Inclusion of the benefits of enhanced cross-protection against cervical cancer and prevention of genital warts in the cost-effectiveness analysis of human papillomavirus vaccination in the Netherlands

Table 1 Epidemiologic and economic parameters used in the model

6 month transition probabilities*	Mean and/or range		Reference
Normal to HPV 6/11^¥	0 – 0.007		model calibration
Normal to lrHPV^¥	0 – 0.04		model calibration
HPV 6/11 to warts	0.34		[14]
lrHPV to warts	0.009		model calibration
Natural clearance HPV infection	0.65		[14]
Natural clearance genital warts	0.65		[16]
Screening costs	Mean (€)
Cytology	50		[11]
Colposcopy	143		[11]
Biopsy	49		[11]
Treatment costs cancer	Mean (€)
CIN 1	1,483		[11]
CIN 2	1,718		[11]
CIN 3	1,868		[11]
Cervical cancer stage 1	19,114		[11]
Cervical cancer stage 2	20,762		[11]
Cervical cancer stage 3	20,762		[11]
Cervical cancer stage 4	26,528		[11]
Treatment costs warts	Mean (€)
GP	114		Table 3
STI clinic	285		Table 3
GP + STI clini	338		Table 3
QALY-losses	Mean
CIN 1	0.026		[11]
CIN 2	0.010		[11]
CIN 3	0.080		[11]
Cervical cancer stage 1	0.03		[11]
Cervical cancer stage 2	0.10		[11]
Cervical cancer stage 3	0.10		[11]
Cervical cancer stage 4	0.38		[11]
Genital warts	0.018		[20]
Vaccine characteristics	Bivalent	Quadrivalent
Efficacy HPV 16/18	95%	95%	[23]
Efficacy HPV 6/11	0%	95%	[23]
Cross-protection HPV 31	79%	57%	[4, 5]
Cross-protection HPV 33	46%	0%	[4, 5]
Cross-protection HPV 45	76%	0%	[4, 5]
Duration of protection	lifelong	lifelong	[25]
Vaccination costs per dose	€105	€105

¥ transition probabilities are age dependent.
* 6-months’ probability of moving from one health state to another.
NA = not applicable; GP = general practitioner; STI = sexually transmitted infection; CIN = cervical intraepithelial neoplasia; HPV = human papillomavirus.

ISSN: 1471-2334