Cost-Effectiveness Analysis of Human Papillomavirus Vaccination in Adolescent Girls in Taiwan

Abstract

Objective: Three vaccines are available to Taiwanese young girls for cervical cancer (CC) prevention. Here<br />we evaluate the cost-effectiveness of the two-dose (2D) AS04-adjuvanted HPV-16/18 vaccine (2D-AS04-HPV-<br />16/18v)+screening compared with a screening programme alone, with 2D human papillomavirus 6/11/16/18 vaccine<br />(2D-4vHPVv)+screening, and with 2D/three-dose (3D) human papillomavirus 6/11/16/18/31/33/45/52/58 vaccine<br />(9vHPVv)+screening, for Taiwan universal mass vaccination. Methods: A static Markov cohort model simulated the<br />natural history of human papillomavirus (HPV) infection and CC screening for a 12-year-old cohort of Taiwanese girls<br />(N=120,000). The model ran in 1-year cycles over the cohort's lifetime. Vaccine efficacy irrespective of HPV type<br />was considered in the analysis for each vaccine. Input data were obtained from published literature, local databases,<br />government reports and websites, and expert opinion. The analysis incorporated direct medical costs only, with an<br />annual discount rate of 3.0%. The threshold was determined as 1 Gross Domestic Product per capita (New Taiwan<br />dollar [NT$] 727,818; year 2016). Results: The 2D-AS04-HPV-16/18v+screening yielded 0.0365 quality-adjusted life<br />year (QALY) gained at an additional cost of NT$ 5,770 per person compared with the screening programme alone. This<br />resulted in an incremental cost-effectiveness ratio well below the threshold. Compared with 2D-4vHPVv+screening and<br />2D/3D-9vHPVv+screening, discounted results demonstrated additional QALYs gained at lower cost for 2D-AS04-HPV-<br />16/18v+screening, making it dominant over both 2D-4vHPVv+screening and 2D/3D-9vHPVv+screening. Conclusions:<br />Vaccinating Taiwanese girls with 2D-AS04-HPV-16/18v in addition to screening to prevent CC is cost-effective<br />compared with using a screening programme alone and the dominant option compared with 2D-4vHPVv+screening<br />and 2D/3D-9vHPVv+screening.