J Gynecol Oncol.  2024 Nov;35(6):e85. 10.3802/jgo.2024.35.e85.

Cost-effectiveness analysis of single-dose or 2-dose of bivalent, quadrivalent, or nonavalent HPV vaccine in a low/middle-income country setting

• Termrungruanglert W
• Khemapech N
• Vasuratna A
• Havanond P
• Tantitamit T

• KMID: 2564977
• DOI: http://doi.org/10.3802/jgo.2024.35.e85

Abstract

Objective
To compare the health impact and economic benefits among individuals who did not receive the human papillomavirus (HPV) vaccine to those who received a single dose, or 2 doses. The comparison was stratified by 4 types of vaccine in conjunction with primary HPV screening in a low/middle-income country setting.
Methods
A Markov model was employed to simulate HPV infection and cervical cancer in a cohort of 100,000 12-year-old girls free of HPV. The study scrutinized 9 strategies: 1 dose and 2 doses of 2vHPV (Cervarix^® ), 2vHPV (Cecolin^® ), 4vHPV (Gardasil^® ), 9vHPV vaccine (Gardasil9^® ), and no vaccination. The primary outcome measure was the quality-adjusted life year (QALY) of each strategy. Incremental cost-effectiveness ratios were estimated over a lifetime horizon, accompanied by sensitivity analyses conducted.
Results
All vaccination programs yielded 41,298–71,057 QALYs gained accompanied by cost savings of 14,914,186–19,821,655 USD compared to no vaccination. Administering 2 doses of 9vHPV vaccine emerged as the most cost-effective strategy, boasting 406 USD/QALY, within a lower willingness to pay threshold. Sensitivity analysis demonstrated an 80% probability of the cost-effectiveness of the 2 doses of 9vHPV vaccine regimen. Furthermore, uncertainty around the costs of vaccination and vaccine efficacy exerted the most substantial influence on the cost-effectiveness findings.
Conclusion
Oping for 2 doses of 9vHPV vaccine in conjunction with a primary HPV screening represents the most cost-effective option for implementing a school-based HPV vaccination program targeting 12-year-old girls in Thailand. Such findings provide valuable insights for policymakers in the realm of cervical cancer prevention.

Keyword

Cost-Effectiveness Analysis; Human Papillomavirus; Lower-Middle-Income Country; Quality-Adjusted Life Years; Uterine Cervical Neoplasms; Vaccination