The cost-effectiveness of controlling cervical cancer using a new 9-valent human papillomavirus vaccine among school-aged girls in Australia

Mahumud, Rashidul Alam ORCID: and Alam, Khorshed ORCID: and Dunn, Jeff and Gow, Jeff (2019) The cost-effectiveness of controlling cervical cancer using a new 9-valent human papillomavirus vaccine among school-aged girls in Australia. PLoS One, 14 (10):e0223658. pp. 1-18.

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Introduction: Cervical cancer imposes a substantial health burden worldwide including in Australia and is caused by persistent infection with one of 13 sexually transmitted high-risk human papillomavirus (HPV) types. The objective of this study was to assess the cost-effectiveness of adding a nonavalent new Gardasil-9® (9vHPV) vaccine to the national immunisation schedule in Australia across three different delivery strategies.

Materials and methods: The Papillomavirus Rapid Interface for Modelling and Economics (PRIME) model was used to examine the cost-effectiveness of 9vHPV vaccine introduction to prevent HPV infection. Academic literature and anecdotal evidence were included on the demographic variables, cervical cancer incidence and mortality, treatment costs, and vaccine delivery costs. The incremental cost-effectiveness ratios (ICERs) were measured per disability-adjusted life years (DALYs) averted, using the heuristic cost-effectiveness threshold defined by the World Health Organisation (WHO). Analyses and data from international agencies were used in scenario analysis from the health system and societal perspectives.

Results: The 9vHPV vaccination was estimated to prevent 113 new cases of cervical cancer (discounted)during a 20-year period. From the health system and societal perspectives, the 9vHPV vaccination was very cost-effective in comparison with the status quo, with an ICER of A$47,008 and A$44,678 per DALY averted, respectively, using the heuristic cost- effectiveness threshold level. Considering delivery strategies, the ICERs per DALY averted were A$47,605, A$46,682, and A$46,738 for school, health facilities, and outreach-based vaccination programs from the health system perspective, wherein, from the societal perspective, the ICERs per DALY averted were A$46,378, A$43,729, A$43,930, respectively. All estimates of ICERs fell below the threshold level (A$73,267).

Conclusions: This cost-effectiveness evaluation suggests that the routine two-dose 9vHPV vaccination strategy of preadolescent girls against HPV is very cost-effective in Australia from both the health system and societal perspectives. If equally priced, the 9vHPV option is the most economically viable vaccine. Overall, this analysis seeks to contribute to an evidence-based recommendation about the new 9vHPV vaccination in the national immunisation program in Australia.

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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Faculty/School / Institute/Centre: Historic - Faculty of Business, Education, Law and Arts - School of Commerce (1 Jul 2013 - 17 Jan 2021)
Faculty/School / Institute/Centre: Historic - Institute for Resilient Regions - Centre for Health, Informatics and Economic Research (1 Aug 2018 - 31 Mar 2020)
Date Deposited: 19 Nov 2019 23:52
Last Modified: 25 May 2021 04:37
Uncontrolled Keywords: Australia; cervical cancer; cost-effectiveness analysis; disability-adjusted life years; school-aged girls; 9vHPV vaccine
Fields of Research (2008): 11 Medical and Health Sciences > 1117 Public Health and Health Services > 111712 Health Promotion
14 Economics > 1402 Applied Economics > 140208 Health Economics
14 Economics > 1403 Econometrics > 140301 Cross-Sectional Analysis
Fields of Research (2020): 42 HEALTH SCIENCES > 4206 Public health > 420603 Health promotion
38 ECONOMICS > 3801 Applied economics > 380108 Health economics
38 ECONOMICS > 3802 Econometrics > 380201 Cross-sectional analysis
Socio-Economic Objectives (2008): C Society > 92 Health > 9204 Public Health (excl. Specific Population Health) > 920401 Behaviour and Health
E Expanding Knowledge > 97 Expanding Knowledge > 970111 Expanding Knowledge in the Medical and Health Sciences
C Society > 92 Health > 9204 Public Health (excl. Specific Population Health) > 920412 Preventive Medicine
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