These researchers compared the health gains, net-cost and cost-effectiveness of New Zealand’s existing national human papillomavirus (HPV) vaccination programme of vaccination dispersed across schools and primary care (an observed coverage of only 47%) with two other alternative vaccine delivery programmes with higher estimated coverage: school-based only (the estimated coverage is 73%), and mandatory school-based vaccination but with opt-out permitted (estimated coverage 93%). A Markov macro-simulation model was developed for 12-year-old girls and boys in 2011, with future health states of: cervical cancer, pre-cancer (CIN I–III), genital warts, and three other HPV-related cancers (oropharyngeal, anal, vulvar cancer). The current HPV vaccination programme has an estimated cost-effectiveness of $NZ18,800/quality-adjusted life-year (QALY) gained compared to the status quo in New Zealand prior to 2008 (no vaccination, screening alone). The incremental costeffectiveness ratio (ICER) of an intensive school-based-only programme of girls, compared to the current situation, was $NZ34,700/QALY gained. Mandatory vaccination appeared least cost-effective (ICER compared to school-based of $NZ122,500/QALY gained). All interventions generated more QALYs per 12-year-old for Māori and people living in deprived areas (range 5–25% greater QALYs gained).
