Cost-effectiveness of 2-dose human papillomavirus vaccination for 12-year-old girls in Zhejiang Province: implications for China’s expanded program on immunization

ABSTRACT

Background

The high cost and insufficient supply of HPV vaccines have substantially slowed their implementation in lower-income countries. This study aimed to assess the incremental cost-effectiveness of two doses of human papillomavirus (HPV) vaccination (bivalent 16/18 vaccine; 2vHPV) compared to a no-vaccination scenario and a three-dose scenario in one province in China.

Methods

A static Markov model was used to model a lifetime cohort of 100,000 girls aged 12 years at the start of vaccination. A two-dose vaccination schedule was assumed to be non-inferior to a three-dose schedule in terms of vaccine efficacy, and both vaccination schemes were assumed to provide lifelong protection. Incremental costs, health effects and incremental cost-effectiveness ratios were used to measure the outcomes when comparing the different strategies.

Results

Compared to no vaccination, the incremental cost-effectiveness ratio (Chinese yuan per quality-adjusted life year) of the two-dose vaccination strategy is 12,472, and the 2-dose strategy is calculated to be cost saving relative to the 3-dose vaccination strategy.

Conclusions

Introducing the 2vHPV vaccine would be highly cost effective at a per-dose vaccine price of CNY 500, which has implications for cervical cancer control in China and other resource-limited countries.

KEYWORDS:

• Cervical cancer
• cost-effectiveness
• HPV vaccine
• bivalent
• China
• expanded program on immunization

Acknowledgments

We gratefully acknowledge Professor Ya Fang and Mr. Mingliang Luo for their technical support. Editing was performed by a specialized company.

Disclosure of potential conflicts of interest

All authors declare that they have no conflicts of interest.

Author contributions

Zhiping Chen and Ting Wu designed the study; Yan Luo and Xuewen Tang reviewed the literature; Yan Luo and Hanqing He developed the model and performed the data analysis; Shenyu Wang and Jun Zhang estimated the validity of the model; and Yan Luo wrote the manuscript. The corresponding authors are the guarantors for the data and have full access to all data. All authors approved the final version of the manuscript.

Ethical approval

The study protocol was approved by the ethics committee of the ZJCDC.

Additional information

Funding

This work was supported by the Medical Health Science and Technology Project of Zhejiang Province, China under Grants [number 2019KY052 and 2017KY295].