Cost-effectiveness of different human papillomavirus vaccines in Singapore

Lee, Vernon J.; Tay, Sun Kuie; Teoh, Yee Leong; Tok, Mei Yin
January 2011
BMC Public Health;2011, Vol. 11 Issue 1, p203
Academic Journal
Background: Human papillomavirus (HPV) vaccines are widely available and there have been studies exploring their potential clinical impact and cost-effectiveness. However, few studies have compared the cost-effectiveness among the 2 main vaccines available - a bivalent vaccine against HPV 16/18, and a quadrivalent vaccine against 6/ 11/16/18. We explore the cost-effectiveness of these two HPV vaccines in tropical Singapore. Methods: We developed a Markov state-transition model to represent the natural history of cervical cancer to predict HPV infection, cancer incidence, mortality, and costs. Cytologic screening and treatment of different outcomes of HPV infection were incorporated. Vaccination was provided to a cohort of 12-year old females in Singapore, followed up until death. Based on available vaccines on the market, the bivalent vaccine had increased effectiveness against a wider range of HPV types, while the quadrivalent vaccine had effectiveness against genital warts. Incremental cost-effectiveness ratios (ICER) compared vaccination to no-vaccination, and between the two vaccines. Sensitivity analyses explored differences in vaccine effectiveness and uptake, and other key input parameters. Results: For the no vaccination scenario, 229 cervical cancer cases occurred over the cohort's lifetime. The total discounted cost per individual due to HPV infection was SGD$275 with 28.54 discounted life-years. With 100% vaccine coverage, the quadrivalent vaccine reduced cancers by 176, and had an ICER of SGD$12,866 per life-year saved. For the bivalent vaccine, 197 cancers were prevented with an ICER of $12,827 per life-year saved. Comparing the bivalent to the quadrivalent vaccine, the ICER was $12,488 per life-year saved. However, the cost per QALY saved for the quadrivalent vaccine compared to no vaccine was $9,071, while it was $10,392 for the bivalent vaccine, with the quadrivalent vaccine dominating the bivalent vaccine due to the additional QALY effect from reduction in genital warts. The overall outcomes were most sensitive to vaccine cost and coverage. Conclusion: HPV vaccination is a cost-effective strategy, and should be considered a possible strategy to reduce the impact of HPV infection.


Related Articles

  • Inclusion of the benefits of enhanced crossprotection against cervical cancer and prevention of genital warts in the cost-effectiveness analysis of human papillomavirus vaccination in the Netherlands. Westra, Tjalke A.; Stirbu-Wagner, Irina; Dorsman, Sara; Tutuhatunewa, Eric D.; de Vrij, Edwin L.; Nijman, Hans W.; Daemen, Toos; Wilschut, Jan C.; Postma, Maarten J. // BMC Infectious Diseases;2013, Vol. 13 Issue 1, p1 

    Background: Infection with HPV 16 and 18, the major causative agents of cervical cancer, can be prevented through vaccination with a bivalent or quadrivalent vaccine. Both vaccines provide cross-protection against HPV-types not included in the vaccines. In particular, the bivalent vaccine...

  • The epidemiological and economic impact of a quadrivalent human papillomavirus (hpv) vaccine in Estonia. Uusküla, Anneli; Müürsepp, Andres; Kawai, Kosuke; Raag, Mait; Jürisson, Mikk; Pillsbury, Matthew // BMC Infectious Diseases;2013, Vol. 13 Issue 1, p1 

    Background: This analysis assessed the epidemiological and economic impact of quadrivalent human papillomavirus (HPV4: 6/11/16/18) vaccination in Estonia. Methods: A dynamic transmission model was used to assess the epidemiological and economic impact of the routine vaccination of 12-year-old...

  • GARDASIL: WHAT YOU NEED TO KNOW ABOUT THE HPV Vaccine.  // Network Magazine of the Canadian Women's Health Network;Spring/Summer2007, Vol. 9 Issue 3/4, p14 

    The article offers information about the Gardasil, a human papillomavirus (HPV) vaccine approved for use in Canada and the U.S. It is noted that this specific vaccine prevents infection from HPV types 6 and 11, which cause genital warts, and HPV types 16 and 18, which cause cancer. However, the...

  • Estimating the clinical benefits of vaccinating boys and girls against HPV-related diseases in Europe. Marty, Rémi; Roze, Stéphane; Bresse, Xavier; Largeron, Nathalie; Smith-Palmer, Jayne // BMC Cancer;2013, Vol. 13 Issue 1, p1 

    Background: HPV is related to a number of cancer types, causing a considerable burden in both genders in Europe. Female vaccination programs can substantially reduce the incidence of HPV-related diseases in women and, to some extent, men through herd immunity. The objective was to estimate the...

  • Epidemiological Aspects of Genital Warts in Romania - a 2012 Retrospective Survey. SALAVASTRU, Carmen Maria; NICULESCU, Mihaela Cristina; ZOTA, Alexandra; NICOLA, Gheorghe; MORARIU, Horia Silviu; SOLOVAN, Caius; PATRASCU, Virgil; POPOVICI, Georgeta; VLADUTA, Raluca; PANDURU, Mihaela; TIPLICA, George-Sorin // Maedica - a Journal of Clinical Medicine;2014, Vol. 9 Issue 2, p144 

    Objectives: Genital infection with human papillomavirus (HPV) has become one of the most frequently viral sexually transmitted diseases. The infection may remain asymptomatic, may take the form of external genital warts and may give raise to cervical cancers. The aim of this study was to assess...

  • Cost-effectiveness of a tetravalent human papillomavirus vaccine in Germany. Hillemanns, Peter; Petry, Karl; Largeron, Nathalie; McAllister, Ruth; Tolley, Keith; Büsch, Katharina // Journal of Public Health (09431853);Apr2009, Vol. 17 Issue 2, p77 

    Clinical trials have demonstrated the efficacy of the tetravalent human papillomavirus (HPV) vaccination in the prevention of cervical cancer and genital warts associated with HPV types 6, 11, 16 and 18. We used an empirically calibrated Markov cohort model of the natural history of HPV to...

  • Comparing bivalent and quadrivalent human papillomavirus vaccines: economic evaluation based on transmission model. Jit, Mark; Chapman, Ruth; Hughes, Owain; Choi, Yoon Hong // BMJ: British Medical Journal (Overseas & Retired Doctors Edition;10/1/2011, Vol. 343 Issue 7825, p677 

    The article reports on the study related to the effect and cost effectiveness of the bivalent and quadrivalent human papillomavirus (HPV) vaccination. It states that bivalent vaccines have advantage in preventing death due to its cost effectiveness. It also informs that quadrivalent vaccines...

  • Optimal interventions to reduce cervical cancer burden in Israel.  // PharmacoEconomics & Outcomes News;Dec2013, Issue 693, p8 

    The article reports on the findings of a study which reveals that human papillomavirus (HPV) vaccination of females aged 12 years, with boosters at ages 32 and 52 years, together with screening interventions are cost effective to reduce the burden of cervical cancer in Israel.

  • CLINICAL, EVOLUTIVE AND THERAPEUTIC ASPECTS OF RECURRENT RESPIRATORY PAPILLOMATOSIS. Pleşca, Doina Anca; Hurduc, Victoria; Ioan, Iulia // Therapeutics, Pharmacology & Clinical Toxicology;2010, Vol. 14 Issue 1, p13 

    HPV infection is one of the most common sexually transmitted diseases. The majority of in­fections cause no symptoms and are self limiting, being cleared without sequelae. Persistent infections are associated with various clinical aspects (cervical cancer, genitoanal warts, recurrent...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics