Cost-effectiveness of different XXXX vaccines in Singapore.

@entity5 @entity1083 @entity3502 @entity1799 @entity1082 @entity6166
BACKGROUND: @entity1082 ) vaccines are widely available and there have been studies exploring their potential clinical impact and cost-effectiveness. However, few studies have compared the cost-effectiveness among the 2 main vaccines available - a bivalent vaccine against @entity1799 /18, and a quadrivalent vaccine against 6/11/16/18. We explore the cost-effectiveness of these two HPV vaccines in tropical Singapore. METHODS: We developed a Markov state-transition model to represent the natural history of cervical @entity5 to predict @entity1083 , @entity5 incidence, mortality, and costs. Cytologic screening and treatment of different outcomes of @entity1083 were incorporated. Vaccination was provided to a cohort of 12-year old females in Singapore, followed up until death. Based on available vaccines on the market, the bivalent vaccine had increased effectiveness against a wider range of HPV types, while the quadrivalent vaccine had effectiveness against @entity3502 . Incremental cost-effectiveness ratios (ICER) compared vaccination to no-vaccination, and between the two vaccines. Sensitivity analyses explored differences in vaccine effectiveness and uptake, and other key input parameters. RESULTS: For the no vaccination scenario, 229 cervical @entity5 cases occurred over the cohort's lifetime. The total discounted cost per individual due to @entity1083 was @entity6166 275 with 28.54 discounted life-years. With 100% vaccine coverage, the quadrivalent vaccine reduced @entity5 by 176, and had an ICER of @entity6166 12,866 per life-year saved. For the bivalent vaccine, 197 @entity5 were prevented with an ICER of  12,827 per life-year saved. Comparing the bivalent to the quadrivalent vaccine, the ICER was  12,488 per life-year saved. However, the cost per QALY saved for the quadrivalent vaccine compared to no vaccine was  9,071, while it was  10,392 for the bivalent vaccine, with the quadrivalent vaccine dominating the bivalent vaccine due to the additional QALY effect from @entity3502 . The overall outcomes were most sensitive to vaccine cost and coverage. CONCLUSION: HPV vaccination is a cost-effective strategy, and should be considered a possible strategy to reduce the impact of @entity1083 .
