Frontiers in public health · 2025
Cost-effectiveness of cervical cancer screening and HPV vaccination: a Markov model from the healthcare payer perspective.
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Liu Weixia, Jing Li, Huang Xiaojun, Huang Hongxin, Jiang Kuan Lie, Lu Wei
Аннотация
BACKGROUND: Substantial progress has been made in cervical cancer screening and HPV vaccination in China. However, evidence on the cost-effectiveness of these interventions remains scarce, particularly for combined vaccination and screening strategies at the provincial level. To address this gap, we evaluated the cost-effectiveness of alternative cervical cancer prevention strategies in a southern province of China from the healthcare payer perspective.
METHODS: A Markov model was constructed to simulate a cohort of 100,000 females beginning at age 9 and followed until death (up to 100 years). The model compared the outcomes of bivalent, quadrivalent, and 9-valent HPV vaccines combined with two screening methods: TCT and HPV testing. Analyses were conducted from the healthcare payer perspective, considering only direct medical costs. The primary outcome was quality-adjusted life years (QALYs), discounted at 3% annually. Herd immunity effects were not incorporated. Model calibration relied on data from the China Health Statistics Yearbook, and sensitivity analyses assessed parameter uncertainty. Reporting followed the CHEERS 2024 guidelines.
RESULTS: Thirteen strategies were evaluated, including no intervention, screening alone, and combinations of screening with the three HPV vaccines. The combination of HPV testing and the 9-valent vaccine was the most cost-effective, with an incremental cost-effectiveness ratio (ICER) of ¥139.58 per QALY, well below the willingness-to-pay threshold. By contrast, TCT combined with the 9-valent vaccine yielded the highest ICER at ¥193,240.60 per QALY, exceeding the threshold. Sensitivity analyses showed ICER estimates were most influenced by screening coverage, vaccination uptake, test sensitivity, and the discount rate.
CONCLUSION: Within the current resource and policy context, combining HPV testing with the 9-valent vaccine provides the highest economic value. This strategy offers evidence to guide future cervical cancer prevention policies in southern China.
METHODS: A Markov model was constructed to simulate a cohort of 100,000 females beginning at age 9 and followed until death (up to 100 years). The model compared the outcomes of bivalent, quadrivalent, and 9-valent HPV vaccines combined with two screening methods: TCT and HPV testing. Analyses were conducted from the healthcare payer perspective, considering only direct medical costs. The primary outcome was quality-adjusted life years (QALYs), discounted at 3% annually. Herd immunity effects were not incorporated. Model calibration relied on data from the China Health Statistics Yearbook, and sensitivity analyses assessed parameter uncertainty. Reporting followed the CHEERS 2024 guidelines.
RESULTS: Thirteen strategies were evaluated, including no intervention, screening alone, and combinations of screening with the three HPV vaccines. The combination of HPV testing and the 9-valent vaccine was the most cost-effective, with an incremental cost-effectiveness ratio (ICER) of ¥139.58 per QALY, well below the willingness-to-pay threshold. By contrast, TCT combined with the 9-valent vaccine yielded the highest ICER at ¥193,240.60 per QALY, exceeding the threshold. Sensitivity analyses showed ICER estimates were most influenced by screening coverage, vaccination uptake, test sensitivity, and the discount rate.
CONCLUSION: Within the current resource and policy context, combining HPV testing with the 9-valent vaccine provides the highest economic value. This strategy offers evidence to guide future cervical cancer prevention policies in southern China.