Estimated health and economic impact of quadrivalent HPV (types 6/11/16/18) vaccination in Brazil using a transmission dynamic model

Table 5 Incremental cost-effectiveness ratio (ICER) for sensitivity analyses

Parameter	Routine vaccination	Routine and a catch-up vaccination
Parameter	US$ per QALYs	US$ per QALYs
Base case	219	450
Cost per year of life saved (no quality of life adjustments)	253	503
HPV16/18-related cervical diseases only	448	698
Duration of vaccine protection = 20 years	Dominated¹	656
Vaccine coverage= 50% for routine and 60% for catch-up	106	250
Vaccine coverage= 95% for routine and 98% for catch-up	258	425
High cost of vaccine series (increased by 25%)	406	686
High cost of treating HPV-related disease (increased by 25%)	86	326
Low cost of treating HPV-related disease (decreased by 25%)	350	573
Discounted at 0%	Cost saving	Cost saving
Discounted at 5%	900	1201
Pessimistic scenario²	Dominated¹	998

¹ A strategy is “weakly” dominated if a more effective strategy has a lower incremental cost-effectiveness ratio.
² Pessimistic scenario assumes low HPV-related disease cost (decreased by 25%), 20 years of vaccine protection, and high health utilities (0.97 for HPV-related disease).

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