Abstract
BackgroundThe World Health Assembly has adopted a global strategy to eliminate cervical cancer. However, neither the optimal pathway nor the corresponding economic and health benefits have been evaluated. We take China as an example to assess the optimal pathway towards elimination and the cost-effectiveness of tailored actions.MethodsA validated hybrid model was used to assess the costs and benefits of alternative strategies combining human papillomavirus vaccination, cervical screening, and treatment of pre-invasive lesions and invasive cancer for females with different immunization history. All Chinese females living or projected to be born during 2015–2100, under projected trends in aging, urbanization, and sexual activity, were considered. Optimal strategies were determined by cost-effectiveness efficiency frontiers. Primary outcomes were cervical cancer cases and deaths averted and incremental cost-effectiveness ratios (ICERs). We employed a lifetime horizon from a societal perspective. One-way and probabilistic sensitivity analyses evaluate model uncertainty.ResultsThe optimal pathway represents an integration of multiple tailored strategies from females with different immunization history. If China adopts the optimal pathway, the age-standardized incidence of cervical cancer is predicted to decrease to fewer than four new cases per 100,000 women (i.e., elimination) by 2047 (95% confidence interval 2043 to 2050). Compared to the status quo, the optimal pathway would avert a total of 7,509,192 (6,922,744 to 8,359,074) cervical cancer cases and 2,529,873 (2,366,826 to 2,802,604) cervical cancer deaths in 2021–2100, with the discounted ICER being $− 339 (− 687 to − 79) per quality-adjusted life-year.ConclusionsBy adopting an optimal pathway from 2021 (namely, the year of the first Chinese Centennial Goals) onwards, cervical cancer could be eliminated by the late 2040s (namely, ahead of the second Chinese Centennial Goals) while saving net economic costs in China.
Highlights
The World Health Assembly has adopted a global strategy to eliminate cervical cancer
The 5.5-year follow-up suggested that the vaccine is highly efficacious in preventing genital lesions and persistent infection associated with human papillomavirus (HPV)-16/18, with no waning protection detected after vaccination [10, 11]
Routine bivalent HPV vaccination should be initiated in 2021 for girls aged 9 years old and switched to 9valent vaccine in 2031 when it becomes available for the Chinese national immunization program (NIP)
Summary
The World Health Assembly has adopted a global strategy to eliminate cervical cancer. Following the call from the World Health Organization (WHO)’s Director-General for action towards the elimination of cervical cancer as a public health problem, several modeling studies suggested that the goal of elimination is within reach globally in the twenty-first century [1,2,3]. All of these studies were designed to evaluate the time frame and intervention strategies needed to achieve cervical cancer elimination or to predict the impact on cervical cancer mortality and deaths averted [1,2,3]. In the absence of evidence-based analyses on the impact of an optimal strategy involving both HPV vaccination and cervical cancer screening, policy-makers in China are still hesitant to make major changes
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