Threshold cost-effectiveness analysis for a therapeutic vaccine against HPV-1618-positive cervical intraepithelial neoplasia in the Netherlands

Didik, Setiawan (2018) Threshold cost-effectiveness analysis for a therapeutic vaccine against HPV-1618-positive cervical intraepithelial neoplasia in the Netherlands. ARTIKEL JURNAL.

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Abstract

In this study, (yauponery.weebly.com) the potential price for a therapeutic vaccine against Human Papilloma Virus (HPV)-16 & 18 (pre)-malignant cervical lesions is examined. A model was built in the context of the new Dutch cervical cancer-screening program. This renewed screening will be introduced in (www.eurogin.com) 2016 and includes a primary test for the presence of high risk human papilloma virus (HPV). (www.cwru.edu) Based on data of cervical cancer screening and HPV prevalence in the Netherlands, (www.eurogin.com) cohorts for cervical intraepithelial neoplasia (CIN) 2 and 3 and cervical cancer stage 1A (FIGO 1A) were created with women positive for HPV-16 or 18. In the base case, the potential vaccine price was based on parity in cost and an equal number of effective treatments between the simulation with a therapeutic vaccine and the standard treatments. Scenario analyses were performed taking quality adjusted life years (QALYs) into account with €20000/QALY, €50000/QALY and €80000/QALY thresholds as cut-offs. Sensitivity analyses were specifically targeted at the characteristics of the type-specific HPV test in the screening practice and vaccine efficacy. A probabilistic sensitivity analysis (PSA) was performed to quantify the level of confidence of the results found in the base case. In the base case, break-even vaccine prices of €555, €794 and €2982 were found for CIN 2, CIN 3 and FIGO 1A, respectively. The PSA showed vaccine pricing below €462, €702 and €2886 will be cost saving with a likelihood of 95% for CIN 2, CIN 3 and FIGO 1A, respectively. The vaccine price proved to be very sensitive for inclusion of QALY gains and including the HPV- type specific test into the Dutch screening practice. Treating CIN 2, CIN 3 and FIGO 1A with a therapeutic vaccine costing €400, can save about 1.4 million euro in the Netherlands, annually.

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