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Comparing bivalent and quadrivalent HPV vaccines

BMJ 2011; 343 doi: (Published 27 September 2011) Cite this as: BMJ 2011;343:d5720

This article has a correction. Please see:

  1. René H M Verheijen, professor of gynaecological oncology
  1. 1Division of Women and Baby, Gynaecological Oncology, University Medical Centre Utrecht, Utrecht 3584 CX, Netherlands
  1. r.verheijen{at}

Modelling can help, but the tender price determines cost

In September 2008, the Department of Health in the United Kingdom started a national vaccination programme of human papillomavirus (HPV) in 12-13 year old schoolgirls. A catch-up programme for girls up to the age of 18 was simultaneously started. At that time, Jit and colleagues reported cost comparisons of the two available vaccines.1 Their cost threshold analysis showed that if the bivalent vaccine, Cervarix, which protects against HPV types 16 and 18, cost £13 (€15; $21) to £21 less per dose than the quadrivalent vaccine, Gardasil, both vaccines would be equally cost effective, although the bivalent vaccine would be less effective because it does not prevent anogenital warts. In an accompanying editorial, Kim concluded that policy decisions would continue to benefit from such model based analysis.2

Now, three years later, a political decision is again needed on the continuation of the vaccination programme, and Jit and colleagues have re-evaluated the two vaccines, taking into account more potential differences between the vaccines (doi:10.1136/bmj.d5775).3 They conclude that at the same price level the quadrivalent vaccine is still more cost effective and that the price differential between both vaccines seems larger than stated in their previous analysis.

In 2008 it …

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