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Assessing the cost-effectiveness of HPV vaccination strategies for adolescent girls and boys in the UK
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Data, Samik, Pink, Joshua, Medley, Graham, Petrou, Stavros, Staniszewska, Sophie, Underwood, Martin, Sonnenberg, Pam and Keeling, Matthew James (2019) Assessing the cost-effectiveness of HPV vaccination strategies for adolescent girls and boys in the UK. BMC Infectious Diseases, 19 . 552 . doi:10.1186/s12879-019-4108-y ISSN 1471-2334.
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Official URL: https://doi.org/10.1186/s12879-019-4108-y
Abstract
Background
Human papillomavirus (HPV) is the most widespread sexually transmitted infection world-wide. It causes several health consequences, in particular accounting for the majority of cervical cancer cases in women. In the United Kingdom, a vaccination campaign targeting 12-year-old girls started in2008; this campaign has been successful, with high uptake and reduced HPV prevalence observed in vaccinated cohorts. Recently, attention has focused on vaccinating both sexes, due to HPV-related diseases in males (particularly for high-risk men who have sex with men) and an equity argument over equalising levels of protection.
Methods
We constructed an epidemiological model for HPV transmission in the UK, accounting for nine of the most common HPV strains. We complemented this with an economic model to determine the likely health outcomes (healthcare costs and quality-adjusted life years) for individuals from the epidemiological model. We then tested vaccination with the three HPV vaccines currently available, vaccinating either girls alone or both sexes. For each strategy we calculated the threshold price per vaccine dose, i.e. the maximum amount paid for the added health benefits of vaccination to be worth the cost of each vaccine dose. We calculated results at 3.5% discounting, and also 1.5%, to consider the long-term health effects of HPV infection.
Results
At 3.5% discounting, continuing to vaccinate girls remains highly cost-effective compared to halting vaccination, with threshold dose prices of£56-£108. Vaccination of girls and boys is less cost-effective (£25-£53). Compared to vaccinating girls only, adding boys to the programme is not cost-effective, with negative threshold prices (-£6 to -£3) due to the costs of administration. All threshold prices increase when using 1.5% discounting, and adding boys becomes cost-effective (£36-£47). These results are contingent on the UK’s high vaccine uptake; for lower uptake rates, adding boys (at the same uptake rate) becomes more cost effective.
Conclusions
Vaccinating girls is extremely cost-effective compared with no vaccination, vaccinating both sexes is less so. Adding boys to an already successful girls-only programme has a low cost-effectiveness, as males have high protection through herd immunity. If future health effects are weighted more heavily, threshold prices increase and vaccination becomes cost-effective
Item Type: | Journal Article | ||||||
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Subjects: | Q Science > QR Microbiology > QR355 Virology R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine |
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Science > Mathematics Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Warwick Research in Nursing > Royal College of Nursing Research Institute (RCN) (- July 2017) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Papillomaviruses -- Vaccination -- Cost effectiveness -- Great Britain, Sexually transmitted diseases, Cervix uteri -- Cancer -- Prevention | ||||||
Journal or Publication Title: | BMC Infectious Diseases | ||||||
Publisher: | BioMed Central Ltd. | ||||||
ISSN: | 1471-2334 | ||||||
Official Date: | 24 June 2019 | ||||||
Dates: |
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Volume: | 19 | ||||||
Article Number: | 552 | ||||||
DOI: | 10.1186/s12879-019-4108-y | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Restricted or Subscription Access | ||||||
Date of first compliant deposit: | 6 June 2019 | ||||||
Date of first compliant Open Access: | 6 June 2019 | ||||||
Funder: | doh | ||||||
RIOXX Funder/Project Grant: |
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