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Table 4 Scenario analyses (expected value analysis; average costs and QALYs DW gained per individual 12-year-old over their whole lives

From: Is expanding HPV vaccination programs to include school-aged boys likely to be value-for-money: a cost-utility analysis in a country with an existing school-girl program

  Each intervention compared to no HPV vaccination Incremental comparisons
Interventions Output Intervention 1G:Replicating the GIRLS-ONLYNZ program in 2011 Intervention 2G:Intensive GIRLS-ONLYprogram, school-based Intervention 1G + B:Adding BOYSto the GIRLSNZ program in 2011 Intervention 2G + B:Adding BOYSto the intensive GIRLSprogram, school-based [A] Intervention 2G c.f. Intervention 1G [B] Intervention 1G + B c.f. Intervention1G [D] Intervention 2G + B c.f. Intervention 2G
From Table 3, expected value only analysis Net cost (NZ$) $81 $129 $235 $372 $47 $154 $244
QALYsDW gained 0.0045 0.0059 0.0059 0.0069 0.0014 0.0014 0.0010
ICER $18,100 $21,900 $40,000 $53,700 $34,000 $111,000 $234,000
Vaccine price halved (NZ$56) Net cost (NZ$) $41 $68 $154 $248 $27 $112 $180
QALYsDW gained 0.0045 0.0059 0.0059 0.0069 0.0014 0.0014 0.0010
ICER $9,200 $11,600 $26,200 $35,800 $19,000 $81,300 $173,000
Very low vaccine price ($7.46) = GAVI price ~ US$5) Net cost (NZ$) $7 $16 $84 $142 $9 $76 $126
QALYsDW gained 0.0045 0.0059 0.0059 0.0069 0.0014 0.0014 0.0010
ICER $1,600 $2,800 $14,300 $20,500 $6,500 $55,300 $121,000
Highly hypothetical vaccine price $NZ 1 Net cost (NZ$) $3 $10 $75 $129 $7 $72 $119
QALYsDW gained 0.0045 0.0059 0.0059 0.0069 0.0014 0.0014 0.0010
ICER $700 $1,700 $12,800 $18,600 $4,900 $52,200 $115,000
Plausibly lower vaccine administration costs (NZ$19) Net cost (NZ$) $-4 $14 $61 $138 $18 $65 $124
QALYsDW gained 0.0045 0.0059 0.0059 0.0069 0.0014 0.0014 0.0010
ICER Dominant $2,400 $10,400 $20,000 $12,800 $47,000 $119,000
Hypothetical vaccine price NZ$1 + lower vaccine administration costs (NZ$19) Net cost (NZ$) $-80 $-103 $-99 $-110 $-22 $-18 $-7
QALYsDW gained 0.0046 0.0059 0.0058 0.0069 0.0013 0.0012 0.0010
ICER Dominant Dominant Dominant Dominant Dominant Dominant Dominant
GAVI vaccine price + lower vaccine administration costs (NZ$19) Net cost (NZ$) $-77 $-99 $-90 $-94 $-22 $-12 $5
QALYsDW gained 0.0045 0.0059 0.0059 0.0069 0.0014 0.0014 0.0010
ICER Dominant Dominant Dominant Dominant Dominant Dominant $5,000
Discount rate 0% Net cost (NZ$) $-28 $-23 $80 $183 $5 $108 $205
QALYsDW gained 0.0135 0.0186 0.0190 0.0233 0.0051 0.0055 0.0047
ICER Dominant Dominant $4,200 $7,900 $1,000 $19,400 $43,900
Cost and QALYsDW discount rate 6% (double baseline) Net cost (NZ$) $123 $186 $293 $443 $63 $170 $257
QALYsDW gained 0.0025 0.0031 0.0030 0.0035 0.0006 0.0006 0.0004
ICER $50,100 $59,900 $96,500 $127,000 $97,000 $294,000 $695,000
Excluding unrelated health system costs † Net cost (NZ$) $73 $117 $222 $356 $44 $150 $240
QALYsDW gained 0.0045 0.0059 0.0059 0.0069 0.0014 0.0014 0.0010
ICER $16,200 $19,800 $37,900 $51,500 $31,500 $109,000 $231,000
Excluding disease DWs (i.e., no morbidity impacts of HPV-related disease) ^ Net cost (NZ$) $81 $129 $235 $372 $47 $154 $244
QALYsDW gained 0.0011 0.0016 0.0017 0.0022 0.0006 0.0007 0.0006
ICER $76,500 $79,800 $137,000 $166,000 $86,200 $233,000 $383,000
Excluding both background morbidity and disease DWs (i.e., life years gained analysis, ignoring morbidity) Net cost (NZ$) $81 $129 $235 $372 $47 $154 $244
QALYsDW gained 0.0015 0.0023 0.0024 0.0031 0.0008 0.0009 0.0009
ICER $53,100 $56,300 $96,700 $119,000 $62,700 $171,000 $284,000
Excluding herd immunity benefits related to anal and oropharyngeal cancers for males when only females vaccinated: 1G (i.e., considering underestimation of benefits to MSM in 1G + B) Net cost (NZ$)   $144  
QALYsDW gained 0.0018
ICER $80,000
  1. † That is ignoring the health costs from diseases other than those specifically modeled, which increase net costs as living longer is associated with costs from (other) future disease and disability.
  2. ^ That is the DWs for cancers, CIN and anogenital warts states are all set to zero – but the background morbidity is retained. The health gain realized from HPV vaccination is therefore only from preventing premature death from cancer. NOTE: all items in bolded font are cost-saving.