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A generally applicable cost-effectiveness model for the evaluation of vaccines against cervical cancer |
Demarteau N, Detournay B, Tehard B, El Hasnaoui A, Standaert B |
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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 The objective was to estimate the cost-effectiveness of human papillomavirus (HPV) vaccination, for 12-year-old French girls. The authors concluded that HPV vaccination was a cost-effective policy in France. The methods were good and reported sufficiently, and the results were reported in full. Given the scope of the study, the authors’ conclusions appear to be appropriate. Type of economic evaluation Study objective The objective was to estimate the cost-effectiveness of human papillomavirus (HPV) vaccination, for 12-year-old French girls. Interventions The two interventions were HPV screening according to usual French practice and screening plus vaccination at 12 years. Methods
Analytical approach:The authors reported that a Markov model was developed to combine the data from published studies to assess the costs and outcomes for the two interventions. The model was based on a published model by Debicki, et al. (2008, see 'Other Publications of Related Interest' below for bibliographic details). The time horizon was the lifetime of the girls. The authors reported that a limited societal perspective (including only the direct health care costs) was adopted.
Effectiveness data:The effectiveness data were from published studies or official reports. These estimates were validated by a panel of four French experts to insure applicability to France, especially where the data were from studies undertaken in other countries. The main effectiveness estimate was the vaccine efficacy, which was from a number of clinical trials.
Monetary benefit and utility valuations:The utility estimates were from a number of published studies.
Measure of benefit:Quality-adjusted life-years (QALYs) gained were the benefit measure. Future benefits were discounted at an annual rate of 1.5%.
Cost data:The direct costs included those of screening, treatment of detected cervical intraepithelial neoplasia (CIN) 1 and 2/3, cancer treatment, and vaccination. These costs were from published studies and the panel of four French experts. All costs were reported in 2007 Euros (EUR) and discounted at an annual rate of 3%.
Analysis of uncertainty:Univariate sensitivity analyses were performed to assess the effects of changes in the input parameters. Most of these were varied by ±20% from their base-case values. The results were presented in a tornado diagram. A probabilistic sensitivity analysis was performed, with distributions assigned to each model parameter. Normal distributions were used if confidence intervals were available, otherwise beta distributions were used. A total of 5,000 simulations were performed, and a multivariate stepwise linear regression was conducted to identify those variables that had the largest impact on the results. Results In the cohort of 100,000 patients, the discounted costs were EUR 30,034,919 for screening and EUR 58,782,797 for screening plus vaccination. The discounted QALYs gained were 4,387,672 with screening and 4,390,634 with screening plus vaccination.
The incremental cost per QALY gained with screening plus vaccination, compared with screening only, was EUR 9,706.
The discount rate was the most influential parameter in the univariate analyses. The probabilistic sensitivity analysis showed that progression and regression from HPV, CIN1, and CIN2/3 were the most influential parameters. Authors' conclusions The authors concluded that HPV vaccination was a cost-effective policy in France. CRD commentary
Interventions:The interventions were described and appear to have been appropriate comparators.
Effectiveness/benefits:The effectiveness data were mainly from published studies and a panel of four French experts ensured the applicability of these data to the French setting. The authors appropriately reported all the parameters for the model, including their base-case value, range of plausible values, and their sources. They did not report a systematic review of the literature to identify these data, and some relevant evidence might have been missed. The measure of benefit appears to have been appropriate as it incorporated morbidity and mortality, but the studies used to estimate the utilities were not described, making it difficult to assess their quality and validity.
Costs:The authors stated that a limited societal perspective that included only the health care costs was used. It appears that all the major relevant health care costs were analysed. These costs were published estimates, supplemented by the expert opinion of the panel of four French experts, who verified the effectiveness data. The authors reported the time horizon, discount rate, price year, and currency.
Analysis and results:The analytic approach was described, but no diagram of the model was provided. The results were clearly presented. Both a deterministic and a probabilistic sensitivity analysis were undertaken, which should have provided a good assessment of the uncertainty in the input parameters and the model overall. The main limitation was reported by the authors to be that their model was not a dynamic transmission model, and did not take into account the benefits of herd protection.
Concluding remarks:The methods were good and reported sufficiently, and the results were reported in full. Given the scope of the study, the authors’ conclusions appear to be appropriate. Funding Funded by GlaxoSmithKline Biologicals SA, Belgium, manufacturer of an HPV vaccine. Bibliographic details Demarteau N, Detournay B, Tehard B, El Hasnaoui A, Standaert B. A generally applicable cost-effectiveness model for the evaluation of vaccines against cervical cancer. International Journal of Public Health 2011; 56(2): 153-162 Other publications of related interest Debicki D, Ferko N, Demarteau N, Gallivan S, Bauch C, Anonychuk A, Mantovani L, Capri S, Chou CY, Standaert B, Annemans L. Comparison of detailed and succinct cohort modelling approaches in a multi-regional evaluation of cervical cancer vaccination. Vaccine 2008; 26(Supplement 5): F16-F28. Indexing Status Subject indexing assigned by NLM MeSH Child; Cohort Studies; Cost-Benefit Analysis; Female; France; Humans; Incidence; Markov Chains; Models, Econometric; Papillomavirus Infections /economics /mortality /prevention & Papillomavirus Vaccines /economics; Uterine Cervical Neoplasms /economics /mortality /prevention & Vaccination /economics; control; control AccessionNumber 22011001436 Date bibliographic record published 05/10/2011 Date abstract record published 27/01/2012 |
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