Table 3.
Cost effectiveness of human papillomavirus (HPV) vaccination and revised screening strategies*
| Strategy† | Cervical‡ (100% efficacy) |
All HPV related conditions in women and men§ | ||
|---|---|---|---|---|
| 50% efficacy¶ | 75% efficacy** (boys only) | 90% efficacy†† (boys only) |
||
| No vaccination+screening every three years | — | — | — | — |
| Vaccination of girls aged 12+screening every three years | 37 940 | 17 560 | 11 930 | 11 930 |
| No vaccination+screening every two years | Dominated | Dominated | Dominated | Dominated |
| Vaccination of girls and boys aged 12+screening every three years | Not cost effective | 131 010 | 122 680 | 88 930 |
| Vaccination of girls aged 12+screening every two years | 190 780 | Dominated | Dominated | Dominated |
| Vaccination of girls and boys aged 12+screening every two years | 390 440 | 220 940 | 212 910 | 220 940 |
*Values represent incremental cost effectiveness ratios (additional cost divided by additional health benefit compared with next less costly strategy) expressed as cost ($) per quality adjusted life year. Costs expressed in 2006 dollars. Strategies are listed in order of increasing costs; those that are “dominated” are more costly and less effective than another strategy; those that are “not cost effective” are less cost effective (have higher cost effectiveness ratios) than a more costly strategy.
†Strategies vary by vaccination (no vaccination, vaccination of 12 year old girls alone, vaccination of 12 year old girls and boys at 75% coverage) and screening (every two or three years using cytology with HPV DNA testing for triage starting at age 25, with a switch to combined cytology and HPV DNA testing at age 35).
‡Includes outcomes related to cervical disease only and assumes 100% lifelong vaccine efficacy against HPV 16 and HPV 18 related cervical disease.
§Includes outcomes related to cervical disease and other HPV 16 and HPV 18 related cancers, and HPV 6 and HPV 11 related genital warts and juvenile onset recurrent respiratory papillomatosis among women and men.
¶Assumes 50% lifelong vaccine efficacy against HPV 16 and HPV 18 related non-cervical cancers, and HPV 6 and HPV 11 related genital warts among men and juvenile onset recurrent respiratory papillomatosis, and 100% lifelong vaccine efficacy against HPV 16 and HPV 18 related cervical disease and HPV 6 and HPV 11 related genital warts among women.
**Assumes 75% lifelong vaccine efficacy against all vaccine type health conditions among men and 100% lifelong vaccine efficacy against all vaccine type health conditions among women.
††Assumes 90% lifelong vaccine efficacy against all vaccine type health conditions among men and 100% lifelong vaccine efficacy against all vaccine type health conditions among women.