UK: Is HPV vaccine choice an economic one?

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Is HPV vaccine choice an economic one?

Friday 18th July 2008

The UK government may save up to £18.6m a year by deciding to use the HPV

vaccine Cervarix, given that it is equally effective as the more expensive

Gardasil in preventing cervical abnormalities, according to a study

published on BMJ.com.

Two HPV vaccines have demonstrated similar efficacy against cervical

abnormalities due to HPV strain types 16 and 18 (responsible for 7 in 0

cases of cervical cancer) up to nearly five years: one which protects

against types 16 and 18 only (the bivalent vaccine, Cervarix) and another

which protects against types 6 and 11 (linked to at least 9 in10 cases of

anogential warsts) as well (the quadrivalent vaccine, Gardasil).

The Department of Health recently chose Cervarix for use in the HPV

immunisation programme in the UK which begins in September.

Mark Jit and colleagues from the Health Protection Agency, describe the

mathematical model used to predict the cost-effectiveness and long-term

outcomes of vaccination programmes in the UK using either of the two

available vaccines, and report the results which helped inform the

Department of Health's decision to choose the bivalent vaccine, Cervarix.

They predict that the HPV vaccination programme in the UK aimed at

12-year-old girls is highly likely to be cost-effective provided that

protection lasts for more than 10 years.

They explain that, because the quadrivalent vaccine includes the added

protection against noncancerous anogenital warts, the bivalent vaccine must

be priced £13 less per dose than the quadrivalent vaccine to be equally

cost-effective.

The researchers say that the vaccination programme would also provide " herd

immunity " benefits to those in the population who had not received the

vaccine, from reduced HPV prevalence in the population.

They also find that vaccinating boys would not be cost-effective because, if

80% of girls were covered, it is likely that most cases of cervical cancer

would be prevented, as well as most cases of anogenital warts if the

quadrivalent vaccine was used.

Using a bivalent vaccine priced at £13 less per dose than the quadrivalent

vaccine translates to financial savings of between £11.5–£18.6m from the

vaccine price alone in the first year of the programme, if 80% of

12-year-olds in the UK receive the full three-dose vaccine series, estimates

Professor Jane Kim from the Harvard School of Public Health, in an

accompanying editorial.

" The decision to select the bivalent vaccine implies that the Department of

Health is willing to accept foregone health benefits (and additional

cost-savings) from averting [noncancerous] cases of genital warts for the

reduced financial outlay, which may be allocated to other priority

investment in health " , says Kim.

Although the authors assume coverage of 70% and a previous study(1) in the

BMJ reported encouraging uptakes of the first and second vaccine doses in

schoolgirls, it is unclear, says Kim, what the uptake rates will be for the

three-dose series, and this will have a significant impact on the direct and

indirect benefits of the vaccination programme.

" Ensuring equitable access to the vaccine may also increase overall success

of the vaccination programme and help mitigate disparities in cancer risk

across socioeconomic groups. And, because nearly one-third of cases of

cervical cancer are attributable to HPV types that are not covered by

vaccines, cervical screening will continue to be a vital component of

efforts to prevent cancer, " she adds.

Reference

1. BMJ 2008;336:1056–58.