Routine immunization services costs and financing in China, 2015

Wang, Yu; Lu, Ming Hsin; Wang, Huaqing; Rodewald, Lance; Ji, Saisai; Ma, Chang–Jin; Li, Yixing; Zheng, Jingshan; Song, Yifan; Wang, Miao; Wang, Yamin; Wu, Dan; Cao, Lei; Fan, Chen; Zhang, Xuan; Liu, Yanmin

doi:10.1016/j.vaccine.2018.04.008

Cited by 31 publications

(26 citation statements)

References 19 publications

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“…A search was conducted for published and unpublished reports on vaccine development and VPD control in China from 1949 to 2016, focusing on Chinese-language documents not widely available in the published literature, and included manual searches through archived documents at the Ministry of Health (MoH), China Center for Disease Control and Prevention, and provincial health departments [8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Data on immunization expenditures was collected as part of national EPI reviews conducted in 1999, 2004, and 2013.…”

Section: Methodsmentioning

confidence: 99%

Vaccine-preventable disease control in the People’s Republic of China: 1949–2016

Wang

Lee²,

Liu

et al. 2018

Vaccine

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Section: Methodsmentioning

confidence: 99%

Vaccine-preventable disease control in the People’s Republic of China: 1949–2016

Wang

Lee²,

Liu

et al. 2018

Vaccine

Self Cite

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“…We used parameters that we obtained from open-source publications or government-released online datasets (appendix pp [18][19][20][21][22][23][24][25]. Briefly, we extracted natural history parameters of cervical cancer from literature reviews and demographic data, which we obtained from national statistical databases and publications.…”

Section: Inputs and Assumptionsmentioning

confidence: 99%

“…21,22 Additionally, the cost of administration of vaccination is $3•33 per dose. 23 The available budget (ie, the current budget in the model, defined as that between 2012 and 2018) towards cervical cancer prevention in China comprises the national and local financial expenditure of rural and urban CCSPs. We estimated the annual budgets towards cervical cancer prevention are $78•1 million in rural China and $132•6 million in urban China, giving a total budget of about $210•7 million per year (appendix pp 12-13).…”

Section: Inputs and Assumptionsmentioning

confidence: 99%

Projections up to 2100 and a budget optimisation strategy towards cervical cancer elimination in China: a modelling study

Xia

et al. 2019

The Lancet Public Health

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Background The incidence of cervical cancer in China is increasing rapidly. We aimed to forecast the age-standardised incidence of cervical cancer in China up to 2100, and to determine the optimal strategy to eliminate cervical cancer under different budget scenarios. Methods In our modelling study, we developed an adapted and calibrated hybrid model to estimate the incidence of cervical cancer in urban and rural China until 2100. All 1•15 billion Chinese women living or projected to live during 2015-2100, under the projected trends in ageing, urbanisation, and sexual activity were considered. We assessed several scenarios of budget constraints (a current budget [2012-18], twice the current budget, and no budget constraints), implementation of human papillomavirus vaccination (with different target populations and coverage), and cervical cancer screening characteristics (with different target ages, screening intervals, and coverage). We used a budget optimisation process to select the best available combinations of vaccination and screening. The primary outcomes were the annual incidence of cervical cancer in 2015-2100, and the year of elimination (the first year in which the incidence was expected to be lower than four new cases per 100 000 women). Findings Under the current strategy, by 2100, the age-standardised incidence of cervical cancer is projected to increase to three times the incidence in 2015. However, if China adopts an optimal strategy under the current budget from 2020 onwards (namely, introducing vaccination of 95% coverage for girls aged 12 years, and expanding coverage of once in a lifetime screening for women aged 45 years of 90% in urban areas and 33% in rural areas), the annual agestandardised incidence of cervical cancer is predicted to decrease to fewer than four new cases per 100 000 women (ie, elimination) by 2072 (95% CI 2070-74) in urban China and 2074 (2072-76) in rural China. If the current budget were doubled from 2020 onwards, elimination would be achieved by 2063 (2059-66) in urban China and 2069 (2066-71) in rural China. The earliest possible year of cervical cancer elimination would be 2057 (2053-60) in urban China and 2060 (2057-63) in rural China, if vaccination coverage for girls aged 12 years and coverage of screening at 5-year intervals for women aged 35-64 years was maximised, with no budgetary restrictions. Interpretation Cervical cancer incidence in China will continue to increase under current cervical cancer prevention strategies. However, under our budget optimisation strategy from 2020 onwards, cervical cancer could be eliminated as a public health problem by the early 2070s. Elimination could be achieved by the late 2050s by increasing the budget towards vaccination against human papillomavirus and cervical cancer screening.

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“…Base-case estimates and ranges for all parameters are listed in tables in the supplementary file (Additional file 2: Table S2) [2,3,14,19,26,28,[30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]. We assumed that infection-acquired immunity would wane over time, whereas vaccine-acquired immunity would be lifelong [2,3,40,52].…”

Section: Inputs and Assumptionsmentioning

confidence: 99%

Effectiveness and cost-effectiveness of eliminating cervical cancer through a tailored optimal pathway: a modeling study

Xia

Zhao

et al. 2021

BMC Med

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Background The 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. Methods A 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. Results The 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. Conclusions By 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.

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Routine immunization services costs and financing in China, 2015

Cited by 31 publications

References 19 publications

Vaccine-preventable disease control in the People’s Republic of China: 1949–2016

Vaccine-preventable disease control in the People’s Republic of China: 1949–2016

Projections up to 2100 and a budget optimisation strategy towards cervical cancer elimination in China: a modelling study

Effectiveness and cost-effectiveness of eliminating cervical cancer through a tailored optimal pathway: a modeling study

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