Jean-François Laprise

Population-Level Impact of the Bivalent, Quadrivalent, and Nonavalent Human Papillomavirus Vaccines: A Model–Based Analysis

BACKGROUND Bivalent and quadrivalent human papillomavirus (HPV) vaccines are now licensed in several countries. Furthermore, clinical trials examining the efficacy of a nonavalent vaccine are underway. We aimed to compare the potential population-level effectiveness of the bivalent, quadrivalent, and candidate nonavalent HPV vaccines. METHODS We developed an individual-based, transmission-dynamic model of HPV infection and disease in a population stratified by age, gender, sexual activity, and screening behavior. The model was calibrated to highly stratified sexual behavior, HPV epidemiology, and cervical screening data from Canada. RESULTS Under base case assumptions, vaccinating 12-year-old girls (70% coverage) with the bivalent (quadrivalent) vaccine is predicted to reduce the cumulative incidence of anogenital warts (AGWs) by 0.0% (72.1%), diagnosed cervical intraepithelial neoplasia lesions 2 and 3 (CIN2 and -3) by 51.0% (46.1%), and cervical squamous cell carcinoma (SCC) by 31.9% (30.5%), over 70 years. Changing from a bivalent (quadrivalent) to a nonavalent vaccine is predicted to reduce the cumulative number of AGW episodes by an additional 66.7% (0.0%), CIN2 and -3 episodes by an additional 9.3% (12.5%), and SCC cases by an additional 4.8% (6.6%) over 70 years. Differences in predicted population-level effectiveness between the vaccines were most sensitive to duration of protection and the time horizon of analysis. The vaccines produced similar effectiveness at preventing noncervical HPV-related cancers. CONCLUSIONS The bivalent vaccine is expected to be slightly more effective at preventing CIN2 and -3 and SCC in the longer term, whereas the quadrivalent vaccine is expected to substantially reduce AGW cases shortly after the start of vaccination programs. Switching to a nonavalent vaccine has the potential to further reduce precancerous lesions and cervical cancer.

Potential cost-effectiveness of the nonavalent human papillomavirus (HPV) vaccine

Randomized clinical trials are currently examining the efficacy of a nonavalent human papillomavirus (HPV) vaccine, including HPV‐types 6/11/16/18/31/33/45/52/58. Evidence on the cost‐effectiveness of the nonavalent is required for timely policy‐decisions. We compared the potential cost‐effectiveness of the nonavalent and quadrivalent HPV vaccines. We used a multi‐type individual‐based transmission‐dynamic model of HPV infection and diseases, 70‐year time‐horizon, 3% discount rate and healthcare payer perspective. We calibrated the model to Canadian sexual behavior and epidemiologic data, and estimated Quality‐Adjusted Life‐Years (QALYs) lost and costs (

Comparison of two dose and three dose human papillomavirus vaccine schedules: cost effectiveness analysis based on transmission model.

CAN 2010) from the literature. Under base‐case assumptions (vaccinating 10‐year‐old girls, 80% coverage, 95

Health and Economic Impact of Switching from a 4-Valent to a 9-Valent HPV Vaccination Program in the United States.

/dose, vaccine‐type efficacy = 95%, cross‐protection for the quadrivalent vaccine, duration of vaccine‐type protection (cross‐protection) = 20 (10) years), using the quadrivalent and nonavalent vaccines is estimated to cost

Comparing the cost-effectiveness of two- and three-dose schedules of human papillomavirus vaccination: A transmission-dynamic modelling study.

15,528 [12,056; 19,140] and

Comparative cost-effectiveness of the quadrivalent and bivalent human papillomavirus vaccines: A transmission-dynamic modeling study

12,203 [9,331; 17,292] per QALY‐gained, respectively. At equal price, the nonavalent vaccine is more cost‐effective than the quadrivalent vaccine, even when assuming both shorter duration of protection (nonavalent = 20 years vs. quadrivalent = lifelong) and lower vaccine‐type efficacy (nonavalent = 85% vs. quadrivalent = 95%). However, the additional cost per dose of the nonavalent vaccine should not exceed

Two-dose strategies for human papillomavirus vaccination: how well do they need to protect?

11 to remain more cost‐effective than the quadrivalent vaccine, and

Sociodemographic Inequalities in Sexual Activity and Cervical Cancer Screening: Implications for the Success of Human Papillomavirus Vaccination

24 to represent a cost‐effective alternative to the quadrivalent vaccine (using a

Comparison of 2-Dose and 3-Dose 9-Valent Human Papillomavirus Vaccine Schedules in the United States: A Cost-effectiveness Analysis.

40,000/QALY‐gained threshold). The nonavalent vaccine can be a cost‐effective alternative to the quadrivalent vaccine, even in scenarios where nonavalent vaccine efficacy is 85%. However, because most cervical cancers are caused by HPV‐16/18, it is unlikely that the nonavalent would be used if its efficacy against these types is lower than current HPV vaccines.

Cost-effectiveness of the next generation nonavalent human papillomavirus vaccine in the context of primary human papillomavirus screening in Australia: a comparative modelling analysis

Objective To investigate the incremental cost effectiveness of two dose human papillomavirus vaccination and of additionally giving a third dose. Design Cost effectiveness study based on a transmission dynamic model of human papillomavirus vaccination. Two dose schedules for bivalent or quadrivalent human papillomavirus vaccines were assumed to provide 10, 20, or 30 years’ vaccine type protection and cross protection or lifelong vaccine type protection without cross protection. Three dose schedules were assumed to give lifelong vaccine type and cross protection. Setting United Kingdom. Population Males and females aged 12-74 years. Interventions No, two, or three doses of human papillomavirus vaccine given routinely to 12 year old girls, with an initial catch-up campaign to 18 years. Main outcome measure Costs (from the healthcare provider’s perspective), health related utilities, and incremental cost effectiveness ratios. Results Giving at least two doses of vaccine seems to be highly cost effective across the entire range of scenarios considered at the quadrivalent vaccine list price of £86.50 (€109.23;