July 02, 2009
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HPV vaccination not cost-effective in Netherlands

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Vaccination for HPV was not cost-effective in the Netherlands, even under favorable assumptions for vaccination.

Researchers from Erasmus Medical Center, University Medical Center in Rotterdam, conducted a cost-effective analysis using a microsimulation screening analysis (MISCAN) model, which simulates a fictitious population.

The researchers used favorable assumptions for vaccination: that it provides lifelong protection against 70% of all cervical cancers, has no side effects and is administered to all women regardless of cervical cancer risk.

Under these assumptions, adding one vaccination to screening in the Netherlands per 100,000 women prevented 36% of cervical intraepithelial neoplasia 2/3 lesions detected by screening alone, 60% of diagnosed cervical cancers and 61% of cervical cancer-related deaths; however, the total costs increased by 64%. This is an increase of €247 per woman throughout her lifetime.

Forty Euros was the threshold price per vaccine dose at which the cost-effectiveness would be €20,000 per quality-adjusted life-year gained. The threshold price was reduced to €33 if one booster is needed and to €16 with four boosters. With a threshold of €50,000, the threshold price per vaccine dose was €110. With one booster the price was reduced to €95, and with four boosters the price became €59.

“All of these threshold prices were lower under less favorable effectiveness assumptions and were considerably less than the current over-the-counter per dose price of €118 in the Netherlands,” the researchers wrote.

The low number of cervical cancer incidence and mortality rates may have impacted the cost-effectiveness of HPV vaccination in the Netherlands, according to the researchers.

Dekok MCM. J Natl Cancer Inst. 2009;101:1083-1092.