Table 2.
Sensitivity analysis - incremental cost-effectiveness ($ per QALY-gained)
| Mean (80% UI) | ||||
|---|---|---|---|---|
| Scenarios | 4-valent gender-neutral vs no vaccination | 9-valent gender-neutral vs 4-valent gender-neutral | ||
| No cross-protection | ||||
| Base-case | 7300 | (4300–11 000) | CS | (CS–CS) |
| Vaccination characteristics | ||||
| Duration of protection = 20 y | 9100 | (5700–13 200) | CS | (CS–CS) |
| Vaccination coverage* | ||||
| High-coverage scenario | 13 000 | (10 200–17 300) | CS | (CS–4100) |
| Low-coverage scenario | 4000 | (1200–7300) | CS | (CS–CS) |
| Cervical screening | ||||
| Cytology/HPV DNA co-testing† | N/A | CS | (CS–CS) | |
| Disease outcomes | ||||
| Disease outcomes included | ||||
| Cervical cancer only | 28 000 | (20 800–39 800) | CS | (CS–200) |
| Cervical lesions only | 212 500 | (108 200–556 900) | CS | (CS–32 000) |
| Low HPV31/33/45/52/58 positivity‡ | ||||
| Cervical cancers | 8800 | (7300–10 400) | CS | (CS–1800) |
| CIN2/3 | 7000 | (4900–10 000) | CS | (CS–3000) |
| Health economic parameters | ||||
| Minimum healthcare costs§ | 14 900 | (12 400–17 800) | CS | (CS–9700) |
| Minimum burden of disease§ | 9900 | (6500–14 400) | CS | (CS–CS) |
| Time horizon | ||||
| 30 y | 30 600 | (21 700–42 500) | CS | (CS→1 million) |
| With cross-protection | ||||
| Base-case | 5500 | (2400–9400) | CS | (CS–11 100) |
| Vaccination characteristics | ||||
| Duration of protection | ||||
| 9- & 4-valent= 20 y | 7300 | (3600–11 200) | CS | (CS–12 700) |
| Crossprotection = 20 y | 5700 | (2600–9600) | CS | (CS–8500) |
| Vaccination coverage* | ||||
| High-coverage scenario | 10 800 | (7600–14 900) | 4600 | (CS–22 100) |
| Low-coverage scenario | 2500 | (CS–6200) | CS | (CS–3900) |
| Cervical screening | ||||
| Cytology/HPV DNA co-testing† | N/A | CS | (CS–11 800) | |
| Disease outcomes | ||||
| Disease outcomes included | ||||
| Cervical cancer only | 23 700 | (16 000–33 600) | 1100 | (CS–19 500) |
| Cervical lesions only | 172 500 | (100 500–458 500) | 3500 | (CS–93 300) |
| Low HPV31/33/45/52/58 positivity‡ | ||||
| Cervical cancers | 7300 | (6100–9300) | 3500 | (CS–19 900) |
| CIN2/3 | 6100 | (3800–8700) | 6000 | (100–20 600) |
| Health economic parameters | ||||
| Minimum healthcare costs§ | 13 200 | (10 400–16 200) | 6600 | (1000–21 800) |
| Minimum burden of disease§ | 7800 | (4300–12 400) | CS | (CS–14 400) |
| Time horizon | ||||
| 30 y | 26 800 | (18 100–39 100) | 7600 | (CS→1 million) |
High vaccination coverage scenario: We use 1 dose US estimates and assume vaccine protection after 1 dose (Supplementary Figure 1, available online); low vaccination coverage scenario: We assume that the 3 dose coverage remains constant at 2012 levels from 2013 onwards (2012 was the lowest estimated uptake rate between 2010–2013).
Co-testing: 21- to 29-year-olds have a cytology test every 3 years, and 30- to 65-year-olds have cytology/HPV DNA co-testing every 5 years.
The 12 parameter sets out of 50, which produce the lowest HPV31/33/45/52/58 positivity in CIN2/3 (≤27% positive) and cervical cancers (≤23% positive).
Minimum: All cancer costs or QALY-lost parameters are set at the minimum value identified from the US literature (Supplementary Table 1, available online). Base-case: vaccine-type efficacy = 95%; cross-protective vaccine efficacy presented in Supplementary Table 3 (available online); duration = lifelong; 4-valent cost/dose = $145; 9-valent cost/dose = $158. CIN2/3 = cervical intraepithelial neoplasia grade 2 and 3; CS = cost saving; ICER = incremental cost-effectiveness ratio; NNV = number needed to vaccinate; QALY = quality-adjusted life-year; UI = uncertainty interval.