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

      Bjog
      Adolescent, Adult, Cervical Intraepithelial Neoplasia, economics, epidemiology, prevention & control, Condylomata Acuminata, Cost-Benefit Analysis, Female, Great Britain, Humans, Incidence, Male, Mass Screening, Papillomavirus Vaccines, Quality-Adjusted Life Years, Uterine Cervical Neoplasms

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          Abstract

          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. Cost-utility analysis. UK. Female and male UK population 12 years or older. 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. Costs, cases avoided, incremental cost per quality-adjusted life year (QALY). 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 pound5882 to pound11,412 per QALY gained. 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.

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