The epidemiological and economic impact of a quadrivalent human papillomavirus vaccine (6/11/16/18) in the UK

Objective To assess the potential epidemiological and economic impact of a prophylactic quadrivalent human papillomavirus (HPV) (6/11/16/18) vaccine for preventing cervical cancer, cervical intraepithelial neoplasia grades 2 and 3 (CIN2/3), CIN1 and genital warts. Design Cost‐utility analysis. Setting UK. Population Female and male UK population 12 years or older. Methods We adapted a previously developed multi‐HPV type dynamic transmission to compare four female vaccination strategies, routine vaccination at age 12 years, and routine vaccination at age 12 years combined with temporary catch‐up vaccination at ages 12–14, 12–17 and 12–24 years. Main outcomes measures Costs, cases avoided, incremental cost per quality‐adjusted life year (QALY). Results The model projected that at year 100, each vaccination strategy could reduce the number of HPV 6/11/16/18‐related cervical cancer, CIN2/3, CIN1 and genital wart cases among women by 86, 85, 79 and 89% respectively. Over 25 years, routine vaccination at age 12 years combined with a 12‐ to 24‐year‐old catch‐up programme was the most effective strategy, reducing the cumulative number of cases of cervical cancer, CIN2/3, CIN1 and genital warts by 5800, 146 000, 28 000, and 1.1 million respectively. Over 100 years, the incremental cost‐effectiveness ratios across all strategies ranged from £5882 to £11,412 per QALY gained. Conclusion In the UK, a quadrivalent HPV vaccination programme that includes a catch‐up strategy can reduce the incidence of cervical cancer, CIN and genital warts at a cost per QALY ratio within the range typically regarded as cost‐effective.