Economic evaluation of a public health strategy: an examination of the human papillomavirus vaccine

Numerous articles have been published evaluating the cost-effectiveness of the human papillomavirus (HPV) vaccine in girls. The overwhelming majority of these papers suggest that these strategies are attractive and should be universally adopted. However closer examination of the methods chosen to perform these evaluations reveal that many of the analyses key assumptions have not been thoroughly tested. Ideally assumptions that have the potential to significantly change the outcomes are varied across a plausible range, either based on existing published research, or alternatively based on confidence intervals of existing data sets. This author finds that most of the existing published articles fail to thoroughly test these assumptions in a transparent fashion. Using existing published data a re-evaluation of a cost-effectiveness model is performed. A focus on model assumptions regarding, time horizon, discount rate, and the disutility of genital warts are the primary parameters being tested more rigorously. This author finds that the model is highly sensitive to several assumptions, in contrast to the majority of published papers that either chooses not to report these analyses or to limit the range of values used. As a consequence policy makers should be cautious when making funding decisions that hinge on these key assumptions.