A cost-utility analysis of cervical cancer screening and human papillomavirus vaccination in the Philippines

Abstract

BackgroundCervical cancer is the second leading cause of cancer cases and deaths among Filipino women because of inadequate access to screening and treatment services. This study aims to evaluate the health and economic benefits of HPV vaccination and its combination with different screening strategies to find the most optimal preventive strategy in the Philippines.MethodsA cost-utility analysis was conducted using an existing semi-Markov model to evaluate different screening (i.e., Pap smear, visual inspection with acetic acid) and vaccination strategies against HPV infection implemented alone or as part of a combination strategy at different coverage scenarios. The model was run using country-specific epidemiologic, cost and clinical parameters from a health system perspective. Sensitivity analysis was performed for vaccine efficacy, duration of protection and costs of vaccination, screening and treatment.ResultsAcross all coverage scenarios, VIA has been shown to be a dominant and cost-saving screening strategy with incremental cost-effectiveness ratio (ICER) ranging from dominant to Php 61,059 (1443 USD) per QALY gained. VIA can reduce cervical cancer cases and deaths by 25 %. Pap smear screening was found to be not cost-effective due to its high cost in the Philippines. Adding HPV vaccination at a cost of 54 USD per vaccinated girl on top of VIA screening was found to be potentially cost-effective using a threshold of 1 GDP per capita (i.e., Php 120,000 or 2835 USD/ QALY) with the most favorable assumption of providing lifelong immunity against high-risk oncogenic HPV types 16/18. The highest incremental QALY gain was achieved with 80 % coverage of the combined strategy of VIA at 35 to 45 years old done every five years following vaccination at 11 years of age with an ICER of Php 33,126 (783 USD). This strategy may result in a two-thirds reduction in cervical cancer burden. HPV vaccination is not cost-effective when vaccine protection lasts for less than 20 years.ConclusionHigh VIA coverage targeting women aged 35–45 years old at five-year intervals is the most efficient and cost-saving strategy in reducing cervical cancer burden in the Philippines. Adding a vaccination program at high coverage among 11-year-old girls is potentially cost-effective in the Philippines assuming a life-long duration of vaccine efficacy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2046-1) contains supplementary material, which is available to authorized users.

Correlation of cervical cytology with high‐risk HPV molecular diagnosis, genotypes, and histopathology—A four year study from the UAE

“…Type 18 was less frequently detected. There was detection of a few Oncogenic HPV types which were not identified in the studies carried out in home country, [23][24][25][26] as highlighted in red in Table VIII, notably types 66,31,59,68 and 56 among Fili-pino expatriates. Among Arab patients in the study, 6 were nationals of UAE and not many published studies available on HPV genotype prevalence in the UAE.…”

Optimal Control against the Human Papillomavirus: Protection versus Eradication of the Infection

“…For control model (14) and the set of admissible controls ( ), we can formulate two different optimal control problems using the objective functionals (16) and (17). Here, we prove the existence of solutions for these optimal control problems and we also obtain the optimality system in order to find a numerical approximation of the optimal controls.…”

“…Let us introduce the states = ( , , , , ) and the controls = ( 1 , 2 , 1 , 2 , ) and denote the right-hand side of the control model (14) as the vector function ( , , ). For the objective functional (16), the optimal control problem of the HPV epidemic model is min ∈ ( )…”

“…To examine the dynamics of HPV spread and control, numerous mathematical models have been proposed [5][6][7][8][9][10][11][12][13][14][15]. While these and other recent studies analyzed different strategies for HPV control and brought important insight into the problem, the majority of them did not take into account the optimality of these interventions.…”

Working Towards Universal Implementation of Human Papillomavirus Vaccination to Prevent Cervical Cancer

“…A study that evaluated resources in the Philippines found that high screening coverage with visual inspection with acetic acid was the most cost effective strategy. The addition of vaccination is potentially cost effective if administered to 11-year-olds but current costs of vaccination limit this option (Guerrero et al, 2015).…”