Table 4.
Scenario analyses (expected value analysis; average costs and QALYs DW gained per individual 12-year-old over their whole lives
| |
Each intervention compared to no HPV vaccination
|
Incremental comparisons
|
||||||
|---|---|---|---|---|---|---|---|---|
| Interventions | Output | Intervention 1G: Replicating the GIRLS-ONLY NZ program in 2011 | Intervention 2G: Intensive GIRLS-ONLY program, school-based | Intervention 1G + B: Adding BOYS to the GIRLS NZ program in 2011 | Intervention 2G + B: Adding BOYS to the intensive GIRLS program, school-based | [A] Intervention 2G c.f. Intervention 1G | [B] Intervention 1G + B c.f. Intervention1G | [D] Intervention 2G + B c.f. Intervention 2G |
| From Table 3, expected value only analysis |
Net cost (NZ$) |
$81 |
$129 |
$235 |
$372 |
$47 |
$154 |
$244 |
| QALYsDW gained |
0.0045 |
0.0059 |
0.0059 |
0.0069 |
0.0014 |
0.0014 |
0.0010 |
|
| ICER |
$18,100 |
$21,900 |
$40,000 |
$53,700 |
$34,000 |
$111,000 |
$234,000 |
|
| Vaccine price halved (NZ$56) |
Net cost (NZ$) |
$41 |
$68 |
$154 |
$248 |
$27 |
$112 |
$180 |
| QALYsDW gained |
0.0045 |
0.0059 |
0.0059 |
0.0069 |
0.0014 |
0.0014 |
0.0010 |
|
| ICER |
$9,200 |
$11,600 |
$26,200 |
$35,800 |
$19,000 |
$81,300 |
$173,000 |
|
| Very low vaccine price ($7.46) = GAVI price ~ US$5) |
Net cost (NZ$) |
$7 |
$16 |
$84 |
$142 |
$9 |
$76 |
$126 |
| QALYsDW gained |
0.0045 |
0.0059 |
0.0059 |
0.0069 |
0.0014 |
0.0014 |
0.0010 |
|
| ICER |
$1,600 |
$2,800 |
$14,300 |
$20,500 |
$6,500 |
$55,300 |
$121,000 |
|
| Highly hypothetical vaccine price $NZ 1 |
Net cost (NZ$) |
$3 |
$10 |
$75 |
$129 |
$7 |
$72 |
$119 |
| QALYsDW gained |
0.0045 |
0.0059 |
0.0059 |
0.0069 |
0.0014 |
0.0014 |
0.0010 |
|
| ICER |
$700 |
$1,700 |
$12,800 |
$18,600 |
$4,900 |
$52,200 |
$115,000 |
|
| Plausibly lower vaccine administration costs (NZ$19) |
Net cost (NZ$) |
$-4 |
$14 |
$61 |
$138 |
$18 |
$65 |
$124 |
| QALYsDW gained |
0.0045 |
0.0059 |
0.0059 |
0.0069 |
0.0014 |
0.0014 |
0.0010 |
|
| ICER |
Dominant |
$2,400 |
$10,400 |
$20,000 |
$12,800 |
$47,000 |
$119,000 |
|
| Hypothetical vaccine price NZ$1 + lower vaccine administration costs (NZ$19) |
Net cost (NZ$) |
$-80 |
$-103 |
$-99 |
$-110 |
$-22 |
$-18 |
$-7 |
| QALYsDW gained |
0.0046 |
0.0059 |
0.0058 |
0.0069 |
0.0013 |
0.0012 |
0.0010 |
|
| ICER |
Dominant |
Dominant |
Dominant |
Dominant |
Dominant |
Dominant |
Dominant |
|
| GAVI vaccine price + lower vaccine administration costs (NZ$19) |
Net cost (NZ$) |
$-77 |
$-99 |
$-90 |
$-94 |
$-22 |
$-12 |
$5 |
| QALYsDW gained |
0.0045 |
0.0059 |
0.0059 |
0.0069 |
0.0014 |
0.0014 |
0.0010 |
|
| ICER |
Dominant |
Dominant |
Dominant |
Dominant |
Dominant |
Dominant |
$5,000 |
|
| Discount rate 0% |
Net cost (NZ$) |
$-28 |
$-23 |
$80 |
$183 |
$5 |
$108 |
$205 |
| QALYsDW gained |
0.0135 |
0.0186 |
0.0190 |
0.0233 |
0.0051 |
0.0055 |
0.0047 |
|
| ICER |
Dominant |
Dominant |
$4,200 |
$7,900 |
$1,000 |
$19,400 |
$43,900 |
|
| Cost and QALYsDW discount rate 6% (double baseline) |
Net cost (NZ$) |
$123 |
$186 |
$293 |
$443 |
$63 |
$170 |
$257 |
| QALYsDW gained |
0.0025 |
0.0031 |
0.0030 |
0.0035 |
0.0006 |
0.0006 |
0.0004 |
|
| ICER |
$50,100 |
$59,900 |
$96,500 |
$127,000 |
$97,000 |
$294,000 |
$695,000 |
|
| Excluding unrelated health system costs † |
Net cost (NZ$) |
$73 |
$117 |
$222 |
$356 |
$44 |
$150 |
$240 |
| QALYsDW gained |
0.0045 |
0.0059 |
0.0059 |
0.0069 |
0.0014 |
0.0014 |
0.0010 |
|
| ICER |
$16,200 |
$19,800 |
$37,900 |
$51,500 |
$31,500 |
$109,000 |
$231,000 |
|
| Excluding disease DWs (i.e., no morbidity impacts of HPV-related disease) ^ |
Net cost (NZ$) |
$81 |
$129 |
$235 |
$372 |
$47 |
$154 |
$244 |
| QALYsDW gained |
0.0011 |
0.0016 |
0.0017 |
0.0022 |
0.0006 |
0.0007 |
0.0006 |
|
| ICER |
$76,500 |
$79,800 |
$137,000 |
$166,000 |
$86,200 |
$233,000 |
$383,000 |
|
| Excluding both background morbidity and disease DWs (i.e., life years gained analysis, ignoring morbidity) |
Net cost (NZ$) |
$81 |
$129 |
$235 |
$372 |
$47 |
$154 |
$244 |
| QALYsDW gained |
0.0015 |
0.0023 |
0.0024 |
0.0031 |
0.0008 |
0.0009 |
0.0009 |
|
| ICER |
$53,100 |
$56,300 |
$96,700 |
$119,000 |
$62,700 |
$171,000 |
$284,000 |
|
| Excluding herd immunity benefits related to anal and oropharyngeal cancers for males when only females vaccinated: 1G (i.e., considering underestimation of benefits to MSM in 1G + B) | Net cost (NZ$) |
$144 |
||||||
| QALYsDW gained |
0.0018 |
|||||||
| ICER | $80,000 | |||||||
† That is ignoring the health costs from diseases other than those specifically modeled, which increase net costs as living longer is associated with costs from (other) future disease and disability.
^ That is the DWs for cancers, CIN and anogenital warts states are all set to zero – but the background morbidity is retained. The health gain realized from HPV vaccination is therefore only from preventing premature death from cancer. NOTE: all items in bolded font are cost-saving.