HPV shot too costly for the Netherlands: study

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The vaccine against the virus responsible for most cases of cervical cancer would have to be a lot cheaper in order for it to be cost effective in the Netherlands, and probably in other countries where cases of cervical cancer and deaths due to the disease are relatively low, Dutch researchers report.

The human papillomavirus (HPV) vaccine protects against infection with the four strains of HPV that cause most cases of cervical cancer and genital warts. Studies to date have found the vaccine is likely to be cost-effective in areas with relatively high rates of cervical cancer and death from the disease. But the benefits are less clear in the Netherlands, where relatively few women develop the disease or die from it, thanks to an efficient national screening program.

To investigate, Dr. Inge M. C. M. de Kok of University Medical Center in Rotterdam and colleagues used a computer model to test the cost-effectiveness of the vaccine in the Netherlands based on the assumption that it would cost 118 euros per dose (about $165) and provide lifelong protection against 70% of all cervical cancers.

Using these assumptions, the researchers found, introducing HPV vaccine to the existing cervical cancer screening program would cost 53,500 euros ($74,500) for every additional healthy year of life gained. Researchers refer to these extra disease-free years as “quality-adjusted life years,” or QALY.

Earlier cost-effectiveness studies conducted while developing the Dutch cervical cancer screening program set the “acceptability threshold” of cost per QALY at 20,000 euros ($28,000), de Kok and her team note.

In order for the HPV vaccine to be cost-effective based on this threshold, the researchers say, the price would have to come down to 40 euros ($56). And because the vaccine typically requires subsequent booster shots, the cost per shot with one booster would have to be 33 euros ($46), and with four boosters, 16 euros ($22).

In countries with higher rates of cervical cancer incidence and mortality, the vaccine is much more cost effective, the researchers note; for example, cost per QALY gained would be 10,900 euros ($15,200) in Brazil, and 4,100 euros ($5,700) in Zimbabwe.

In a report in the Journal of the National Cancer Institute, the investigators conclude: “Our cost-effectiveness analysis shows that in the Netherlands, a country with low cervical cancer incidence and mortality, HPV vaccination is not cost-effective (even under as yet unproven favorable assumptions). To become cost effective, the vaccine price would have to be decreased considerably, depending on the effectiveness of the vaccine.”

SOURCE: Journal of the National Cancer Institute, online July 1, 2009.

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