One of the most important aspects arising from the study was the difficulty to retrieve data about both direct and indirect costs; their evaluation would have allowed us to consider the social impact of vaccination and not only the National Health Service perspective. This could represent the most important limit

of our analysis GSI-IX nmr together with the use of international data about utilities. It should be added moreover that this analysis was preliminary in assessing clinical and economic impact of HPV vaccine because was made using epidemiology, cost and vaccine efficacy data available in 2007. Nevertheless the values used are now confirmed and reinforced by the new evidences on epidemiology and vaccine efficacy [45], and the evidence was gathered in several HTA report in different countries [46], [47], [48], [49] and [50]. Nevertheless some strength clearly emerges from our study: the thoroughness of the evaluation allowed us accounting for all the aspects of HPV infection/diseases. For example the survey showed that find more informative and educative campaigns should be carried out to improve knowledge of women about STDs. Anyway, women showed to be very interested in receiving the HPV vaccine. This let us able to consider also citizens’ perspective on this hot topic which has been faced in different ways by social and religious movements.

In conclusion, this first attempt to standardise the HTA application to the new field of vaccines led us to establish that HPV vaccines, and in particular bivalent HPV vaccine, could have a great impact on population being on the whole cost-effective. Moreover, the project arose questions and challenges about the standardisation of HTA methods and the improvement of research, and highlighted

the need for a continuing process of HTA production given the updated increase of evidence in this field. “
“Prior to the implementation of routine varicella vaccination, important concerns were raised. Firstly, vaccination could lead to a shift in the average age at infection from children to adults where risk of complication is greater. The worry was that, by increasing incidence in adults, varicella vaccination programs could lead to only an overall reduction in public health. Mathematical models however predicted that this was unlikely to happen [1]. Secondly, there were concerns related to the high number of varicella cases in vaccinees in the clinical trials [2], [3], [4] and [5]. Thirdly, there were concerns that vaccination could increase the incidence of zoster. It has long been hypothesized that exposure to varicella might reduce the risk of reactivation (zoster) by boosting specific immunity to the Varicella Zoster Virus (VZV) [6]. Two epidemiological studies have suggested that this mechanism plays an important role in protection against zoster [7] and [8].