Economic evidence for expansion of HPV vaccination for the prevention of cervical cancer in LMICs: BIA framework construction and empirical analysis in China.

INTRODUCTION

Low- and Middle-Income Countries (LMICs), burdened with a high incidence of cervical cancer, often face challenges in implementing National Immunization Programs (NIP) or Provincial Immunization Programs (PIP) of Human Papillomavirus (HPV) vaccines. In the context of limited resources, the economic evidence provided by Budget Impact Analysis (BIA) becomes crucial for the inclusion of vaccines in the NIP and PIP.

METHODS

This study adopted the perspective of the Basic Medical Insurance System (BMIS) payer, took the imported and domestic bivalent HPV vaccines as the target vaccines. We estimated the effect of HPV vaccines on burden of cervical cancer in China from 2019 to 2110, assuming that there were different reimbursement rates and market substitution rates for the vaccines. This study aimed to establish a comprehensive and standardized BIA framework that can be referenced to promote HPV vaccination in LMICs. Input parameters included vaccine efficacy vs. HPV 16/18, target age group, cancer treatment cost (per episode, over lifetime), discount rate, cohort size at 9 years old and etc., which were mainly derived from public sources, published literature, and a database of field surveys on treatment costs for patients of cervical cancer in China. Main outcomes encompassed incidence and treatment costs of cervical cancer, vaccination costs.

RESULTS

The proposed BIA framework included the target population, BIA, and uncertainty analysis across three scenarios based on origin. In the case of China, without immunization program, the average yearly spent on cervical cancer treatment throughout the country amounts to $6,736,507.32. Upon the execution of the immunization program (2019–2025), this expenditure reduced to $6,645,564.95 each year. Under Scenario 1–3, the vaccine reimbursement costs were $62,513,268.73, $44,927,307.37, and $58,916,163.27, respectively. During the period of immunization program, annual vaccination costs constituted a range of 0.05 to 1.08 parts per million relative to the current expenditure of BMIS fund and 2.68 and 14.12 parts per million relative to current balance of BMIS fund.

CONCLUSION

The BIA framework provided a valuable reference for policy formulation in other LMICs with a high burden of cervical cancer that have not yet included the vaccine in their NIPs.