An analysis in the British Medical Journal which claims that the UK government could save £18.6 million annually following its recent decision to pick GlaxoSmithKline's cervical cancer vaccine Cervarix for its human papillomavirus immunisation programme has led to renewed criticism from those who feel Merck & Co’s Gardasil should have been chosen.

The article, carried out by the Health Protection Agency, looks at mathematical model used by the Department of Health to help make its decision. The two jabs that were considered are Cervarix, which provides protection against two strains of the HPV virus – 16 and 18 – which cause 70% of cases of cervical cancer – and Gardasil, sold in Europe by Sanofi Pasteur MSD, a joint venture between Sanofi-Aventis and Merck, protects against strains 16 and 18, plus 6 and 11, which cause lesions and genital warts.

Cervarix won the day last month after closed bids were put forward. The authors of the analysis said that "a bivalent vaccine (GSK’s jab) with the same efficacy against HPV types 16 and 18 costing £13-£21 less per dose (depending on the duration of vaccine protection) may be as cost effective as the quadrivalent vaccine (Gardasil) although less effective as it does not prevent anogenital warts."

In an accompanying editorial in the BMJ, Jane Kim of the Harvard School of Public Health wrote that the decision to select Cervarix implies the DoH “is willing to accept foregone health benefits (and additional cost savings) from averting cases of genital warts for the reduced financial outlay". She added that "assuming 80% coverage of current 12-year-old girls in the UK with the full three-dose vaccine series, this price differential translates to savings of £11.5-£18.6 million from the vaccine price alone in the first year of the programme.”

The DoH said "the contract has been awarded for the vaccine that scored best overall against a number of pre-agreed criteria and offers best value overall to the National Health Service", but this failed to appease a number of critics. Colm O'Mahony, a consultant in sexual health at Chester Foundation Trust, told The Times that “all the clinical evidence pointed to Gardasil” and instead the DoH has chosen “a vaccine suitable for the Third World”.

GSK obviously disagreed and noted that data on Cervarix have demonstrated the prevention of pre-cancerous lesions and a strong immune response for 6.4 years, which is the longest duration of protection demonstrated clinically for any vaccine against HPV 16 and 18.

Extra 300,000 to be vaccinated
In a further development, however, Health Minister Dawn Primarolo has just announced that the national vaccination programme against HPV is being extended to offer protection to an additional 300,000 girls aged 17-18, starting in September. This is in addition to the routine vaccination of 12-13 year-olds.

The DoH said this extension “was made possible thanks to the considerable savings that were achieved through the negotiation of the vaccine procurement process”. Ms Primarolo said that “by choosing the right vaccine we have been able to make savings which means we can extend the programme…this could save an additional 400 lives."