Abstract
Background:Cervical cancer is caused by the human papillomavirus and is a leading cause of cancer death among young Korean women. Current screening programmes could benefit from the addition of HPV vaccination into their schedule to help reduce disease burden. Two-dose vaccination schedules targeting HPV types 16 and 18, which are responsible for most cervical cancer cases, have recently been approved. Of the two available vaccines, AS04-adjuvanted HPV16/18 vaccine (AS04-HPV16/18v) provides greater protection against non-vaccine oncogenic HPV, while HPV-6/11/16/18 vaccine (4vHPVv) provides protection against genital warts. Methods:The health and economic consequences of introducing a two-dose HPV vaccination programme in 12-year-old girls together with screening were assessed in the Korean healthcare setting using a previously-published Markov model. Results:Compared with screening alone, AS04-HPV16/18v was cost-effective (incremental cost-effectiveness ratio below and within the Korean Won [KRW] 20-30 million treshold). When comparing the two vaccines, at 3% discount rate, AS04-HPV16/18v dominated 4vHPVv (i.e., provided 174 more quality-adjusted life-years (QALYs), 304 more life-years (LYs) and cost-savings of KRW 980 million). At a 5% discount rate, AS04-HPV16/18v provided comparable QALYs (albeit 5 fewer), 105 more LYs and cost-savings of KRW 292 million compared with 4vHPVv. Results were particularly sensitive to the discount rate used, as the health benefits of preventing cervical cancer are observed much later than those of preventing genital warts. Conclusion:For the Korean setting, HPV vaccination with a two-dose schedule is a cost-effective option, and AS04-HPV16/18v is likely to offer better health outcomes at a cost-saving compared with 4vHPVv.
Highlights
Cervical cancer (CC) is the 4th most common cancer, and 3rd leading cause of cancer death among Korean women aged 15 to 44 years (Korean Statistical Information Service (KOSIS), 2015)
Overall quality-adjusted life-years (QALY) associated with both vaccines were fairly comparable, they were driven by greater prevention of oncogenic disease in the case of AS04-HPV16/18v (i.e., 3,494 more precancerous cases, 239 more CC cases and 96 more CC deaths prevented than with 4vHPVv), and driven by lower prevention of oncogenic disease plus prevention of GWs (10,682 GW cases prevented) in the case of 4vHPVv
The model predicted 4vHPVv would prevent GW cases compared with AS04-HPV16/18v, AS04-HPV16/18v would prevent more CC cases and deaths, increasing LYs and QALYs versus 4vHPVv
Summary
Cervical cancer (CC) is the 4th most common cancer, and 3rd leading cause of cancer death among Korean women aged 15 to 44 years (Korean Statistical Information Service (KOSIS), 2015). Inc., USA; 4vHPVv) (Centers for Disease Control and Prevention, 2016) Both vaccines target HPV-16/18 types, and, 4vHPVv targets low-risk HPV types (6 and 11) causing genital warts (GW) and some grade 1 CIN (CIN1). Methods: The health and economic consequences of introducing a two-dose HPV vaccination programme in 12-year-old girls together with screening were assessed in the Korean healthcare setting using a previously-published Markov model. At a 5% discount rate, AS04-HPV16/18v provided comparable QALYs (albeit 5 fewer), 105 more LYs and cost-savings of KRW 292 million compared with 4vHPVv. Results were sensitive to the discount rate used, as the health benefits of preventing cervical cancer are observed much later than those of preventing genital warts. Conclusion: For the Korean setting, HPV vaccination with a two-dose schedule is a cost-effective option, and AS04-HPV16/18v is likely to offer better health outcomes at a cost-saving compared with 4vHPVv
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