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Volume 13, Number 1—January 2007


Model for Assessing Human Papillomavirus Vaccination Strategies

Elamin H. Elbasha*Comments to Author , Erik J. Dasbach*, and Ralph P. Insinga*
Author affiliations: *Merck Research Laboratories, North Wales, Pennsylvania, USA;

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Table 2

Sensitivity of incremental cost-effectiveness ratios (US $/QALY) of alternative HPV vaccination strategies to changes in inputs*

InputF12 onlyF12-only+
CUF onlyF&M12+
Cost of vaccination series = $3009972,42233,46936,161
Cost of vaccination series = $5007,5539,90061,25065,810
Utility weights for CIN, CIS, GW = 0.975,2417,73982,70083,714
Duration of protection = 10 yWeakly dominated21,12154,75554,928
Degree of protection against HPV 6/11/16/18 = 100%2,0944,187Weakly dominated51,436
Degree of protection against HPV 6/11/16/18 = 74%4,2735,40339,99043,930
Degree of protection against disease = 87%3,1164,92240,26943,974
Coverage with vaccination = 50%2,6364,22123,86236,235
Coverage with vaccination = 90%3,4495,269Weakly dominated100,418

*Unless specified otherwise, cost of vaccination series is US $360, and duration of protection is lifelong. QALY, quality-adjusted life years; HPV, human papillomavirus; F12-only, female vaccination by age 12; CUF, catch-up female vaccination for ages 12–24; F&M12+CUF only, female and male vaccination by age 12 and CUF; CIN, cervical intraepithelial neoplasia; CIS, carcinoma in situ; GW, genital warts.
†Compared with the preceding nondominated strategy. Strategy A is dominated if there is another strategy, B, that is more effective and less costly than strategy A. The strategy of female and male vaccination by age 12 that did not include a catch-up program was dominated. A strategy is weakly dominated if there is another more effective program that has a lower incremental cost-effectiveness ratio.

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