To examine cost effectiveness of quadrivalent human papillomavirus (HPV) vaccine compared with bivalent vaccine and no vaccination (screening only) in Costa Rica.
Previously published dynamic transmission model was adapted and calibrated for Costa Rica. The HPV model simulated the natural history of cervical cancer and genital warts in Costa Rica. It was assumed that the vaccination program would be combined with current cervical cancer screening in Costa Rica. For the model, it was assumed that 70% of girls 9-10 years would receive two doses of HPV vaccine. The relative effectiveness of two doses of vaccine was assumed to be the same as three doses. Impact of HPV types 6/11/16/18 only were considered for this model. The quadrivalent HPV vaccination program (combined with cervical cancer screening) was compared with a program for cervical cancer screening only (no HPV vaccination) and with a bivalent vaccination program (combined with cervical cancer screening). Life-long duration of protection was assumed for both HPV vaccines.
The quadrivalent HPV vaccines resulted in the reduction of HPV types 6/11 related genital warts in females (77%) and males (75%) and CIN1 (76%). The implementation of the quadrivalent vaccination program was cost saving as compared to the bivalent vaccination program and the program for cervical cancer screening only. The quadrivalent vaccination program strongly dominated the bivalent vaccination program and the program with cervical cancer screening only.
In Costa Rica, vaccinating 9-10 year old girls with the quadrivalent HPV vaccine has additional public health impact and is cost saving as compared with the bivalent HPV Vaccine program or the screening only program.