| Background:Human papillomavirus (HPV) vaccines are widely available and there have been studies exploring their potential clinical impact and cost-effectiveness. However, the bivalent vaccine against HPV 16/18 and quadrivalent vaccine against 6/11/16/18 are not available in China mainland, and few studies have compared the cost-effectiveness among two main prophylactic vaccines in China mainland region.Objective:To assess cost-effectiveness of various screening strategies combined HPV vaccines of cervical cancer to provide evidence for decision makers on cervical cancer control in China.Methods:Using Tree Age Pro2011, a Markov cohort model was developed to simulate the natural evolution of HPV of low risk and high risk and its progress to cervical cancer or genital warts. Three recommended screening strategies, which include screen 1 (liquid-based cytology test+HPV DNA test), screen 2 (Pap smear cytology test+HPV DNA test), screen 3 (visual inspection with acetic acid), and two different vaccines (a bivalent vaccine which targets HPV 16/18, and a quadrivalent vaccine which targets 6/11/16/18) were incorporated to simulate 12 different strategies and economic evaluations are made. Vaccination was assumed to a cohort of 12-year old females, followed up until 100 years old. Data were synthesized from published papers or reports, and whenever possible, those specific to China were used. Sensitivity analyses were performed to account for important uncertainties and different vaccination scenarios.Results:For the no intervention scenario,4042 cervical cancer cases occurred over the cohort’s lifetime. In our base case analysis (vaccine coverage and screen coverage were assumed as 20%), the administration of bivalent vaccine could reduce 20.50% of the total incident cervical cancer cases,27.03% of death from cancer and 4.13% of warts, while quadrivalent vaccine could reduce 19.96% of cervical cancer, 22.39% of death from cancer and 22.19% of warts. There were little difference between the current recommended screen type 1 and type 2 in the reduction in cancer, warts and increment of QALYs. And the two types of screening showed better results in cancer and warts prevention than screen type 3. Compared with no intervention scenario, despite the fact that quadrivalent vaccine plus screenl would improve the most QALYs by 0.11378 QALYs with reduction 38.08% in cancer incidence,37.35% in cancer mortality and 27.56% in warts, the screenl is not cost-effective when compared to screen2, since its ICER is over a willingness to pay. The overall outcomes were most sensitive to screen coverage, vaccine cost and vaccine coverage. The results showed that however the coverage of vaccine or screening change, bivalent vaccine is always dominated by quadrivalent vaccine. When bivalent vaccine is added to screen, its ICER would be not cost effective comparing to screen only strategy if screen coverage is over 60%.Conclusions:Combined screening strategies recommended by the Guideline for Screening and Early Detection and Treatment of Cervical Cancer and vaccination approaches are cost-effectiveness strategies, and should be considered a possible strategy to reduce the impact of HPV infection in China mainland. Screen 2 strategy combined quadrivalent vaccine is suitable in moderately developed regions while screen 3 strategy combined quadrivalent vaccine in low-resource settings. High-risk exposed to cervical cancer women are recommended the screen2 plus a bivalent vaccine. |
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