Effect Of Vaccination Age On Cost-effectiveness Of Human Papillomavirus Vaccination Against Cervical Cancer In China

Objectives: To estimate the cost-effective(CE) of a 3-dose bivalent HPV vaccination in both pre and post-sexual debut women from 12 to 55 years of age in both rural and urban settings in China. Identify the optimal age range for vaccination and the more CE vaccination catch-up strategy for China. Methods: We used magnitude epidemic and cost data simulating the natural history of HPV infection and including the effect of screening and HPV vaccination over the lifetime of a 100,000 female cohort for 12 years of age in rural and urban China. Screening, diagnosis and treatment costs were collected from a societal perspective with a micro-costing approach to estimate aggregated costs associated with cervical cancer, then updated through a Delphi panel. Vaccine cost was assumed Hong Kong listed price. Vaccine efficacy(VE) was based on the global clinical trial(PATRICIA) data assuming VE irrespective of HPV type at all ages on incident HPV. In the base case analysis, the VE assuming constant across ages. Costs and outcomes were discounted at 3%. Cervical cancer(CC) cases and incremental cost-effectiveness ratio(ICER) for vaccination and screening compared with screening alone were estimated for each vaccination age. Reduced VE in women post-sexual debut were investigated in scenario analyses. Results: With 70% vaccination coverage, a reduction of CC cases varying from 585 to 33 in rural and 691 to 32 in urban were estimated at ages 12 to 55, respectively. Vaccination remains CE up to age 23 in rural and age 25 in urban, as the discounted ICER were lower than the current threshold(3×national GDP 2013/capita=125,723 RMB). Scenario analyses with lower VE post-sexual debut confirmed the results with age 20 in rural and 21 in urban to remain CE. The more ‘catch-up’ cohorts vaccinated at the start of a program, the more pre-cancer and cancer lesions are avoided in the long-term. The addition of the last catch-up cohort of 36-year-old in rural and 38 in urban could still be CE. Conclusions: When using national per capita GDP as threshold and 3% discount rate for costs and outcomes, 14 years old was the optimal age of vaccination for rural and urban population. HPV vaccination program in girls before age 23 in rural and 25 in urban setting was shown to be CE strategies for the prevention of CC in China. Catch-up until the age of 36 years in rural and 38 in urban could still be CE.