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A cost-effectiveness analysis of adding a human papillomavirus vaccine to the Australian National Cervical Cancer Screening Program

Shalini Kulasingam A J , Luke Connelly B , Elizabeth Conway C , Jane S. Hocking D , Evan Myers E , David G. Regan F , David Roder G , Jayne Ross H and Gerard Wain I

A Duke University, Center for Clinical Health Policy Research, Durham, NC 27710, USA.

B The University of Queensland, Mayne Medical School, Herston, Qld 4006, Australia.

C CSL Limited, Parkville, Vic. 3052, Australia.

D The University of Melbourne, Parkville, Vic. 3010, Australia.

E Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA.

F National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Darlinghurst, NSW 2010, Australia.

G Group Executive, Research and Information Science, The Cancer Council South Australia, Unley, SA 5061, Australia.

H Jayne Ross & Associates, Cheltenham, NSW 2118, Australia.

I Department of Gynaecological Oncology, Westmead Hospital, Westmead, NSW 2145, Australia.

J Corresponding author. Email:

Sexual Health 4(3) 165-175
Submitted: 19 June 2007  Accepted: 22 June 2007   Published: 23 August 2007


Background: The cost-effectiveness of adding a human papillomavirus (HPV) vaccine to the Australian National Cervical Screening Program compared to screening alone was examined. Methods: A Markov model of the natural history of HPV infection that incorporates screening and vaccination was developed. A vaccine that prevents 100% of HPV 16/18-associated disease, with a lifetime duration of efficacy and 80% coverage offered through a school program to girls aged 12 years, in conjunction with current screening was compared with screening alone using cost (in Australian dollars) per life-year (LY) saved and quality-adjusted life-year (QALY) saved. Sensitivity analyses included determining the cost-effectiveness of offering a catch-up vaccination program to 14–26-year-olds and accounting for the benefits of herd immunity. Results: Vaccination with screening compared with screening alone was associated with an incremental cost-effectiveness ratio (ICER) of $51 103 per LY and $18 735 per QALY, assuming a cost per vaccine dose of $115. Results were sensitive to assumptions about the duration of vaccine efficacy, including the need for a booster ($68 158 per LY and $24 988 per QALY) to produce lifetime immunity. Accounting for herd immunity resulted in a more attractive ICER ($36 343 per LY and $13 316 per QALY) for girls only. The cost per LY of vaccinating boys and girls was $92 052 and the cost per QALY was $33 644. The cost per LY of implementing a catch-up vaccination program ranged from $45 652 ($16 727 per QALY) for extending vaccination to 14-year-olds to $78 702 ($34 536 per QALY) for 26-year-olds. Conclusions: These results suggest that adding an HPV vaccine to Australia’s current screening regimen is a potentially cost-effective way to reduce cervical cancer and the clinical interventions that are currently associated with its prevention via screening alone.


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