ArticleBMC public health2009
A cost-utility analysis of cervical cancer vaccination in preadolescent Canadian females.
Article in BMC public health, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it, 37 citations in OpenAlex.
- Economic evaluation of vaccines in Canada: A systematic review.Human vaccines & immunotherapeutics · 2016Pooled it
- Pooled it
- A Scoping Review on Calibration Methods for Cancer Simulation Models.Medical decision making : an international journal of the Society for Medical Decision Making · 2025Article
- Health economic evaluation of Human Papillomavirus vaccines in women from Venezuela by a lifetime Markov cohort model.BMC public health · 2017Article
- Economic evaluations of vaccines in Canada: a scoping review.Cost effectiveness and resource allocation : C/E · 2017Article
- Evaluation of the cost of cervical cancer at the National Institute of Oncology, Rabat.The Pan African medical journal · 2016Article
- Health economic analysis of human papillomavirus vaccines in women of Chile: perspective of the health care payer using a Markov model.BMC public health · 2014Article
- The need for economic evaluation in primary prevention of cancer.Canadian journal of public health = Revue canadienne de sante publique · 2012Article
- Modeling the impact of the difference in cross-protection data between a human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine and a human papillomavirus (HPV)-6/11/16/18 vaccine in Canada.BMC public health · 2012Article
- Comparative evaluation of the potential impact of rotavirus versus HPV vaccination in GAVI-eligible countries: a preliminary analysis focused on the relative disease burden.BMC infectious diseases · 2011Article
- Human papillomavirus vaccine introduction in low-income and middle-income countries: guidance on the use of cost-effectiveness models.BMC medicine · 2011Article
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDespite the fact that approximately 70% of Canadian women undergo cervical cancer screening at least once every 3 years, approximately 1,300 women were diagnosed with cervical cancer and approximately 380 died from it in 2008. This study estimates the effectiveness and cost-effectiveness of vaccinating 12-year old Canadian females with an AS04-adjuvanted cervical cancer vaccine. The indirect effect of vaccination, via herd immunity, is also estimated.
methodsA 12-health-state 1-year-cycle Markov model was developed to estimate lifetime HPV related events for a cohort of 12-year old females. Annual transition probabilities between health-states were derived from published literature and Canadian population statistics. The model was calibrated using Canadian cancer statistics. From a healthcare perspective, the cost-effectiveness of introducing a vaccine with efficacy against HPV-16/18 and evidence of cross-protection against other oncogenic HPV types was evaluated in a population undergoing current screening practices. The base-case analysis included 70% screening coverage, 75% vaccination coverage, $135/dose for vaccine, and 3% discount rate on future costs and health effects. Conservative herd immunity effects were taken into account by estimated HPV incidence using a mathematical model parameterized by reported age-stratified sexual mixing data. Sensitivity analyses were performed to address parameter uncertainties.
resultsVaccinating 12-year old females (n = 100,000) was estimated to prevent between 390-633 undiscounted cervical cancer cases (reduction of 47%-77%) and 168-275 undiscounted deaths (48%-78%) over their lifetime, depending on whether or not herd immunity and cross-protection against other oncogenic HPV types were included. Vaccination was estimated to cost $18,672-$31,687 per QALY-gained, the lower range representing inclusion of cross-protective efficacy and herd immunity. The cost per QALY-gained was most sensitive to duration of vaccine protection, discount rate, and the correlation between probability of screening and probability of vaccination.
conclusionIn the context of current screening patterns, vaccination of 12-year old Canadian females with an ASO4-ajuvanted cervical cancer vaccine is estimated to significantly reduce cervical cancer and mortality, and is a cost-effective option. However, the economic attractiveness of vaccination is impacted by the vaccine's duration of protection and the discount rate used in the analysis.
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