Estimating the cost-effectiveness profile of a universal vaccination programme with a nine-valent HPV vaccine in Austria.

BACKGROUND: HPV is a major cancer-causing factor in both sexes in the cervix, vulva, vagina, anus, penis, oropharynx as well as the causal factor in other diseases such as genital warts and recurrent respiratory papillomatis. In the context of the arrival of a nonavalent HPV vaccine (6/11/16/18/31/33/45/52/58), this analysis aims to estimate the public health impact and the incremental cost-effectiveness of a universal (girls and boys) vaccination program with a nonavalent HPV vaccine as compared to the current universal vaccination program with a quadrivalent HPV vaccine (6/11/16/18), in Austria. METHOD: A dynamic transmission model including a wide range of health and cost outcomes related to cervical, anal, vulvar, vaginal diseases and genital warts was calibrated to Austrian epidemiological data. The clinical impact due to the 5 new types was included for cervical and anal diseases outcomes only. In the base case, a two-dose schedule, lifelong vaccine type-specific protection and a vaccination coverage rate of 60% and 40% for girls and boys respectively for the 9-year old cohorts were assumed. A cost-effectiveness threshold of €30,000/QALY-gained was considered. RESULTS: Universal vaccination with the nonavalent vaccine was shown to reduce the incidence of HPV16/18/31/33/45/52/58 -related cervical cancer by 92%, the related CIN2/3 cases by 96% and anal cancer by 83% and 76% respectively in females and males after 100 years, relative to 75%, 76%, 80% and 74% with the quadrivalent vaccine, respectively. Furthermore, the nonavalent vaccine was projected to prevent an additional 14,893 cases of CIN2/3 and 2544 cases of cervical cancer, over 100 years. Depending on the vaccine price, the strategy was shown to be from cost-saving to cost-effective. CONCLUSION: The present evaluation showed that vaccinating 60% of girls and 40% of boys aged 9 in Austria with a 9-valent vaccine will substantially reduce the incidence of cervical cancer, CIN and anal cancer compared to the existing strategy. The vaccination strategies performed with the 9-valent vaccine in the current study were all found to be cost-effective compared to the current quadrivalent vaccination strategy by considering a cost-effectiveness threshold of 30,000€/QALY gained.

Health and economic impact associated with a quadrivalent HPV vaccine in Italy.

OBJECTIVE: The aim of this study was to determine the health impact and cost-effectiveness of introducing a human papillomavirus (HPV) vaccination programme with a quadrivalent vaccine alongside the existing cervical cancer screening programme in comparison to the current context in Italy. METHODS: A US Markov model was adapted to the Italian context, assuming under base case 80% vaccine coverage rate, lifetime duration of protection in a cohort of girls aged 12 years and discount rates of 1.5% and 3% for health benefits and costs, respectively, and estimating direct medical costs. RESULTS: The HPV vaccination in association with the current screening programme would allow to avoid 1432 cases of cervical cancer (-63.3%) and 513 deaths (-63.4%) compared to screening only, with an incremental cost-effectiveness ratio (ICER) of 9569 euros per additional quality-adjusted life-year (QALY) gained. The sensitivity analysis highlighted that this model was robust to all parameters presenting uncertainties as the ICERs ranged from 2,781 euros to 48,122 euros per QALY gained. CONCLUSION: This study showed that HPV vaccination in adolescent girls would be a beneficial and cost-effective public health programme in Italy.

Treatment patterns and associated costs for genital warts in Italy.

OBJECTIVE: Genital warts are caused by human papillomavirus (HPV), principally types 6 and 11, and are highly contagious. This study assessed treatment patterns and costs of management of genital warts in Italy. RESEARCH DESIGN AND METHODS: This was a retrospective, observational study conducted among gynaecologists, dermatologists, and specialists at sexually transmitted disease clinics in Italy. Resource-use data related to genital warts were collected for patients at risk in the age range 14-64 years examined during 2005. Unit costs were assigned to resource use to provide estimates of the direct, indirect and total costs per case of genital warts. RESULTS: Twenty-eight investigators enrolled 341 patients aged 15-64 years, including 194 (56.9%), 81 (23.7%) and 66 (19.4%) patients with newly diagnosed, recurrent and resistant genital warts, respectively. Most patients (333/341; 97.7%) had at least one outpatient visit, while 43 (12.6%) patients were hospitalised, including 39 patients without an overnight stay (day-hospital cases, 11.4%). Self-applied medication was prescribed for 124 (36.4%) patients. Most outpatient cases (267/333; 80.2%) underwent an office-based procedure. Mean annual direct medical costs per patient, which were funded predominantly by the Italian National Health Service (there was some patient co-payment), were €242 for men and €332 for women. When productivity losses were included, mean total annual costs were €325 for men and €464 for women. CONCLUSIONS: This is the first study of treatment patterns and costs for genital warts in Italy. Treatment patterns differ in some respects from those observed in other European countries, but costs generally appear similar. Despite the limitations of physician selection bias and over-representation of North Italy in the patient sample, the findings of this study may be useful in estimating the cost-effectiveness of introducing a quadrivalent HPV vaccination programme in Italy.

[Economic evaluation of acute paediatric rotavirus gastroenteritis in France]. / Evaluation du coût de la prise en charge pédiatrique des gastroentérites aiguës à rotavirus.

BACKGROUND: Acute paediatric rotavirus gastroenteritis (RVGE) is the leading cause of paediatric gastroenteritis worldwide. The objective of the study was to assess the average cost of a RVGE episode in children between 0 and 5 years in France. METHOD: An epidemiological study performed in Dijon provided the amount of resources used in the case of a RVGE episode. Their evaluation was based on current national local tariffs. Three different care settings were included: RVGE cases taken in charge only by community health care providers, RVGE cases leading to an emergency visit without hospitalisation, and cases leading to hospitalisation. This evaluation considered direct and indirect costs. RESULTS: Ninety-nine children with rotavirus gastroenteritis were included in the epidemiological study, 30 patients after hospitalisation, 50 patients in emergency departments, and 19 were included by physicians. The average French social security costs for one episode of rotavirus gastroenteritis was 1,270 euro for hospitalised cases, 80 euro for emergency cases and 34 euro for community health care cases. The part of costs not reimbursed by the social security was mainly due to loss of productivity. It amounted to 287, 254 and 255 euro for emergency visit cases, hospitalised cases and community health care respectively. CONCLUSION: This cost of disease study demonstrated that paediatric rotavirus gastroenteritis results in high expenditures for the French social security as well as for society. The implementation of a vaccination programme would reduce the economic burden of gastroenteritis disease in France.

[Epidemiology and burden of rotavirus diarrhea in day care centers in Lyon, France]. / Epidémiologie et impact de la gastroentérite aiguë à rotavirus dans les crèches municipales de la ville de Lyon - saison 2004-2005.

Rotavirus is the main cause of severe, dehydrating diarrhoea in infants and young children. In industrialized countries, pediatric rotavirus gastroenteritis (PRGE) is responsible for high morbidity, particularly among children under 3 years of age attending day care centers (DCCs). The objectives of this study were to estimate the incidence, management and cost of PRGE in DCCs. We also described the nature of group A rotavirus genotypes. This study also compared the performance of different diagnostic techniques. The study was conducted from November 2004 to May 2005. Children aged less than 36 months, attending a participating DCC at least 4 times a week were included in the study. For any episode of acute gastroenteritis (AGE), defined as the occurrence of 3 or more watery or looser than normal stools and/or forceful vomiting within a 24 h period, a fecal specimen was tested by Elisa test IDEIA Rotavirus (Dako) and the immunochromatographic test VIKIA Rota-Adeno (BioMérieux). Sequencing by RT-PCR was performed to identify the rotavirus genotype. Among the 41 DCCs contacted, 18 (43.9%) agreed to participate. Out of 966 children, 547 attended a participating DCC at least 4 times a week and met the inclusion criteria. A total of 302 were included in the study. The clinical diagnosis of AGE was confirmed and validated, by the Elisa test, in 63 fecal specimens, of which 29 (46%) were positive for rotavirus antigen, with a predominance of P[8]G9 (86%). Our results showed good sensitivity and specificity for the VIKIA and Elisa methods when compared to RT-PCR. Among the PRGE cases, 36% were male and the median age was 12.2 months. The first rotavirus case was observed in December 2004 with a peak in January 2005. The incidence of PRGE cases was 2.2 [1.4-3.0] per 100 child-months in children aged less than 36 months of age, increasing to 3.4 per 100 child-months among children aged less than 24 months. Vomiting (P<0.0005) and behavior modification (P<0.001) were significantly more frequent for PRGE cases. A total of 85.7% PRGE cases sought medical attention. In 58.3% of these cases, at least one parent had to miss work for a mean duration of 2.1 days. The total cost of rotavirus cases seeking medical attention (with or without prescribed medication, days off work for parents or additional diaper consumption) was estimated at 275.54 euros/case. The PRGE incidence rate is similar to that estimated in European studies conducted in DDC. These findings confirm that rotavirus transmission occurs not only in DCCs but within the family. This is the first study to give an estimate of the incidence and the cost of rotavirus infection in DCCs in France.