Modelling costs and outcomes of HPV vaccination.

The purpose of this guidance is to lay down the scientific basis for the potential introduction of human papillomavirus (HPV) vaccines in order to help European Union (EU) Member States to make policy choices. It highlights the issues to be considered and it provides a list of policy options for each of these issues. This guidance has been developed by a Scientific Panel of experts set up and coordinated by the Scientific Advice Unit of the European Centre for Disease Prevention and Control (ECDC). One of the main tasks of this unit is to provide independent scientific opinions, expert advice, data, and information. No conflicts of interest were declared by any of the Panel members. The guidance was reviewed by the Advisory Forum of ECDC. HPV vaccines are becoming introduced in an increasing number of countries and EU policy makers are urged to take position on HPV vaccination. This guidance note should help facilitate this process. The target audiences for this guidance are national immunisation programme managers, policy makers at the EU level and at the ministries of health and other relevant ministries, and experts involved in the decision making process on introduction of HPV vaccines in the country such as oncologists, gynaecologists, paediatricians, epidemiologists, infectious disease specialists, specialists in adolescent health, sexual health, primary care physicians, and others. There are only five-year follow-up data on the HPV vaccines and many questions still need to be answered. This guidance note, made on the basis of current knowledge will probably need to be re-evaluated in six to 12 months. Key points • Human papillomavirus (HPV) vaccination should be evaluated not only for its efficacy, but also from an economic point of view. • Economic evaluation aims to determine whether the cost incurred by the society to save a year of life adjusted by its quality (quality-adjusted life year or QALY) due to HPV vaccination is similar to that of other commonly accepted interventions in the medical care sector. • Economic evaluations are not entirely exportable, due to the variability of costs and healthcare systems in different countries. • Therefore, an effort should be made by each country to perform such an evaluation (also taking into account the kind of cervical screening in place) before making a decision about the best strategy to prevent cervical cancer. • Economic evaluations to date seem to indicate that administering HPV vaccination to pre-adolescent girls (with or without catch-up of older age groups) has an acceptable cost-effectiveness profile. • The results are more favourable when dynamic simulation models are used, where the effect of vaccination on transmission rates is also taken into account.