Comparing the cost-effectiveness of two- and three-dose schedules of human papillomavirus vaccination: a transmission-dynamic modelling study.
BACKGROUND
Recent evidence suggests that two doses of HPV vaccines may be as protective as three doses in the short-term. We estimated the incremental cost-effectiveness of two- and three-dose schedules of girls-only and girls & boys HPV vaccination programmes in Canada.


METHODS
We used HPV-ADVISE, an individual-based transmission-dynamic model of multi-type HPV infection and diseases (anogenital warts, and cancers of the cervix, vulva, vagina, anus, penis and oropharynx). We conducted the analysis from the health payer perspective, with a 70-year time horizon and 3% discount rate, and performed extensive sensitivity analyses, including duration of vaccine protection and vaccine cost.


FINDINGS
Assuming 80% coverage and a vaccine cost per dose of $85, two-dose girls-only vaccination (vs. no vaccination) produced cost/quality-adjusted life-year (QALY)-gained varying between $7900-24,300. The incremental cost-effectiveness ratio of giving the third dose to girls (vs. two doses) was below $40,000/QALY-gained when: (i) three doses provide longer protection than two doses and (ii) two-dose protection was shorter than 30 years. Vaccinating boys (with two or three doses) was not cost-effective (vs. girls-only vaccination) under most scenarios investigated.


INTERPRETATION
Two-dose HPV vaccination is likely to be cost-effective if its duration of protection is at least 10 years. A third dose of HPV vaccine is unlikely to be cost-effective if two-dose duration of protection is longer than 30 years. Finally, two-dose girls & boys HPV vaccination is unlikely to be cost-effective unless the cost per dose for boys is substantially lower than the cost for girls.
['Laprise|Jean-François|JF|', 'Drolet|Mélanie|M|', 'Boily|Marie-Claude|MC|', 'Jit|Mark|M|', 'Sauvageau|Chantal|C|', 'Franco|Eduardo L|EL|', 'Lemieux-Mellouki|Philippe|P|', 'Malagón|Talía|T|', 'Brisson|Marc|M|']
D002170:Canada D003362:Cost-Benefit Analysis D005260:Female D006801:Humans D007115:Immunization Schedule D008297:Male D018803:Models, Economic D030361:Papillomavirus Infections D053918:Papillomavirus Vaccines D019057:Quality-Adjusted Life Years D014611:Vaccination
Cost-effectiveness Transmission-dynamic modelling Anogenital warts Cervical cancer Human papillomavirus (HPV) Immunisation Programme optimisation Vaccine schedules