Thursday, 17 May 2012

HPV paper

Our paper on HPV vaccination has been accepted for publication in Medical Care (I believe it will appear shortly in the electronic version). I think it was a nice piece of modelling, which we did in a very large research group (we needed so many people, clinicians, economists, etc - although if one wanted to be quite cynical, one might say that only a few of us did most of the work... But then again, as Sheldon Cooper would put it: "Incidentally, one can get beaten up in school simply by referring to oneself as one")


But I digress! Here is a presentation that I gave last year, presenting the main findings of the paper, and here is a graph of what these are:
That's the base-case scenario which assumes making vaccination available for all 12 years old and comparing vaccination to current practice (screening every 3 years). The cost-effectiveness of vaccination is evident - it will produce a (relatively small) increase in the overall costs of management of the disease, but it will also improve the quality of life (and by the way, HPV is kind of nasty and causes all sorts of problems from genital warts to cervical cancer!).

Even if you relax some of the assumptions (eg discount rates), the bottom line does not change terribly and vaccination seems to remain good value for money. The model is based on published evidence, individual data and clinical expert opinions, which we, of course, have integrated using a full Bayesian model.

There are quite a few things we could do better (ie some of the parameters are at the moment considered as deterministic, which of course they aren't). More importantly, there is a crucial and complex issue with herd immunity (so if you vaccinate girls, then they are less likely to be infected, thus when they have sex with a boy he is less likely to be infected, and then when he has sex with another girl she is less likely to be infected, ad libitum).

We're working on this - but it's a bitch to model! 

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