Cost-effectiveness of human papillomavirus vaccination for prevention of cervical cancer in Taiwan

Abstract

BackgroundHuman papillomavirus (HPV) infection has been shown to be a major risk factor for cervical cancer. Vaccines against HPV-16 and HPV-18 are highly effective in preventing type-specific HPV infections and related cervical lesions. There is, however, limited data available describing the health and economic impacts of HPV vaccination in Taiwan. The objective of this study was to assess the cost-effectiveness of prophylactic HPV vaccination for the prevention of cervical cancer in Taiwan.MethodsWe developed a Markov model to compare the health and economic outcomes of vaccinating preadolescent girls (at the age of 12 years) for the prevention of cervical cancer with current practice, including cervical cytological screening. Data were synthesized from published papers or reports, and whenever possible, those specific to Taiwan were used. Sensitivity analyses were performed to account for important uncertainties and different vaccination scenarios.ResultsUnder the assumption that the HPV vaccine could provide lifelong protection, the massive vaccination among preadolescent girls in Taiwan would lead to reduction in 73.3% of the total incident cervical cancer cases and would result in a life expectancy gain of 4.9 days or 8.7 quality-adjusted life days at a cost of US$324 as compared to the current practice. The incremental cost-effectiveness ratio (ICER) was US$23,939 per life year gained or US$13,674 per quality-adjusted life year (QALY) gained given the discount rate of 3%. Sensitivity analyses showed that this ICER would remain below US$30,000 per QALY under most conditions, even when vaccine efficacy was suboptimal or when vaccine-induced immunity required booster shots every 13 years.ConclusionsAlthough gains in life expectancy may be modest at the individual level, the results indicate that prophylactic HPV vaccination of preadolescent girls in Taiwan would result in substantial population benefits with a favorable cost-effectiveness ratio. Nevertheless, we should not overlook the urgency to improve the compliance rate of cervical screening, particularly for older individuals.

Cost-effectiveness of different human papillomavirus vaccines in Singapore

“…This is similar to a recent study in Taiwan which showed the cost-effectiveness of universal vaccination of adolescent girls [51]. …”

Efficacy of Human Papillomavirus 16 and 18 (HPV-16/18) AS04-Adjuvanted Vaccine against Cervical Infection and Precancer in Young Women: Final Event-Driven Analysis of the Randomized, Double-Blind PATRICIA Trial

“…Inconsistent or negligible efficacy was observed for women aged 21 to 25 years, likely due to a higher proportion of women with prevalent infections at baseline. This is in line with analyses suggesting reduced or negligible cost-effectiveness of vaccination programs in women aged 21 years and above (36,44). For women aged 18 to 25 years, unfortunately neither the models nor our data are conclusive.…”

Cost-Effectiveness Analysis of the Bivalent Compared with the Quadrivalent Human Papillomavirus Vaccines in Taiwan

“…Another cost-effectiveness study comparing HPV vaccination with no vaccination for Taiwan estimated the incremental cost-effectiveness at US $13,674 per QALY. Although this ratio was slightly higher than the ratio estimated by Suárez et al (partly because of differences in the perspective and the discount rate applied for outcomes in both studies, 3% in the Liu et al study and 1.5% in the Suarez study), it was also concluded that HPV vaccination would result in a favorable cost-effectiveness ratio [22]. Therefore, we may accept that the introduction of HPV vaccination can be cost-effective in Taiwan.…”