Possible Role of Cost-Effectiveness of HPV Vaccination within the Decision Context on Inclusion of HPV in the Country-Specific National Immunization Programs

Mark Hermannes Rozenbaum*, 1, Carolin Grahlmann1, Maarten Jacobus Postma1, 2
1 Unit of PharmacoEpidemiology PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
2 Department of Epidemiology, University Medical Centre Groningen (UMCG), Groningen, The Netherlands

Article Metrics

CrossRef Citations:
Total Statistics:

Full-Text HTML Views: 1360
Abstract HTML Views: 1887
PDF Downloads: 226
Total Views/Downloads: 3473
Unique Statistics:

Full-Text HTML Views: 667
Abstract HTML Views: 1041
PDF Downloads: 177
Total Views/Downloads: 1885

© Rozenbaum et al.;

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Correspondence: Address correspondence to this author at the Unit of Pharmacoepidemiology PharmacoEconomics (PE2), Department of Pharmacy, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands; Tel: +31 050 363 8204; Fax: +31 50 363 2772; E-mail:



Vaccination against HPV presents a new primary prevention strategy against cervical cancer and is now being introduced in countries all over Europe. Health-economic modelling plays an increasingly important role in the decision making process when introducing new health-care technologies into national programmes. This study compares the economic evaluations used by European countries in the decision making process about the introduction of HPV vaccination in European countries and evaluate the role of these evaluations in this decision making process.


Publicly available reports from official government advisory and regulatory bodies were obtained and analysed in terms of their perspective, discount rate, time horizon, type of mathematical model, assumptions made regarding the vaccine and the current screening practice, sensitivity analysis, and outcome.


Health-economic studies were found for nine European countries. All analysed in the base-case analysis the costeffectiveness of vaccination of girls around the age of 12 year in addition to a cervical carcinoma screening program. Both static and dynamic models were used and especially assumptions regarding cost data varied widely among included studies. Estimated incremental cost-effectiveness ratios varied from ∈11, 400 to ∈64, 000 per life-year gained in the base cases. Results were most sensitive to the choice of discount rate, vaccine costs and duration of protection after vaccination.


We show that cost-effectiveness results cannot be transferred among European countries due to large variations in parameter assumptions. In those countries that undertook an economic evaluation health-economic analyses seem to have played an important role in the decision-making process surrounding the potential introduction of HPV vaccination.

Keywords: Human papillomavirus, vaccination, reimbursement, health economics, decision making.