health Economists Association); 2003.Google Scholar
6. Bergeron, C, Breugelmans, JG, Bouee, S, et al. Cervical cancer screening and associated treatment costs in France. Gynecol Obstet Fertil. 2006;34:10361042.CrossRefGoogle ScholarPubMed
7. Bonneux, L, Birnie, E. The discount rate in the economic evaluation of prevention: A thought experiment. J Epidemiol Community Health. 2001;55:123125.CrossRefGoogle ScholarPubMed
8. Bos, JM, Postma, MJ, Annemans, L. Discounting health effects in pharmacoeconomic evaluations: Current controversies. Pharmacoeconomics. 2005;23:639649.CrossRefGoogle ScholarPubMed
9. Bray, F, Sankila, R, Ferlay, J, et al. Estimates of cancer incidence and mortality in Europe in 1995. Eur J Cancer. 2002;38:99166.CrossRefGoogle ScholarPubMed
10. Canfell, K, Barnabas, R, Patnick, J, et al. The predicted effect of changes in cervical screening practice in the UK: Results from a modelling study. Br J Cancer. 2004;91:530536.CrossRefGoogle ScholarPubMed
11. Clifford, GM, Rana, RK, Franceschi S, et al. Human papillomavirus genotype distribution in low-grade cervical lesions: Comparison by geographic region and with cervical cancer. Cancer Epidemiol Biomarkers Prev. 2005;14:11571164.CrossRefGoogle Scholar
12. Clifford, GM, Smith, JS, Aguado, T, et al. Comparison of HPV type distribution in high-grade cervical lesions and cervical cancer: A meta-analysis. Br J Cancer. 2003;89:101105.CrossRefGoogle ScholarPubMed
13. Cosson, M. Hystérectomies pour pathologies bénignes. Paris: Masson-Williams and Wilkins; 1997.Google Scholar
14. Dasbach, EJ, Elbasha, EH, Insinga, RP. Mathematical models for predicting the epidemiologic and economic impact of vaccination against human papillomavirus infection and disease. Epidemiol Rev. 2006;28:88100.CrossRefGoogle ScholarPubMed
15. Elbasha, EH, Dasbach, EJ, Insinga, RP. Model for assessing human papillomavirus vaccination strategies. Emerg Infect Dis. 2007;13:2841.CrossRefGoogle ScholarPubMed
16. Exbrayat, C. Evolution de l'incidence et de la mortalité par cancer en France de 1978 a 2000. Rapport InVS, 21 Octobre 2003;107-112.Google Scholar
17. Fender, M, Schott, J, Baldauf, JJ, et al. EVE, une campagne régionale de dépistage du cancer du col de l'utérus. Organisation, résultats à 7 ans et perspectives. Presse Méd. 2003;32:15451551.Google Scholar
18. Ferlay, J, Bray, F, Pisani, P, et al. GLOBOCAN 2002. Cancer incidence, mortality and prevalence worldwide. Lyon: IARC Press 2004; No.5(2).Google Scholar
19. French Health Insurance. (L'assurance maladie). Available at: http://www.ameli.fr/ 2007.Google Scholar
20. Garland, SM, Hernandez-Avila, M, Wheeler, CM, et al. Quadrivalent vaccine against Human papillomavirus to prevent anogenital diseases. N Engl J Med. 2007;356:19281943.CrossRefGoogle ScholarPubMed
21. Goldie, SJ, Kohli, M, Grima, D, et al. Projected clinical benefits and cost-effectiveness of a human papillomavirus 16/18 vaccine. J Natl Cancer Inst. 2004;96:604615.CrossRefGoogle ScholarPubMed
22. Insinga, RP, Elbasha, EH. A preliminary assessment of the cost-effectiveness of a quadrivalent HPV vaccine in the United Kingdom using a multi-type transmission dynamic model. 23rd International Papillomavirus Conference and Clinical Workshop; September 1-7, 2006. Prague, Czech Republic.Google Scholar
23. Karnon, J, Peters, J, Platt, J, et al. Liquid-based cytology in cervical screening: An updated rapid and systematic review and economic analysis. Health Technol Assess. 2004;8:iii, 1-iii,78.CrossRefGoogle ScholarPubMed
24. Koutsky, L. Epidemiology of genital human papillomavirus infection. Am J Med. 1997;102:38.CrossRefGoogle ScholarPubMed
25. Kulasingam, SL, Myers, ER. Potential health and economic impact of adding a human papillomavirus vaccine to screening programs. JAMA. 2003;290:781789.CrossRefGoogle ScholarPubMed
26. Lamblin, G. Association radio-chirurgicale dans le traitement du cancer du col utérin de plus de 4cm. Université Claude Bernard. UFR Lyon-RTH Laennec, France, 2001; Thèse no. 172.Google Scholar
27. Le secteur libéral des professions de santé en 2003. résultats provisoires (source SNIR). Point Stat N°40 http://wwwsf-endocrinonet/sedmen/indexphp?pageID=821b8df9a316f818e39c7faa001d3fa2 2003.Google Scholar
28. Lukasiewicz, E, Aractingi, S, Flahault, A. Incidence and management of condylomata acuminata by French general physicians. Ann Dermatol Venereol. 2002;129:991996.Google ScholarPubMed
29. Lukasiewicz, E, Martel, J, Roujeau, JC, et al. Dermatology in private practice in France in 2000. Ann Dermatol Venereol. 2002;129:12611265.Google ScholarPubMed
30. Mahe, E, Descamps, V, Bouscarat, F, Crickx, B. [Management of external genital warts by dermatologists: A French survey]. Ann Dermatol Venereol. 2002;129:9971002.Google ScholarPubMed
31. Martin, X. L'hystérectomie élargie laparoscopico-vaginale dans le traitement des cancers du col utérin. Université Claude Bernard. UFR Lyon-RTH Laennec, France 1997; Thèse no. 191.Google Scholar
32. McCrory, DC, Matchar, DB, Bastian, L, et al. Evaluation of cervical cytology. Evid Rep Technol Assess (Summ). 1999;5:16.Google Scholar
33. Mitchell, MF, Schottenfeld, D, Tortolero-Luna, G, et al. Colposcopy for the diagnosis of squamous intraepithelial lesions: A meta-analysis. Obstet Gynecol. 1998;91:626631.Google ScholarPubMed
34. Monsonego, J, Breugelmans, JG, Bouee, S, et al. Anogenital warts incidence, medical management and costs in women consulting gynaecologists in France. Gynecol Obstet Fertil. 2007;35:107113.Google ScholarPubMed
35. Mubiayi, N, Bogaert, E, Boman, F, et al. Cytological history of 148 women presenting with invasive cervical cancer. Gynecol Obstet Fertil. 2002;30:210217.CrossRefGoogle ScholarPubMed
36. Myers, ER, Green, S, Lipkus, I. Patient preferences for health states related to HPV infection: Visual analogue scales vs. time trade-off elicitation. Proceedings of the 21st International Papillomavirus Conference. Mexico City, Mexico; 2004.Google Scholar
37. Myers, ER, McCrory, DC, Nanda, K, et al. Mathematical model for the natural history of human papillomavirus infection and cervical carcinogenesis. Am J Epidemiol. 2000;151:11581171.CrossRefGoogle ScholarPubMed
38. Nanda, K, McCrory, DC, Myers, ER, et al. Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: A systematic review. Ann Intern Med. 2000;132:810819.CrossRefGoogle ScholarPubMed
39. National Agency for Accreditation and Evaluation of Health (ANAES). Recommandations pour la pratique clinique: Conduite à tenir devant un frottis anormal du col de l'utérus. 1998 et actualisation 2002. Available at: http://www.has-sante.fr/portail/display.jsp?id=c_272243.Google Scholar
40. Olsson, SE, Villa, LL, Costa, RLR, et al. Induction of immune memory following administration of a prophylactic quadrivalent human papillomavirus (HPV) types 6/11/16/18 L1 virus-like particle (VLP) vaccine. Vaccine. 2007;25:49314939.CrossRefGoogle ScholarPubMed
41. Pagliusi, SR. Efficacy and other milestones for human papillomavirus vaccine introduction. Vaccine. 2004;23:569578.CrossRefGoogle ScholarPubMed
42. Parkin, DM. The epidemiological basis for evaluating screening policies. In New developments in cervical cancer screening and prevention. Oxford: Blackwell Science Limited; 1997.Google Scholar
43. Pretet, JL, Jacquard, AC, Carcopino, X, et al. . Human papillomavirus genotype distribution in invasive cervical cancer in France: EDITH study. Int J. Cancer. 2007, in press.CrossRefGoogle Scholar
44. Rousseau, A, Bohet, P, Merliere, J, et al. Évaluation du dépistage individuel du cancer du col de l'utérus: Utilité des données de l'assurance maladie. Bull Epidémiol Hebdomadaire (BEH). 2002;19:8183.Google Scholar
45. Sanders, GD, Taira, AV. Cost-effectiveness of a potential vaccine for human papillomavirus. Emerg Infect Dis. 2003;9:3748.CrossRefGoogle ScholarPubMed
46. The FUTURE II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. 2007;356:19151927.CrossRefGoogle Scholar
47. Van de Velde, N, Brisson, M, Boily, MC. Modeling human papillomavirus vaccine effectiveness: Quantifying the impact of parameter uncertainty. Am J Epidemiol. 2007;165:762775.CrossRefGoogle ScholarPubMed
48. Villa, LL, Costa, RL, Petta, C, et al. High sustained efficacy of a prophylactic quadrivalent human papillomavirus types 6/11/16/18 L1 virus-like particle vaccine through 5 years of follow-up. Br J Cancer. 2006;95:14591466.CrossRefGoogle ScholarPubMed
49. von Krogh, G. Management of anogenital warts (condylomata acuminata). Eur J Dermatol. 2001;11:598603.Google ScholarPubMed
50. Walboomers, JM, Jacobs, MV, Manos, MM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999;189:1219.3.0.CO;2-F>CrossRefGoogle ScholarPubMed