The cost-effectiveness of a quadrivalent human papillomavirus vaccine in Taiwan

Abstract

Background: A quadrivalent human papillomavirus (HPV 6/11/16/18) vaccine has recently received regulatory approval in Taiwan for the prevention of cervical carcinoma, high-grade cervical dysplasia (cervical intraepithelial neoplasia 2/3 [CIN 2/3]), low-grade cervical dysplasia (CIN 1), high-grade vulvar and vaginal dysplasia, and external genital warts. Objective: To examine the potential long-term epidemiologic and economic consequences of a quadrivalent HPV (6/11/16/18) vaccination program in Taiwan. Methods: A transmission dynamic model was used to estimate the long-term epidemiologic and economic consequences of quadrivalent HPV vaccination. Two vaccination strategies were evaluated in conjunction with current cervical cancer screening: 1) vaccination of 12-year-old girls and 2) vaccination of 12-year-old girls with a temporary 5-year catch-up vaccination of females aged 12-24 years (catch-up). Results: From an epidemiologic perspective, both vaccination strategies reduce the overall incidence of HPV 16/18-related cervical cancer relative to no vaccination by 91% during year 100 following vaccine introduction. Likewise, both vaccination strategies reduce the incidence of CIN 2/3, CIN 1, and genital warts by ~90%, 86%, and 94%, respectively, at this time point. However, the catch-up program consistently achieves greater benefit earlier than the 12-year-old program. The catch-up strategy is both more effective and efficient than the strategy that vaccinates 12-year-old girls only, with an incremental cost-effectiveness ratio of New Taiwan dollars (NT$) 410,477 per quality-adjusted life-year gained. Conclusions: The results from this model suggest that in Taiwan, prophylactic HPV 6/11/16/18 vaccination of females can 1) substantially reduce genital warts, CIN, and cervical cancer, 2) improve quality of life and survival, and 3) be cost-effective when implemented as a vaccination strategy that includes a temporary catch-up program.