Learning Objectives for this Presentation:
By the end of this presentation, participants will be able to understand the results generated by a model developed to assess the cost-effectiveness of alternative prophylactic human papillomavirus (HPV) vaccination strategies.

Background:
The health and economic burden of HPV disease is significant. A safe, efficacious, prophylactic quadrivalent HPV (6/11/16/18) vaccine that reduces the overall incidence of cervical cancer, cervical intraepithelial neoplasias (CIN), genital warts, and HPV infection may soon be available.

Objectives:
To assess the cost-effectiveness of alternative HPV vaccination strategies (i.e., routine vaccination of 12-year old females versus 12-year old females and males) in settings with established cervical cancer screening programs in the U.S.

Methods:
A non-linear, deterministic, age-structured, mathematical model of the transmission dynamics of HPV and disease development in a population was developed and integrated with an economic model. Inputs for the model were obtained from public data sources, published literature, and clinical trials. We assumed a vaccine uptake of 70%. We varied duration of protection from 10 years to lifetime and the cost of the vaccination series from $300–$500.

Results:
Assuming lifetime duration of protection, vaccination combined with screening reduced the prevalence of high risk HPV by 60% and the incidence of genital warts, CIN, and cervical cancer by 76%, 43%, and 44% respectively after 100 years. The incremental cost-effectiveness ratios ranged from cost-saving to ~$124,000 per quality adjusted life year gained. The following parameters exerted the greatest influence on the results: vaccine characteristics of degree and duration of protection, preference weights, and cost of vaccination.

Conclusions:
Vaccination with a prophylactic quadrivalent HPV vaccine can reduce the incidence of cervical cancer, CIN, and genital warts and provide survival benefits and quality of life improvements at a cost within the range accepted as cost-effective for a reasonably wide range of model input values.