Article
Reference
HPV vaccination in Switzerland: where are we?
CHASTONAY, Philippe
CHASTONAY, Philippe. HPV vaccination in Switzerland: where are we? Health Policy Monitor , 2007, vol. 10
Available at:
http://archive-ouverte.unige.ch/unige:33584
Disclaimer: layout of this document may differ from the published version.
HPV vaccination in Switzerland: where are we?
Country: Switzerland
Partner Institute: Università della Svizzera Italiana, Lugano Survey no: (10)2007
Author(s): Philippe Chastonay (proof-reading by Luca Crivelli and Mary Ries) Health Policy Issues: Public Health, Prevention, Funding / Pooling, Benefit Basket Current Process Stages
Featured in half-yearly report: Health Policy Developments 10
1. Abstract
The Federal Commission for Vaccination recommended that every girl between 11 and 14 should be vaccinated against the Human Papilloma Virus and during the transition period also girls aged 15 to 19 should be included. Since the Federal Government has not yet decided whether to reimburse the vaccination, which costs around 700 CHF at present, until now only two cantons (Geneva and Valais) have decided to offer the vaccine free to all 7th grade girls as from now, limited to one year.
2. Purpose of health policy or idea
In the long term the objective is to reduce cervical cancer morbidity and mortality drastically. In the short and long term the aim is to reduce HPV transmission/infection and in the long term again to reduce the costs related to HPV
infection and to cervical screening by Pap smears .
Groups affected
Girls between the ages of 11 and 19, Health insurers (who would pay the vaccine)
3. Characteristics of this policy
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Degree of Innovation traditional innovative
Degree of Controversy consensual highly controversial
Structural or Systemic Impact marginal fundamental
Public Visibility very low very high
Transferability strongly system-dependent system-neutral
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An excellent job was done by the expert committee. The Public Health authorities of the cantons Geneva and Valais have made a courageous and scientifically sound decision. However, the Federal Government has been slow and somewhat irresponsible in their lack of decision regarding the integration of the HPV vaccination into the federal insurance benefit basket.
4. Political and economic background
Human Papilloma Viruses are the most frequent Sexually Transmitted Diseases. Up to 80% of the population will contract HPV infection over the course of time. Certain types of HPV will cause cervical cancer (500,000 new cases a year world-wide, which makes it the 2nd most frequent form of cancer in women after breast cancer). In 70% of the cases HPV16/HPV18 are involved.
In Switzerland the estimated prevalence of HPV16/18 infection is 1% in girls between the ages of 12-14, and 7-9% in young women aged between 16 and 25.
Each year severe cervical dyspasia is diagnosed in 5000 women. Over the past 30 years regular cervical screening by Pap smears has brought down cervical cancer incidence by 38%, with rather less than one hundred deaths yearly related to cervical cancer at present.
5. Purpose and process analysis
Origins of health policy idea
A quadrivalent vaccine is registered and available in Switzerland (Sanofi-Pasteur MSD). The vaccine contains the L1 proteins of the HPV 6/11/16/18 capsids produced through molecular genetic procedures. Its immunogenicity is excellent with seroconversion between 75% (HPV18) and 100% (HPV16). Antibody titles remain high for at least 5 years.
The Federal Commission for Vaccination submitted its report on Human Papilloma Virus (HPV) vaccination recommendations to the Federal Government in spring 2007 [see 2, 3, and 4]. The recommendations are straight forward; the vaccination against HPV is recommended for every girl aged 11 to 14 as well as those aged 15-19 during the transition period.
Though the recommendations of the Federal Commission for Vaccination are clear, the Federal Government has not yet decided whether to reimburse the vaccination (the vaccine costs around 700 CHF at present). This will certainly be a major hurdle to widespread adhesion by the population to the expert committee recommendation.
So far two cantons, Geneva and Valais, have recognized the problem and have decided that they will offer the vaccine free to all the 7th grade girls as from now (limited to one year).
Initiators of idea/main actors Government
Payers: Prices are considered as too high Civil Society
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
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Scientific CommunityActors and positions
Description of actors and their positions
Influences in policy making and legislation
The decision of the two cantons to pay for the vaccine will put pressure on the Federal Office of Public Health who is in charge to decide whether HPV vaccination has to be included or not in the benefit basket of mandatory health insurance.
Legislative outcome Actors and influence
Description of actors and their influence
Positions and Influences at a glance
6. Expected outcome
Due to the high efficacy of the vaccine (after 3 years' observation a 98% protection against in situ cervical cancer was recorded) incidence of and morbidity / mortality related to HPV infection will dramatically decrease in the years
Government
Cantonal health authorities in Geneva and Valais
very supportive strongly opposed
Payers
Health insurers very supportive strongly opposed
Civil Society
Supporters of natural medicine very supportive strongly opposed
Scientific Community
Federal experts (Federal Commission for Vaccination)
very supportive strongly opposed
Government
Cantonal health authorities in Geneva and Valais
very strong none
Payers
Health insurers very strong none
Civil Society
Supporters of natural medicine very strong none
Scientific Community
Federal experts (Federal Commission for Vaccination)
very strong none
1.
2.
3.
4.
5.
following massive vaccination. A cost benefit analysis in Switzerland suggests a 26,000 CHF/QALY [see 5].
7. References
Sources of Information www.ekif.ch
Empfehlung für die Basisimpfung von Jugendlichen gegen das Zervixkarzinom (Gebärmutterhalskrebs) und andere durch humane Papillomaviren (HPV) verursachte Krankheiten. (
www.ekif.ch/fr/downloads/Com_presse_EKIF_18062007finalDE.pdf)
Empfehlungen zur Impfung gegen humane Papillomaviren (HPV). Das Wichtigste in Kürze (Mai 2007)(
www.ekif.ch/fr/downloads/BAG25_HPV_Wichtigste_dt.pdf)
Empfehlungen zur Impfung gegen humane Papillomaviren (HPV), Juli 2007(
www.ekif.ch/fr/downloads/RichtlinienundEmpfehlungen21_2007_07_06.pdf)
St[è]ve consultants, Largeron N. Rapport sur l'impact medico-economique de Gardasil en Suisse. Lyon, 2 avril 2007
Quality of Health Care Services marginal fundamental
Level of Equity system less equitable system more equitable
Cost Efficiency very low very high
Author/s and/or contributors to this survey
Philippe Chastonay (proof-reading by Luca Crivelli and Mary Ries)
Suggested citation for this online article
Philippe Chastonay (proof-reading by Luca Crivelli and Mary Ries). "HPV vaccination in Switzerland: where are we?".
Health Policy Monitor, October 2007. Available at http://www.hpm.org/survey/ch/a10/1
