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Abstract
BackgroundThe cost-effectiveness of human papillomavirus (HPV) vaccination in women pre-sexual debut has been demonstrated in many countries. This study aimed to estimate the cost-effectiveness of a 3-dose bivalent HPV vaccination at ages 12 to 55 year in both rural and urban settings in China.MethodsThe Markov cohort model simulated the natural history of HPV infection and included the effect of screening and HPV vaccination over the lifetime of a 100,000 female cohort. Transition probabilities and utilities were obtained from published literature. Cost data were estimated by Delphi panel using healthcare payers’ perspective. Vaccine cost was assumed Hong Kong listed price. Vaccine efficacy (VE) was based on the PATRICIA trial data assuming VE irrespective of HPV type at all ages on incident HPV. Costs and outcomes were discounted at 3 %. Cervical cancer cases and incremental cost-effectiveness ratio (ICER) for vaccination and screening compared with screening alone were estimated for each vaccination age. Reduced VE in women post-sexual debut were investigated in scenario analyses.ResultsWith 70 % vaccination coverage, a reduction of cancer cases varying from 585 to 33 in rural and 691 to 32 in urban were estimated at ages 12 to 55, respectively. The discounted ICERs of vaccination at any age under 23 years in rural and any age under 25 years in urban were lower than the current threshold. Scenario analyses with lower VE post-sexual debut confirmed the results with age 20 in rural and 21 in urban had consistent lower ICERs. The more ‘catch-up’ cohorts vaccinated at the start of a program, the more cancer lesions are avoided in the long-term.ConclusionsVaccination at any age under 23 years old in rural and any age under 25 years old in urban were cost-effective. Catch-up to the age of 25 years in rural and urban could still be cost-effective.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2207-3) contains supplementary material, which is available to authorized users.
Highlights
The cost-effectiveness of human papillomavirus (HPV) vaccination in women pre-sexual debut has been demonstrated in many countries
We propose to estimate the cost-effectiveness of a 3-dose bivalent HPV vaccination (3DBV) versus current screening practices at ages 12 to 55 years in both rural and urban settings in China
We found what we estimated from the existing HBV vaccination program (54 China Yuan (CNY)) was consistent with the data from Cameroon [24], one of the developing countries, where the administrative cost of HPV vaccine was 8 United States Dollar (USD) per 3 doses
Summary
The cost-effectiveness of human papillomavirus (HPV) vaccination in women pre-sexual debut has been demonstrated in many countries. Cervical cancer (CC) is an important cause of morbidity and mortality among Chinese women It is estimated the age-standardized incidence and mortality rates were 7.5 and 3.4 per 100,000 women in China in 2012, lower than corresponding world statistics, 14.0 and 6.8 per 100,000 [1]. Phase III clinical trials on a 3 doses of bivalent HPV vaccination (3DBV) have been ongoing for over 7 years in mainland China [5]. Though at this stage, it is uncertain whether a fullscale initiative to vaccinate girls in China will be available [6], we expect that it will be approved by the State Food and Drug Administration in the foreseeable future
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