From: Cost-effectiveness of different human papillomavirus vaccines in Singapore
Parameters | Base case | Ranges | Source |
---|---|---|---|
Vaccination | Â | Â | Â |
Cohort size | 25,000 | Â | [20] |
Vaccine coverage | 100% | Â | Assumption |
Age at vaccination | 12 | Â | Â |
Vaccine efficacy* - bivalent vaccine | 87.2% | 70%-95% | |
Vaccine efficacy* - quadrivalent vaccine | 78.8% | 70%-95% | [23] |
Duration of efficacy | Lifetime | 5 years to lifetime | Assumption |
Vaccine waning + booster | None | 5, 10, 20 years | Assumption |
Screening | Â | Â | Â |
Screening age range | 25-65 | Â | [4] |
Screening interval | every 3 years | Â | [4] |
Percentage screened per year | 17% | 10-20 | Estimated |
Cytology sensitivity to detect CIN1 | 0.58 | none | |
Cytology sensitivity to detect CIN2/3 | 0.61 | none | |
Compliance to CIN1 treatment | 75% | 50%-100% | Assumption |
Compliance to CIN2/3 treatment | 75% | 50%-100% | Assumption |
Cancer detection rate | Low | High | Â |
Probability Of symptons CC1 | 0.075 | 0.185 | Â |
Probability Of symptons CC2 | 0.113 | 0.3 | Â |
Probability Of symptons CC3 | 0.3 | 0.75 | |
Probability Of symptons CC4 | 0.45 | 0.8 | Â |
Cost, SGD$ (2008) | Â | (-20%/+50%) except vaccine cost (200-400) | Â |
Vaccine cost per vaccinated woman, bivalent vaccine # | 400 | Â | Â |
Vaccine cost per vaccinated woman, quadrivalent vaccine# | 400 | Â | Assumption |
Cytology test^ | 40 | Â | Â |
Colposcopy and Biopsy^ | 207 | Â | Â |
CIN 1 treatment | 1,105 | Â | Â |
CIN 2/3 treatment | 1,480 | Â | Â |
Stage 1 Cancer treatment cost | 9,388 | Â | Singapore public sector hospitals |
Stage 2 Cancer treatment cost | 9,765 | Â | Â |
Stage 3 Cancer treatment cost | 9,765 | Â | Â |
Stage 4 Cancer treatment cost | 11,047 | Â | Â |
Genital warts | 750 | Â | Â |
Discounting | Â | Â | Â |
Costs, Outcomes | 3%, 3% | (0%-5%) | Assumption |
Transition Probabilities | Â | Â | Â |
Well to HPV | 0.05 | 0-0.2 | Â |
HPV to clearance | 0.4 | 0.29-0.55 | Â |
HPV to CIN1 | 0.05 | 0.014-0.14 | |
CIN1 clearance | 0.4 | 0.24-0.5 | Â |
CIN1 to CIN2/3 | 0.09 | 0.02-0.32 | Â |
CIN2/3 clearance | 0.25 | 0.01-0.45 | Â |
CIN2/3 to persistent CIN2/3 | 0.11 | 0.03-0.20 | Â |
Persistent CIN2/3 to Cancer stage 1 | 0.05 | 0.001-0.15 | Â |
Cancer stage 1 to Cancer stage 2 | 0.22 | 0.11-0.4 | Â |
Cancer 1 to cancer cured | 0.84 | 0.63-0.98 | Â |
Cancer stage 1 to Cancer stage 3 | 0.24 | 0.12-0.5 | Â |
Cancer 2 to cancer cured | 0.66 | 0.49-0.83 | Â |
Cancer stage 3 to Cancer stage 4 | 0.24 | 0.12-0.8 | Â |
Cancer 3 to cancer cured | 0.38 | 0.28-0.48 | |
Cancer 4 to cancer cured | 0.11 | 0.08-0.14 | Â |
Detected CIN1 to well | 0.9 | 0.8-1 | Â |
Detected CIN1 to Detected CIN2/3 | 0.09 | 0.02-0.32 | Â |
Detected CIN2/3 to Well | 0.9 | 0.8-1 | Â |
Detected CIN2/3 to Detected PCIN2/3 | 0.11 | 0.03-0.20 | Â |
Detected PCIN2/3 to Cancer 1 | 0.05 | 0.001-0.15 | Â |
Mortality of cervical cancer | 0.11 | Â | Â |
Cervical Warts | Â | Â | Â |
Effectiveness of vaccination against warts | 0.90 | Â | |
Cost of treatment | 750 | Â | Â |
Well to low risk HPV | 0.050 | Â | Â |
Low risk HPV to well | 0.500 | Â | Â |
Low risk HPV to CIN1 low risk | 0.036 | Â | Â |
Low risk HPV to warts | 0.027 | Â | Â |
Warts to well | 0.875 | Â | Â |
CIN1 low risk to well | 0.500 | Â | Â |
CIN1 low risk to detected CIN 1 low risk | 0.099 | Â | Â |
Detected CIN 1 low risk to well | 0.950 | Â | Â |
QALYs | Â | Â | Â |
Disease free | 1 | Â | Â |
Genital warts | 0.96 | 0.91-0.99 | |
Detected CIN | 0.89 | 0.84-0.94 | Â |
Cancer detected | Â | Â | Â |
Stage I | 0.65 | 0.49-0.81 | Â |
Stage II | 0.56 | 0.42-0.70 | Â |
Stage III | 0.56 | 0.42-0.70 | Â |
Stage IV | 0.48 | 0.36-0.60 | Â |
Cancer cured | 0.94 | Â | Â |