Cost-effectiveness of HPV catch-up vaccination program in women aged 13-24 years in a middle income country.

OBJECTIVE

This study evaluated the cost-effectiveness of expanding the current routine human papillomavirus (HPV) vaccination program to women aged 13-24 years in Thailand.

METHODS

A Markov model of HPV infection and cervical cancer was adapted. We compared catch-up cohorts of 13- to 24-year-old women vaccinated with (1) bivalent HPV vaccine (Cervarix®), (2) 2vHPV (Cecolin®), (3) quadrivalent HPV vaccine (Gardasil®), (4) nonavalent HPV vaccine (Gardasil9®), and (5) no vaccination. The outcomes included the number of new cancer cases, cancer-related deaths, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) of each strategy from a healthcare perspective. Extensive sensitivity analyses were performed to ensure the robustness of the findings.

RESULTS

Compared to no vaccination, the catch-up vaccination programs decreased the incidence of cervical cancer cases and cancer-related deaths 44.8%-63.4% over a lifetime. Vaccinating with 2vHPV (Cervarix®), 2vHPV (Cecolin®), 4vHPV (Gardasil®), and 9vHPV (Gardasil9®) resulted in decremental costs of 3,093.53, 3,377.94, 3,117.78 and 2,846.59 Thai baht (THB) (88.03, 96.11, 88.72, 81.01 USD) per capita and incremental benefits of 0.29, 0.30, 0.32 and 0.45 QALYs per capita, compared to no vaccination, respectively. Based on the incremental analysis, after excluding extended dominated comparators, 9vHPV was the most cost-effective intervention with the ICER of 3,661.38 THB (104.19 USD) per QALY, given the current willingness-to-pay threshold of 160,000 THB (4,552.50 USD) per QALY (1 USD=33.67 THB).

CONCLUSION

All catch-up vaccination programs for women aged 13 to 24 years produce additional health benefits and reduce healthcare costs. Vaccination with 9vHPV was considered the most cost-effective option.