Abstract

Background

Most anal cancers are caused by the human papilloma virus (HPV) infection. The incidence is increasing, especially in high-risk individuals such as HIV-positive men. Evidence shows that the new quadrivalent HPV vaccine reduces the rates of anal intraepithelial neoplasia among men who have sex with men.

Objective

To determine whether vaccinating against HPV-related anal cancer is cost-effective in HIV-positive men in Chile.

Methods

A cost-effectiveness analysis was conducted by constructing a cohort multistate life-table–based Markov model in MS Excel in which the prevention of HPV infection was expected to influence the incidence of anal cancer in HIV-positive men. The comparator was the current practice of no systematic HPV prevention. Estimates of the efficacy of the vaccine were obtained from a substudy of a larger randomized controlled trial, incidence rates from the Chilean Population Cancer Registries, mortality rates from the National Institute of Statistics, and disease costs from a cost-effectiveness report. A public health care sector perspective was applied. The outcome was measured in averted disability-adjusted life-years. The incremental cost-effectiveness ratio was calculated considering a lifetime horizon for costs and health outcomes.

Results

The estimated incremental cost-effectiveness ratio was US $138,269/ disability-adjusted life-year (95% confidence interval $95,936–$221,862). Assuming a threshold of 3 times the gross domestic product per capita, the intervention was not cost-effective. The outcome was sensitive to the vaccine price and vaccine efficacy.

Conclusions

HPV vaccination in HIV-positive men from a Chilean public health care sector perspective is not cost-effective.