Cost-effectiveness analysis of different types of human papillomavirus vaccination combined with a cervical cancer screening program in mainland China

• Published in: BMC infectious diseases 2017-07, Vol.17 (1), p.502-502, Article 502
• Main Authors: Mo, Xiuting, Gai Tobe, Ruoyan, Wang, Lijie, Liu, Xianchen, Wu, Bin, Luo, Huiwen, Nagata, Chie, Mori, Rintaro, Nakayama, Takeo
• Format: Article
• Language: English
• Subjects: Acetic acid; Adolescent; Age; BASIC (programming language); Cancer; Cancer screening; Carcinoma; Cellular biology; Cervical cancer; Cervical intraepithelial neoplasia; Cervix; Child; China - epidemiology; Clinical trials; Cohort Studies; Cost analysis; Cost-Benefit Analysis; Cytology; Demographics; Deoxyribonucleic acid; Developing countries; Diagnosis; DNA; Economic impact; Fatalities; Female; Genetic testing; Genital cancers; Girls; Guidelines; Gynecology; Human papillomavirus; Humans; Incidence; Incremental cost-effectiveness ratio; Infections; Infrastructure; Inspection; LDCs; Markov Chains; Mass Screening - economics; Medical research; Medical screening; Mortality; Papanicolaou Test; Papillomaviridae; Papillomavirus Infections - economics; Papillomavirus Infections - epidemiology; Papillomavirus Infections - prevention & control; Papillomavirus Vaccines - economics; Papillomavirus Vaccines - therapeutic use; Prevention; Public health; Quality-Adjusted Life Years; Uterine cancer; Uterine Cervical Neoplasms - economics; Uterine Cervical Neoplasms - epidemiology; Uterine Cervical Neoplasms - prevention & control; Uterus; Vaccination - economics; Vaccine; Vaccines; Vaginal Smears; Visual perception; Womens health
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-017-2592-5

China has a high prevalence of human papillomavirus (HPV) and a consequently high burden of disease with respect to cervical cancer. The HPV vaccine has proved to be effective in preventing cervical cancer and is now a part of routine immunization programs worldwide. It has also proved to be cost effective. This study aimed to assess the cost-effectiveness of 2-, 4-, and 9-valent HPV vaccines (hereafter, HPV2, 4 or 9) combined with current screening strategies in China. A Markov model was developed for a cohort of 100,000 HPV-free girls to simulate the natural history to HPV infection. Three recommended screening methods (1. liquid-based cytology test + HPV DNA test; 2. pap smear cytology test + HPV DNA test; 3. visual inspection with acetic acid) and three types of HPV vaccination program (HPV2/4/9) were incorporated into 15 intervention options, and the incremental cost-effectiveness ratio (ICER) was calculated to determine the dominant strategies. Costs, transition probabilities and utilities were obtained from a review of the literature and national databases. One-way sensitivity analyses and threshold analyses were performed for key variables in different vaccination scenarios. HPV9 combined with screening showed the highest health impact in terms of reducing HPV-related diseases and increasing the number of quality-adjusted life years (QALYs). Under the current thresholds of willingness to pay (WTP, 3 times the per capita GDP or USD$ 23,880), HPV4/9 proved highly cost effective, while HPV2 combined with screening cost more and was less cost effective. Only when screening coverage increased to 60% ~ 70% did the HPV2 and screening combination strategy become economically feasible. The combination of the HPV4/9 vaccine with current screening strategies for adolescent girls was highly cost-effective and had a significant impact on reducing the HPV infection-related disease burden in Mainland China.