Reduction in Domestic HPV Vaccine Price Enables Good Economic Returns for Cervical Cancer Prevention in China: A Cost-Effectiveness Analysis

Abstract

Background: Coinciding with the first and soon-to-be released Chinese domestic human papillomavirus (HPV) vaccine, Innovax, and the substantial advancements in cervical cancer screening technology, we evaluated the cost-effectiveness of universal schoolgirls vaccination with Innovax and several cervical cancer screening programmes and identified the cost-effectiveness threshold for the vaccination cost in China. Methods: We developed a Markov model of cervical cancer to evaluate the incremental cost-effectiveness ratios (ICERs) of sixty-one intervention strategies, including a combination of various screening methods at different frequencies with and without vaccination, and also vaccination alone, from a healthcare system perspective. We conducted univariate and probabilistic sensitivity analyses to assess the robustness of the model findings. Findings: Compared with ‘no intervention’, all intervention strategies resulted in an ICER less than 3-time Chinese per-capita gross domestic product (GDP) (ranging from cost-saving to US$24,302/quality-adjusted-life-year (QALY)), except 3-yearly liquid-based cytology+Hybrid Capture-2 screening. With a willingness-to-pay (WTP) threshold of 3-time per-capita GDP, 5-yearly careHPV screening alone would be the most cost-effective strategy with an ICER of US$16,447/QALY compared with the lower-cost non-dominated strategy on the cost-effectiveness frontier, and the probability of it being optimal (42%) outperformed other strategies. Strategies that combined screening and vaccination were only more cost-effective than screening alone strategies when the vaccination cost was below US$100/3 doses at the current WTP. Interpretation: Five-yearly careHPV screening is the most cost-effective strategy. Reduction in domestic HPV vaccine price is necessary to ascertain a good economic return for the future vaccination programme. Funding Statement: LZ is supported by Xi’An Jiaotong University Young Talent Support Program, with project title ‘Innovative approaches for risk prediction and prevention of HIV and sexually transmitted infections in China’. KC is co-PI of an unrelated investigator-initiated trial of cervical cytology and primary HPV screening in Australia (‘Compass’), which is conducted and funded by the VCS foundation, a government-funded health promotion charity. The VCS foundation has received equipment and a funding contribution for the Compass trial from Roche Molecular Systems and Ventana Inc USA. However neither she nor her institution on her behalf (Cancer Council NSW) receives direct funding from industry Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Not required.