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The European Journal of Public Health Advance Access published online on October 28, 2009
The European Journal of Public Health, doi:10.1093/eurpub/ckp141
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© The Author 2009. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

A cost–utility analysis of adding a bivalent or quadrivalent HPV vaccine to the Irish cervical screening programme

Anne Dee1 and Fenton Howell2

1 Health Service Executive Mid-West Region, 31/33 Catherine Street, Limerick, Ireland
2 Health Service Executive Population Health Directorate, Railway Street, Navan, Co., Meath, Ireland

Correspondence: Anne Dee, Specialist Registrar in Public Health Medicine, Health Service Executive Mid-West Region, 31/33 Catherine Street, Limerick, Ireland, tel: +353 61 483337, fax: +353 61 464205, e-mail: anne.dee1{at}hse.ie

Received February 27, 2009 , accepted August 18, 2009

Background: Cervical cancer is a leading cause of death worldwide, and in Ireland it is the ninth most commonly diagnosed cancer in women. Almost 100% of these cancers are caused by human papillomavirus (HPV) infection. Two newly developed vaccines against HPV infection have become available. This study is a cost–utility analysis of the HPV vaccine in Ireland, and it compares the cost–effectiveness profiles of the two vaccines. Methods: A cost–utility analysis of the HPV vaccine in Ireland was performed using a Markov model. A cohort of screened and vaccinated women was compared with an unvaccinated screened cohort, and both cohorts were followed over their lifetimes. The model looked at uptake of services related to HPV disease in both cohorts. Outcomes were measured in quality adjusted life years (QALYs). Extensive sensitivity analysis was done. Results: For the base case analysis, the model showed that the incremental cost–effectiveness ratio (ICER) for quadrivalent HPV vaccination would be {euro}25 349/QALY and {euro}30 460/QALY for the bivalent vaccine. The ICER for the quadrivalent vaccine ranged from {euro}2877 to {euro}36 548, and for the bivalent from {euro}3399 to {euro}45 237. At current prices, the bivalent vaccine would need to be 22% cheaper than the quadrivalent vaccine in order to have equivalent cost effectiveness. Conclusion: HPV vaccination has the potential to be very cost effective in Ireland. The quadrivalent vaccine is more cost effective than the bivalent vaccine.

Keywords: cervical cancer, cost–utility analysis, genital warts, human papillomavirus vaccine, Markov model.


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