The Potential Health and Economic Benefits of Preventing Recurrent Respiratory Papillomatosis (RRP) Through Quadrivalent Human Papillomavirus (HPV) Vaccination

Background:
One of the potential benefits of quadrivalent (types 6,11,16,18) human papillomavirus (HPV) vaccine is the prevention of recurrent respiratory papillomatosis (RRP), which is caused by HPV types 6 and 11.

Objective:
To estimate the health and economic benefits of preventing RRP through quadrivalent HPV vaccination in the United States.

Method:
We applied an incidence-based model to estimate the averted costs and quality-adjusted life years (QALYs) saved by preventing RRP in children whose mothers had been vaccinated at age 12 years. We then examined how three hypothetical scenarios of HPV vaccine cost-effectiveness ($5,000, $25,000, and $45,000 per QALY saved) would change when including the averted medical costs and QALYs saved by preventing RRP. The model required relatively few parameters, such as the incidence of RRP and the cost and number of QALYs lost per RRP case. Base case parameter values and ranges used in sensitivity analyses were obtained from the literature.

Result:
Under base case assumptions, the prevention of RRP in children of vaccinated mothers averted an estimated $23 (range: $2 - $112) in medical costs (2006 US dollars) and saved 0.00014 QALYs (range: 0.00001 - 0.00125) per 12-year-old girl vaccinated against HPV. Wide ranges of these estimates were attributable primarily to uncertainty regarding the incidence of RRP. Including the benefits of preventing RRP reduced the estimated cost per QALY gained by 16%, 9%, and 9% in the $5,000, $25,000, and $45,000 cost per QALY scenarios, respectively and by <1% to >50% in sensitivity analyses.

Conclusion:
Inclusion of RRP prevention in models can reduce the estimated cost per QALY gained by quadrivalent HPV vaccine by 9% -16%, although this estimate is subject to uncertainty.

Implications:
RRP prevention may be an important benefit of quadrivalent HPV vaccine. More information about RRP incidence is needed to quantify this benefit more reliably.