Cost-effectiveness of sex-neutral HPV-vaccination in Sweden, accounting for herd-immunity and sexual behaviour

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Cost-effectiveness of sex-neutral HPV-vaccination in Sweden, accounting for herd-immunity and sexual behaviour. / Wolff, Ellen; Elfström, K. Miriam; Haugen Cange, Hedda; Larsson, Sofie; Englund, Helene; Sparén, Pär; Roth, Adam.

In: Vaccine, Vol. 36, No. 34, 16.08.2018, p. 5160-5165.

Research output: Contribution to journalArticle

Harvard

Wolff, E, Elfström, KM, Haugen Cange, H, Larsson, S, Englund, H, Sparén, P & Roth, A 2018, 'Cost-effectiveness of sex-neutral HPV-vaccination in Sweden, accounting for herd-immunity and sexual behaviour', Vaccine, vol. 36, no. 34, pp. 5160-5165. https://doi.org/10.1016/j.vaccine.2018.07.018

APA

Wolff, E., Elfström, K. M., Haugen Cange, H., Larsson, S., Englund, H., Sparén, P., & Roth, A. (2018). Cost-effectiveness of sex-neutral HPV-vaccination in Sweden, accounting for herd-immunity and sexual behaviour. Vaccine, 36(34), 5160-5165. https://doi.org/10.1016/j.vaccine.2018.07.018

CBE

MLA

Vancouver

Wolff E, Elfström KM, Haugen Cange H, Larsson S, Englund H, Sparén P et al. Cost-effectiveness of sex-neutral HPV-vaccination in Sweden, accounting for herd-immunity and sexual behaviour. Vaccine. 2018 Aug 16;36(34):5160-5165. https://doi.org/10.1016/j.vaccine.2018.07.018

Author

Wolff, Ellen ; Elfström, K. Miriam ; Haugen Cange, Hedda ; Larsson, Sofie ; Englund, Helene ; Sparén, Pär ; Roth, Adam. / Cost-effectiveness of sex-neutral HPV-vaccination in Sweden, accounting for herd-immunity and sexual behaviour. In: Vaccine. 2018 ; Vol. 36, No. 34. pp. 5160-5165.

RIS

TY - JOUR

T1 - Cost-effectiveness of sex-neutral HPV-vaccination in Sweden, accounting for herd-immunity and sexual behaviour

AU - Wolff, Ellen

AU - Elfström, K. Miriam

AU - Haugen Cange, Hedda

AU - Larsson, Sofie

AU - Englund, Helene

AU - Sparén, Pär

AU - Roth, Adam

PY - 2018/8/16

Y1 - 2018/8/16

N2 - Introduction: The aim was to assess cost-effectiveness of expanding the Swedish HPV-vaccination program to include preadolescent boys, by comparing health-effects and costs of HPV-related disease, with a sex-neutral vaccination program versus only vaccinating girls. Methods: We used a dynamic compartmental model to simulate the burden of HPV16/18-related disease in Sweden, accounting for indirect effects of vaccination through herd-immunity. The model accounted for sexual behaviour, such as age preferences and men who have sex with men. The main outcome was number of individuals with HPV-related cancers (cervical, genital, anal and oropharyngeal cancer) and cervical intraepithelial neoplasia (CIN). Costs included in the analysis were those incurred when treating HPV-related cancer and CIN, production losses during sick-leave, and acquisition and administration of vaccine. Health effects were measured as quality-adjusted life years (QALY). The time horizon was set to 100 years, and both effects and costs were discounted by 3% annually. Health effects and costs were accumulated over the time horizon and used to create an incremental cost-effectiveness ratio. Results: A sex-neutral vaccination program would reduce HPV-related cancer and CIN, both due to direct effects among vaccinated as well as through herd-immunity, further decreasing HPV-related cancer burden annually by around 60 cases among men and women respectively in steady-state. The cost per gained QALY was estimated to 40,000 euro. Applying the procurement price of 2017, sex-neutral vaccination was dominant. Conclusion: Introducing a sex-neutral HPV-vaccination program would be good value for money also in Sweden where there this 80% coverage in the current HPV-vaccination program for preadolescent girls. The cost-effectiveness of a sex-neutral program is highly dependent on the price of the vaccine, the lower the price the more favourable it is to also vaccinate boys.

AB - Introduction: The aim was to assess cost-effectiveness of expanding the Swedish HPV-vaccination program to include preadolescent boys, by comparing health-effects and costs of HPV-related disease, with a sex-neutral vaccination program versus only vaccinating girls. Methods: We used a dynamic compartmental model to simulate the burden of HPV16/18-related disease in Sweden, accounting for indirect effects of vaccination through herd-immunity. The model accounted for sexual behaviour, such as age preferences and men who have sex with men. The main outcome was number of individuals with HPV-related cancers (cervical, genital, anal and oropharyngeal cancer) and cervical intraepithelial neoplasia (CIN). Costs included in the analysis were those incurred when treating HPV-related cancer and CIN, production losses during sick-leave, and acquisition and administration of vaccine. Health effects were measured as quality-adjusted life years (QALY). The time horizon was set to 100 years, and both effects and costs were discounted by 3% annually. Health effects and costs were accumulated over the time horizon and used to create an incremental cost-effectiveness ratio. Results: A sex-neutral vaccination program would reduce HPV-related cancer and CIN, both due to direct effects among vaccinated as well as through herd-immunity, further decreasing HPV-related cancer burden annually by around 60 cases among men and women respectively in steady-state. The cost per gained QALY was estimated to 40,000 euro. Applying the procurement price of 2017, sex-neutral vaccination was dominant. Conclusion: Introducing a sex-neutral HPV-vaccination program would be good value for money also in Sweden where there this 80% coverage in the current HPV-vaccination program for preadolescent girls. The cost-effectiveness of a sex-neutral program is highly dependent on the price of the vaccine, the lower the price the more favourable it is to also vaccinate boys.

KW - Cost effectiveness

KW - Dynamic modelling

KW - Health economic evaluation

KW - HPV

KW - Human papillomavirus

KW - Vaccination

U2 - 10.1016/j.vaccine.2018.07.018

DO - 10.1016/j.vaccine.2018.07.018

M3 - Article

C2 - 30017146

AN - SCOPUS:85049798714

VL - 36

SP - 5160

EP - 5165

JO - Vaccine

JF - Vaccine

SN - 1873-2518

IS - 34

ER -