1 / 23

Cost Effectiveness of a Human Papillomavirus Vaccine in reducing the risk of cervical cancer in Ireland using a transm

Cost Effectiveness of a Human Papillomavirus Vaccine in reducing the risk of cervical cancer in Ireland using a transmission dynamic model. Cara Usher 1 , Lesley Tilson 1 , Cathal Walsh 2 , Jens Olsen 3 , Martin Rudbeck Jepsen 4 , Michael Barry 1 .

gino
Download Presentation

Cost Effectiveness of a Human Papillomavirus Vaccine in reducing the risk of cervical cancer in Ireland using a transm

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Cost Effectiveness of a Human Papillomavirus Vaccine in reducing the risk of cervical cancer in Ireland using a transmission dynamic model. Cara Usher1, Lesley Tilson1, Cathal Walsh2, Jens Olsen3, Martin Rudbeck Jepsen4, Michael Barry1. 1. National Centre for Pharmacoeconomics, Dublin, Ireland. 2. Dept. of Statistics, Trinity College Dublin, Ireland. 3. University of Southern Denmark, Odense, Denmark. 4. Statens Serum Institut, Copenhagen, Denmark.

  2. Aim To evaluate the cost effectiveness of a combined primary (vaccination) and secondary (screening) approach to managing pre-cancerous and cancerous lesions vs A population-based cervical cancer screening programme alone in Ireland.

  3. Human Papilloma Virus (HPV) • More than 100 different types of HPV infection have been characterised: • High risk – most common are HPV 16, 18, 45 and 31. • Low risk- include HPV types 6, 11. Cause ~70% of cervical cancers Cause ~ 90% of anogenital warts

  4. Human Papilloma Virus (HPV) Vaccine • Two vaccines currently developed: • Gardasil® – protects against HPV types 16, 18, 6 and 11. • Cervarix ® – protects against HPV types 16 and 18. • Efficacy demonstrated for up to 5.5 years after vaccination. • Requirement for booster dose at later time not established. • Routine cytology screening still required, as vaccines do not protect against all oncogenic types of HPV.

  5. Natural history of HPV Infection Progression HPV infected Cervix (CIN 1) Cancer Normal Cervix CIN 2/3 Clearance Regression

  6. Methods • Framework • Scope of analysis agreed with economic modelling group • in Denmark and EAG in Ireland. • Comparator • Population-based cervical cancer screening programme • Perspective • Healthcare payer

  7. Model Structure Transmission model Cost Effectiveness Model • Simulated infection caused • by HPV 16&18 only, using sexual behaviour patterns1. • HPV type-specific prevalence • Artistic trial2. • Calibration: Estimates CIN1-3, CC incidence • Layte et al, 2006. • Kitchener et al, 2006. Outputs from transmission model combined with resource use and cost data Incremental effects ( incidence CIN 1-3, CC) Incremental costs (costs of vaccination vs no vaccination)

  8. Model Inputs • Epidemiological data • Sexual behaviour patterns • HPV-type distribution • Prevalence of HPV infection • Incidence of premalignant and invasive CC • Resource use data • Vaccination costs • Direct medical costs • Unit cost data

  9. Model Inputs • Time Horizon • 70 yrs (9 – 79 years) • Outcome Measure • Life Years Gained • Vaccine Coverage • 80% (based on Men C catch-up programme). • Discounting • 3.5% costs & benefits

  10. Model Inputs (Summary)

  11. Results (1) – Simulation Model

  12. Health state Estimated total number of cases in 2004 Average annual number of cases averted due to HPV vaccination CIN 1 7,259 2,245 CIN2/3 3,515 1,435 Cervical cancer 200 111 Deaths from cervical cancer 93 52 Results (2) – Cases Averted

  13. Incremental costs (discounted) Incremental life years gained (discounted) ICER € 6,984,496 401.8 years € 17,383 / LYG Results (3) – Cost Effectiveness of the base-case vaccination programme (HPV vaccination & screening vs screening alone)

  14. Results (3) – Cost Effectiveness of catch-up vaccination programmes ICER €24,534/LYG ICER €22,038/LYG ICER €20,646/LYG ICER €18,893/LYG ICER €17,383/LYG 12 yr olds + Catch-Up to 15 yrs: ICER€52,968/LYG.

  15. Results (4) – Sensitivity Analysis: Probabilistic 97.5 centile 2.5 centile

  16. Results (5) – Sensitivity Analysis: One-Way €17,383/LYG

  17. Summary • Cost-effectiveness of base-case vaccination programme ICER €17,383/LYG • Cost-effectiveness of catch-up vaccination programmes • ICER €52,968/LYG (12-15 yr olds)

  18. Strengths / Limitations • Study framework, i.e. a collaborative approach to assessing • cost-effectiveness of an intervention in a short timeframe. • Uncertainty with data. • cross-protection • requirement for booster • vaccine efficacy against types 6 & 11

  19. Conclusions • Epidemiological impact of vaccination • Cost effective to vaccinate 12 yr old females • Cost effective to vaccinate 12 – 15 yr old females

  20. 5th August 2008 Minister for Health Approves Introduction Of Cervical Cancer Vaccination Programme “It is clear the main priority now is to move to the introduction of the vaccination programme for 12 year old girls to commence in September 2009” .

  21. Acknowledgements

More Related