Cost-Utility of a Two-Dose Human Papillomavirus Vaccination Programme Added to Cervical Cancer Screening Compared with Cervical Cancer Screening Alone in Korea

Abstract

Background: Cervical cancer is caused by the human papillomavirus and is a leading cause of cancer death among<br />young Korean women. Current screening programmes could benefit from the addition of HPV vaccination into their<br />schedule to help reduce disease burden. Two-dose vaccination schedules targeting HPV types 16 and 18, which are<br />responsible for most cervical cancer cases, have recently been approved. Of the two available vaccines, AS04-adjuvanted<br />HPV16/18 vaccine (AS04-HPV16/18v) provides greater protection against non-vaccine oncogenic HPV, while<br />HPV-6/11/16/18 vaccine (4vHPVv) provides protection against genital warts. Methods: The health and economic<br />consequences of introducing a two-dose HPV vaccination programme in 12-year-old girls together with screening were<br />assessed in the Korean healthcare setting using a previously-published Markov model. Results: Compared with screening<br />alone, AS04-HPV16/18v was cost-effective (incremental cost-effectiveness ratio below and within the Korean Won<br />[KRW] 20-30 million treshold). When comparing the two vaccines, at 3% discount rate, AS04-HPV16/18v dominated<br />4vHPVv (i.e., provided 174 more quality-adjusted life-years (QALYs), 304 more life-years (LYs) and cost-savings of<br />KRW 980 million). At a 5% discount rate, AS04-HPV16/18v provided comparable QALYs (albeit 5 fewer), 105 more<br />LYs and cost-savings of KRW 292 million compared with 4vHPVv. Results were particularly sensitive to the discount<br />rate used, as the health benefits of preventing cervical cancer are observed much later than those of preventing genital<br />warts. Conclusion: For the Korean setting, HPV vaccination with a two-dose schedule is a cost-effective option, and<br />AS04-HPV16/18v is likely to offer better health outcomes at a cost-saving compared with 4vHPVv.