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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 4

Summary of previously published models and estimates of the cost per QALY gained by adding routine HPV vaccination of 12-y-old girls to existing cervical cancer screening in the United States*†

Variable Goldie et al. 2004 (10) Sanders and Taira 2003 (11) Taira et al. 2004 (13) Elbasha et al. 2007 (9)
Key assumptions in published models
Target of HPV vaccine HPV 16,18 High risk HPV types HPV 16,18 HPV 6,11,16,18
Efficacy of vaccine 90% 75% 90% 100%‡
Vaccine cost per series $393 $300 $300 + $100 booster $360
Base year of $US
Estimated cost per QALY of vaccination
Published model estimate $24,300 $12,700§ $14,600 $3,000
Simplified model estimate $20,600 $8,700 $17,100 $5,300

*QALY, quality-adjusted life year; HPV, human papillomavirus.
†In all comparisons, the simplified model was modified (as necessary) so that the assumptions regarding the target of the HPV vaccine, vaccine efficacy and cost, vaccine duration of protection (except in the comparison to Taira and colleagues [13], as noted in the Technical Appendix, and the base year of US$ were consistent with the published models (Technical Appendix). The simplified model estimate was based on the cohort model in the comparisons with the findings of Goldie et al. (10) and Sanders and Taira (11) and was based on the population model (assuming transmission effects) in the comparison with the estimates of Taira and colleagues (13) and Elbasha and colleagues (9).
‡Elbasha and colleagues (9) assumed 90% protection against infection with HPV and 100% protection against HPV-related disease.§To enhance comparability, the published estimate from Sanders and Taira (11) was based on their sensitivity analyses when assuming lifetime duration of vaccination, not their base-case estimate of $22,800 when 10-y vaccine duration of protection was assumed.

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