Clinical and economic impact of school‐based nonavalent human papillomavirus vaccine on women in Singapore: a transmission dynamic mathematical model analysis

• Published in: BJOG : an international journal of obstetrics and gynaecology 2018-03, Vol.125 (4), p.478-486
• Main Authors: Tay, SK, Hsu, T‐Y, Pavelyev, A, Walia, A, Kulkarni, AS
• Format: Article
• Language: English
• Subjects: Bivalent vaccine; Cancer Vaccines - economics; Cancer Vaccines - therapeutic use; Cervical cancer; cervical mortality; Cervix; Child; CIN; Condyloma acuminatum; Cost analysis; Cost-Benefit Analysis - methods; cost‐effectiveness; Cytology; Demography; Disease prevention; Economic impact; Epidemiology; Female; genital warts; Human papillomavirus; Humans; Immunization; Immunization Programs - economics; Immunization Programs - methods; Incidence; Mathematical models; Models, Theoretical; Mortality; Papillomavirus Infections - prevention & control; Papillomavirus Vaccines - classification; Papillomavirus Vaccines - economics; Papillomavirus Vaccines - therapeutic use; quadrivalent vaccine; Quality-Adjusted Life Years; Singapore - epidemiology; Teenagers; Uterine Cervical Neoplasms - epidemiology; Uterine Cervical Neoplasms - prevention & control; Vaccines; Warts; Womens health
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/1471-0528.15106

Objective To examine the epidemiological and economic impact of a nine‐valent (nonavalent) human papillomavirus (HPV) 6/11/16/18/31/33/45/52/58 vaccine programme for young teenagers in Singapore. Design Mathematical modelling. Setting Pharmaco‐economic simulation projection. Population Singapore demography. Methods Clinical, epidemiological and financial data from Singapore were used in a validated HPV transmission dynamic mathematical model to analyse the impact of nonavalent HPV vaccination over quadrivalent and bivalent vaccines in a school‐based 2‐dose vaccination for 11‐ to 12‐year‐old girls in the country. The model assumed routine cytology screening in the current rate (50%) and vaccine coverage rate of 80%. Main outcome measures Changes over a 100‐year time period in the incidence and mortality rates of cervical cancer, case load of genital warts, and incremental cost–effectiveness ratio (ICER). Results Compared with bivalent and quadrivalent HPV vaccination programmes, nonavalent HPV universal vaccination resulted in an additional reduction of HPV31/33/45/52/58 related CIN1 of 40.5%, CIN 2/3 of 35.4%, cervical cancer of 23.5%, and cervical cancer mortality of 20.2%. Compared with bivalent HPV vaccination, there was an additional reduction in HPV‐6/11 related CIN1 of 75.7%, and genital warts of 78.9% in women and 73.4% in men. Over the 100 years, after applying a discount of 3%, disease management cost will be reduced by 32.5% (versus bivalent) and 7.5% (versus quadrivalent). The incremental cost‐effectiveness ratio (ICER) per quality‐adjusted life‐year gained was SGD 929 compared with bivalent vaccination and SGD 9864 compared with quadrivalent vaccination. Conclusion Universal two‐dose nonavalent HPV vaccination for 11‐ to 12‐year‐old adolescent women is very cost‐effective in Singapore. Tweetable Nonavalent HPV vaccination of 11‐ to 12‐year‐old girls is cost‐effective in Singapore. Tweetable Nonavalent HPV vaccination of 11‐ to 12‐year‐old girls is cost‐effective in Singapore.