|
The cost-effectiveness of male HPV vaccination in the United States |
Chesson HW, Ekwueme DU, Saraiya M, Dunne EF, Markowitz LE |
|
|
Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. CRD summary This study assessed the cost-effectiveness of adding human papillomavirus (HPV) vaccination for 12-year-old males, to the vaccination programme for females aged 12 to 26 years. The authors concluded that male vaccination might provide value for money, if the female coverage was low and all the benefits were included. Increasing female coverage could be more cost-effective than adding male vaccination. The cost-effectiveness framework was valid and key areas of uncertainty were considered, supporting the authors’ conclusions. Type of economic evaluation Study objective This study assessed the cost-effectiveness of adding human papillomavirus (HPV) vaccination for 12-year-old males, to the implemented vaccination programme for females aged 12 to 26 years. Interventions The intervention was the addition of vaccination of 12-year-old males to HPV vaccination for females aged 12 to 26 years, compared with continuing vaccination of females only. No vaccination was also considered. The quadrivalent HPV vaccine (against types six, 11, 16, and 18) was administered in three doses. Three reduced coverage strategies were considered: vaccination of 12-year-old girls with 30% coverage, vaccination of 12-year-old-girls with 45% coverage, and vaccination of 12-year-old-girls and boys with 30% coverage for each gender. Methods Analytical approach:The analysis was based on a published deterministic, dynamic, population-based model of the economic and health burden of HPV with or without vaccination. A lifetime horizon was considered. The authors stated that it was conducted from a societal perspective. Effectiveness data:The clinical data were from relevant studies. The epidemiological inputs were from national databases, such as the Centers for Disease Control and Prevention (CDC), the National Program of Cancer Registries (NPCR), and the Surveillance, Epidemiology, and End Results (SEER) database. The key inputs were the incidence rates for HPV-associated health outcomes, such as cervical intraepithelial neoplasia (CIN), genital warts, juvenile-onset recurrent respiratory papillomatosis, and cervical, vaginal, vulvar, anal, oropharyngeal, and penile cancers. The vaccine efficacy was based on trial data. Vaccination coverage was an important parameter and the data were from the National Immunization Survey. Monetary benefit and utility valuations:The utility values were from several published sources and expert opinion. Measure of benefit:Quality-adjusted life-years (QALYs) were the summary benefit measure and they were discounted at an annual rate of 3%. Cost data:The economic analysis included two broad cost categories: vaccination (vaccine acquisition, administration, and wastage) and HPV-related health outcomes. Most of the economic data were from published sources, including a study by the authors of this study. The vaccine cost was based on its official price (average of that for the public and the private sectors). All costs were in US dollars ($) and the price year was 2008. A 3% annual discount rate was applied. Analysis of uncertainty:Three coverage scenarios were considered (both for males and females): 30%, 20%, and 75%. One-way sensitivity analyses were carried out on selected inputs using ranges from published sources or authors’ opinions. A multi-way probabilistic sensitivity analysis was performed varying the following parameters: the cost and the number of QALYs lost per HPV-associated health outcome; the incidences of health outcomes in the absence of vaccination, the percentages of these outcomes attributable to the four HPV types, and the vaccination impact. Results When including all possible health outcomes, the incremental cost per QALY gained with female vaccination compared with no intervention was $7,200 with 30% coverage, $5,700 with 20% coverage, and $10,500 with 75% coverage. With male and female vaccination compared with female vaccination alone, it was $41,400 with 30%, $23,600 with 20%, and $184,300, with 75% coverage. When only cervical outcomes were considered, the incremental cost per QALY gained with male and female vaccination compared with female vaccination alone increased substantially and was generally not cost-effective. The incremental cost per QALY gained was $2,000 with 30% coverage for girls, over no vaccination, $8,200 with 45% coverage for girls, over 30% coverage for girls, $25,000 with 30% coverage for boys and girls, over 30% coverage for girls, and $103,500 with 30% coverage for boys and girls, over 45% coverage for girls. Increasing the female vaccination coverage was more cost-effective than adding male vaccination. The most influential inputs were the number of QALYs lost per health outcome, the male vaccination efficacy, the incidences of health outcomes, and the vaccine costs. The probabilistic analysis indicated that the incremental cost per QALY gained with male vaccination was below the threshold of $100,000 in all simulations with 20% or 30% coverage, but it was above this threshold in almost all simulations with 75% coverage. Authors' conclusions The authors concluded that male HPV vaccination might provide value for money, if the female vaccination coverage was low and all the benefits were included. Increasing female coverage appeared to be more cost-effective than adding male vaccination. CRD commentary Interventions:The selection of the comparators was appropriate as the various possible vaccination strategies were considered, including increasing female vaccination coverage rather than investing in male vaccination. Effectiveness/benefits:No systematic search was reported to identify the sources of evidence. Limited information was reported on these data sources; the authors stated that nationally representative databases were used for the epidemiological inputs, and a clinical trial was used for the vaccine efficacy. These types of source are generally appropriate for each type of parameter. Different levels of coverage for boys and girls were considered and a wide range of values was tested. In general, the clinical parameters were varied in the sensitivity analysis. QALYs were an appropriate benefit measure because the disease affects both survival and quality of life. The utility weights were from several published studies, which were not fully described, and expert opinion was needed. Costs:The authors stated that a societal perspective was adopted, but only appear to have included the direct medical costs. They stated that patient time and transport costs were not included. Most of the costs were from a published economic evaluation conducted by the authors of this study. Other data were from standard US sources. The costs were treated deterministically, with some values varied in the sensitivity analysis. Details, such as the price year and the discount rate, were reported. Analysis and results:An incremental approach was used to combine the costs and benefits of the alternative strategies. The expected costs and benefits were not reported; only the incremental cost-utility ratios were given. Most of the details of the economic evaluation and the model assumptions were presented in an online appendix and the report published by the authors in 2008 (Chesson, et al. 2008, see 'Other Publications of Related Interest' below for bibliographic details). Various approaches were used to assess uncertainty, and the results were extensively presented in the appendix. The authors stated that their results were similar to those of other published economic evaluations on male HPV vaccination. They acknowledged that they assumed that screening uptake did not change with changes in vaccination coverage. The results were specific to the USA and might not be transferable to settings with different epidemiology and prices. Concluding remarks:The cost-effectiveness framework was valid and key areas of uncertainty were considered, supporting the authors’ conclusions. Bibliographic details Chesson HW, Ekwueme DU, Saraiya M, Dunne EF, Markowitz LE. The cost-effectiveness of male HPV vaccination in the United States. Vaccine 2011; 29(46): 8443-8450 Other publications of related interest Chesson HW, Ekwueme DU, Saraiya M, Markowitz LE. Cost-effectiveness of human papillomavirus vaccination in the United States. Emerging Infectious Diseases 2008; 14: 244–251. Indexing Status Subject indexing assigned by NLM MeSH Adolescent; Adult; Child; Cost-Benefit Analysis; Female; Humans; Incidence; Male; Models, Statistical; Papillomavirus Infections /economics /epidemiology /prevention & Papillomavirus Vaccines /administration & Quality of Life; United States /epidemiology; Vaccination /economics /methods; Young Adult; control /transmission; dosage /economics /immunology AccessionNumber 22011001852 Date bibliographic record published 13/02/2012 Date abstract record published 13/03/2012 |
|
|
|