Incremental cost-effectiveness evaluation of vaccinating girls against cervical cancer pre- and post-sexual debut in Belgium

Vaccine. 2013 Aug 20;31(37):3962-71. doi: 10.1016/j.vaccine.2013.06.008. Epub 2013 Jun 15.


Background: Vaccination against human papillomavirus (HPV) to prevent cervical cancer (CC) primarily targets young girls before sexual debut and is cost-effective. We assessed whether vaccination with the HPV-16/18 AS04-adjuvanted vaccine added to screening remains cost-effective in females after sexual debut compared to screening alone in Belgium. The role of protection against non-HPV-16/18 was also investigated.

Methods: A published Markov cohort model was adapted to Belgium. The model replicated the natural history of HPV infection, the effects of screening, and vaccination. Vaccine efficacy (VE) included non-HPV-16/18 protection based on the PATRICIA clinical trial data. Pre- and post-HPV exposure VE were differentiated. Lifetime vaccine protection was assumed. Input data were obtained from literature review, national databases and a Delphi panel. Costing was from a healthcare payer perspective. Costs were discounted at 3% and effects at 1.5%. The incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) gained and the number of lesions prevented with vaccination from age 12 to 40 was evaluated. The specific effect of non-HPV-16/18 protection was investigated. Univariate sensitivity analysis was performed on key variables.

Results: The model estimated that vaccinating a cohort of 100,000 girls at age 12 would prevent 646 CC cases over a lifetime (102 non-HPV-16/18) with an ICER of €9171/QALY. Vaccinating at age 26 would prevent 340 CC cases (40 non-HPV-16/18) with an ICER of €17,348/QALY and vaccinating at age 40 would prevent 146 CC cases (17 non-HPV-16/18) with an ICER of €42,847/QALY. The ICER remained under the highly cost-effective threshold (1×GDP/capita) until age 33 years and under the cost-effective threshold (3×GDP/capita) beyond age 40.

Conclusion: Extending HPV vaccination to females post-sexual debut could lead to a substantial reduction in CC-related burden and would be cost-effective in Belgium.

Keywords: Adult; Belgium; CC; CIN; CIS; Cervical cancer; Cost-effectiveness; GDP; HPV; Human papillomavirus; ICER; QALY; TVC; VE; Vaccination; carcinoma in situ; cervical cancer; cervical intraepithelial neoplasia; gross domestic product; human papillomavirus; incremental cost-effectiveness ratio; quality-adjusted life-year; total vaccinated cohort; vaccine efficacy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adjuvants, Immunologic / economics
  • Adult
  • Age Factors
  • Aged
  • Belgium / epidemiology
  • Child
  • Cohort Studies
  • Cost-Benefit Analysis
  • Cross Protection
  • Female
  • Human papillomavirus 16 / pathogenicity
  • Human papillomavirus 18 / pathogenicity
  • Humans
  • Markov Chains
  • Middle Aged
  • Models, Theoretical
  • Papillomavirus Infections / economics
  • Papillomavirus Infections / prevention & control*
  • Papillomavirus Infections / virology
  • Papillomavirus Vaccines / economics*
  • Papillomavirus Vaccines / therapeutic use
  • Quality-Adjusted Life Years
  • Uterine Cervical Neoplasms / economics
  • Uterine Cervical Neoplasms / prevention & control*
  • Uterine Cervical Neoplasms / virology
  • Vaccination / economics*


  • Adjuvants, Immunologic
  • Papillomavirus Vaccines