"Let them have warts" Gardasil vs Cervarix - economic evaluation

[Deetee]

There was a lot of discussion and some criticism recently when England and Wales government opted to go for vaccination against human papilloma virus (HPV) using the bivalent GSK cervarix product (which protects against types 6 & 11) rather than the quadrivalent Merck gardasil vaccine which protects against types 6, 11, 16 & 18). The USA and Scotland have opted for gardasil, and the decision in the rest of the UK to use cervarix was criticised because it covers 2 fewer strains of virus which can cause genital warts, and because of possible conflicts of interest because of some alleged government links with one of GSK's directors (the makers of cervarix).

Story here.

The economic evaluation on which the government's decision was based has now been published in the BMJ, along with an editorial.

Abstract:

Vaccinating 12 year old schoolgirls with a quadrivalent vaccine at 80% coverage is likely to be cost effective at a willingness to pay threshold of £30 000 (

37 700; $59 163) per QALY gained, if the average duration of protection from the vaccine is more than 10 years. Implementing a catch-up campaign of girls up to age 18 is likely to be cost effective. Vaccination of boys is unlikely to be cost effective. A bivalent vaccine with the same efficacy against human papillomavirus types 16 and 18 costing £13-£21 less per dose (depending on the duration of vaccine protection) may be as cost effective as the quadrivalent vaccine although less effective as it does not prevent anogenital warts.

Extracts from accompanying editorial:

One of the study’s unique contributions is a cost threshold analysis that compares the bivalent and quadrivalent vaccines. Because the quadrivalent vaccine protects against genital warts caused by human papillomavirus types 6 and 11, to be equally cost effective the bivalent vaccine must be less expensive—the authors estimate that the bivalent vaccine must be £13 to £21 less expensive per dose than the current price of the quadrivalent vaccine. Assuming 80% coverage of current 12 year old girls in the UK with the full three dose vaccine series, this price differential translates to savings of £11.5m to £18.6m from the vaccine price alone in the first year of the programme, compared with adopting the quadrivalent vaccine. The decision to select the bivalent vaccine implies that the Department of Health is willing to accept foregone health benefits (and additional cost savings) from averting cases of genital warts for the reduced financial outlay, which may be allocated to other priority investments in health.

Despite the study’s findings, several important questions need to be considered.For example, the authors assume that coverage of 80% is achievable and vary this value within a limited range only. Although a study in the BMJ reported encouraging uptake rates of first and second doses of vaccine in schoolgirls, the uptake rate for the full three dose series is unknown, and this will affect the magnitude of direct and indirect benefits. Also, an important finding from that study was that uptake was lower in girls from minority groups and from less affluent backgrounds. The extent to which these girls receive less screening in adulthood—and consequently face a higher incidence of cervical cancer—will influence the overall success of the vaccination programme and may widen disparities in the risk of developing cervical cancer among socioeconomic groups.

Furthermore, because nearly a third of cases of cervical cancer are attributable to non-vaccine human papillomavirus types, cervical screening will continue to be a vital component of cancer prevention efforts in the UK. Several analyses have shown that human papillomavirus vaccination is more cost effective when followed by less frequent screening, starting at later ages and with newer screening technology, such as testing for human papillomavirus DNA.

 

[casebro]

First quote, first sentence, what does the acronym "QALY" stand for?

 

[Dragon]

First quote, first sentence, what does the acronym "QALY" stand for?

QALY = Quality-adjusted life years

 

[casebro]

So $60,000 of treatment to extend one life one year? With the average income $20k/year, sounds like societal bankruptcy is right around the corner?

But Ah dunno, never having had an economics course. Is this considered a 'growth segment of the economy'? How much health can we afford?

 

[Nick Bogaerts]

With the average income $20k/year, sounds like societal bankruptcy is right around the corner?

Where do you get that number from?

 

[casebro]

My donkey spit it out. (it was out of my ass), you can use your own. But I'd say to use not average wage, but average for the whole population, less than half of whom work. Or GDP divide by population. Whatever, can a society spend more to extend a life than the extension's contribution to society, on a grand scale? My guess is 2 1/2 times, for 40% of the population. But it is only printed paper anyhow, does it matter?