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Keywords:

  • Cervical intraepithelial neoplasia;
  • cost-effectiveness analysis;
  • economics;
  • epidemiology;
  • human papillomavirus;
  • uterine cervical neoplasms;
  • vaccines

Objective  To assess the potential epidemiological and economic impact of a prophylactic quadrivalent human papillomavirus (HPV) (6/11/16/18) vaccine for preventing cervical cancer, cervical intraepithelial neoplasia grades 2 and 3 (CIN2/3), CIN1 and genital warts.

Design  Cost-utility analysis.

Setting  UK.

Population  Female and male UK population 12 years or older.

Methods  We adapted a previously developed multi-HPV type dynamic transmission to compare four female vaccination strategies, routine vaccination at age 12 years, and routine vaccination at age 12 years combined with temporary catch-up vaccination at ages 12–14, 12–17 and 12–24 years.

Main outcomes measures  Costs, cases avoided, incremental cost per quality-adjusted life year (QALY).

Results  The model projected that at year 100, each vaccination strategy could reduce the number of HPV 6/11/16/18-related cervical cancer, CIN2/3, CIN1 and genital wart cases among women by 86, 85, 79 and 89% respectively. Over 25 years, routine vaccination at age 12 years combined with a 12- to 24-year-old catch-up programme was the most effective strategy, reducing the cumulative number of cases of cervical cancer, CIN2/3, CIN1 and genital warts by 5800, 146 000, 28 000, and 1.1 million respectively. Over 100 years, the incremental cost-effectiveness ratios across all strategies ranged from £5882 to £11,412 per QALY gained.

Conclusion  In the UK, a quadrivalent HPV vaccination programme that includes a catch-up strategy can reduce the incidence of cervical cancer, CIN and genital warts at a cost per QALY ratio within the range typically regarded as cost-effective.