Table 1.
Selected Input Parameters
| Parameter | Incidence, Cases/100 000a,c | 5-year Survival, %b | Cases Due to HPV-16/18, %c | Utilityd | Cost, $e |
|---|---|---|---|---|---|
| HPV-related condition | |||||
| Anal cancer, women | 1.9 (0–9.1) | 70.4 | 82 | 0.57 | 37 500 |
| Anal cancer, men | 0.9 (0–5.7) | 51.3 | 82 | 0.57 | 37 500 |
| Cervical cancer | 24.0 (0–32.0) | 19.9–91.0 | 72 | 0.48–0.76 | 25 800–59 600 |
| Oropharyngeal cancer, women | 1.5 (0–6.5) | 57.6 | 54 | 0.58 | 49 000 |
| Oropharyngeal cancer, men | 3.8 (0–14.1) | 60.3 | 54 | 0.58 | 49 000 |
| Penile cancer | 2.0 (0–11.4) | 81 | 46 | 0.79 | 17 500 |
| Vaginal cancer | 0.6 (0–4.3) | 48.6 | 66 | 0.59 | 26 400 |
| Vulvar cancer | 3.4 (0–26.5) | 72.8 | 44 | 0.65 | 27 900 |
| Genital warts, women | 0.0–7.14 | … | 90 | 0.9277 | 400 |
| Genital warts, men | 0.0–8.85 | … | 90 | 0.9277 | 400 |
| Juvenile RRP | 0.17 | … | 100 | 0.69 | 133 800 |
| HPV vaccine, per dose | |||||
| Vaccine | … | … | … | … | 50–150 |
| Supplies and administration, ≤19 y | … | … | … | … | 14 |
| Supplies, administration, and transport, >19 ye | … | … | … | … | 117 |
Abbreviations: HPV, human papillomavirus; RRP, recurrent respiratory papillomatosis.
a Data are from the Cancer Registry of Norway [17] (2008–2010) for all noncervical HPV-related cancers. For invasive cervical cancer incidence, prescreening rates (1953–1969) reported by the Norwegian Cancer Registry were used to calibrate the natural history microsimulation model. See Methods for details. The incidence of genital warts is per 1000.
b Data are estimated on the basis of information from the Cancer Registry of Norway [17], using calendar-period observations for 2006–2010. For cervical cancer, the range represents stage-specific estimates for local (91%), regional (66%), and distant (19.9%) cancers.
c The noncervical incidence-based models were based on data from the Cancer Registry of Norway (cancer-specific incidence and survival [17]), published studies (eg, incidence of genital warts and RRP [33–35]), and the World Health Organization HPV database (proportion of cases attributable HPV-16 and -18, by site) [36, 37].
d Quality-of-life adjustment range from a health state utility weight of 0 (death) to 1 (perfect health). For cancer-specific conditions, we conservatively assumed that individuals would remain in a reduced quality of life for 5 years, after which they would return to their age- and sex-specific utility values elicited from another Scandinavian country [27]. Disease-specific utility weights were multiplied by baseline age-specific utility weights to estimate overall utility. Weights for cervical cancer varied according to stage (local, 0.76 for 5 years; regional, 0.67 for 5 years; distant, 0.48 for lifetime with disease); utility weights for other noncervical HPV-related cancers were applied for 5 years [20]. For genital warts, a mean quality-of-life loss of 6.6 days was assumed [21], which is approximately a utility weight of 0.9277 over 3 months; for RRP, a health state utility weight of 0.68 over 4 years was assumed.
e The cost per case is expressed in 2010 US dollars ($1 = 6.05 Norwegian Krone) and represents discounted (4% per year) costs for diagnosis and 5-year follow-up, inclusive of direct costs (procedures, inpatient stays, and general practitioner visits), direct nonmedical costs (transport), and patient time costs. The proportion of direct nonmedical and patient-time costs for all noncervical conditions was estimated from cervical cancer (15%) applied to baseline direct medical costs. The cost of treatment of cervical cancer varies according to stage of detection (local, $25 800; regional, $51 600; distant, $59 600).
f Data include the cost of an office visit (adjusted according to Norwegian economic evaluation guidelines), co-pay, and time and transport (using the average 2010 monthly earning plus fringe benefits for females <25 years old [http://www.ssb.no/en]) associated with vaccine administration outside the school-based program. The office visit, office wait time, and travel time (to/from) the appointment was assumed to take 1.5 hours.