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Volume 14, Number 2—February 2008


Cost-effectiveness of Human Papillomavirus Vaccination in the United States

Harrell W. Chesson*Comments to Author , Donatus U. Ekwueme*, Mona Saraiya*, and Lauri E. Markowitz*
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA;

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Table 2

One-way sensitivity analyses: estimated cost per QALY gained by adding routine vaccination of 12-y-old girls to existing cervical cancer screening in the United States*

Parameter or parameter set varied Values applied in sensitivity analysis Cost/QALY gained
Excluding anal, vaginal, vulvar, oropharyngeal cancers, $US Including anal, vaginal, vulvar, oropharyngeal cancers, $US
None NA 10,294 8,137
Vaccine cost per series (base case = $360) $300, $490 5,811–20,009 4,237–16,587
Vaccine efficacy (base case = 100%) 95%, 99% 10,566–11,710 8,374–9,369
Cost of cervical cancer, CIN 1–CIN 3, genital warts* Base case ±25% 6,142–14,446 4,332–11,953
Reduction in quality of life due to HPV-related health outcomes Base case ±50%† 7,720–15,519 6,141–12,135
Incidence rates of cervical cancer, CIN 1–CIN 3, genital warts‡ Base case ±25%† 6,999–16,333 5,181–13,379
% of health outcomes attributable to HPV vaccine types Base case ±20% 6,014–17,020 4,400–13,987
Discount rate (base case = 3%) 0%, 5% 675–24,901 <0–21,966
Time horizon (base case = 100 y) 25 y, 50 y 21,600–81,786 19,943–81,398

*When key parameter values were varied in the population model of quadrivalent HPV vaccine (excluding herd immunity). QALY, quality-adjusted life year; HPV, human papillomavirus; NA, not applicable; CIN, cervical intraepithelial neoplasia.
†See text and Technical Appendix for details.
‡And, when applicable, anal, vaginal, vulvar, and oropharyngeal cancers.

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