Cost-Effectiveness of HPV Catch-up Vaccination Program in Women Aged 13-24 Years in Low-and Middle- Income Country

OBJECTIVES: The routine Human Papillomavirus (HPV) vaccination program in Thailand, a member of LMICs, has implemented two doses of quadrivalent HPV vaccine (4vHPV) for girls only at 12 years of age. The catch-up vaccination programs have been successfully implemented in several countries. This study evaluated the cost-effectiveness of expanding the current routine HPV vaccination program to women aged 13-24 years.

METHODS: A Markov model of HPV infection and cervical cancer was adapted to the population and healthcare setting in Thailand. We compared catch-up cohorts of 13- to 24-year-old women vaccinated with (1) bivalent HPV vaccine (2vHPV), (2) 2vHPV (biosimilar), (3) quadrivalent HPV vaccine (4vHPV), (4) nonavalent HPV vaccine (9vHPV), 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 under a healthcare perspective. Extensive sensitivity analyses were performed to ensure robustness of findings.

RESULTS: Compared to no vaccination (status quo), the model showed that catch-up vaccination programs decreased the incidence of cervical cancer cases and cancer-related deaths by 41.0-59.8 % over lifetime. Vaccinating with 2vHPV, 2vHPV (biosimilar), 4vHPV, and 9vHPV resulted in decremental costs of 3,094, 3,378, 3,118 and 2,847 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, 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, compared to 2vHPV (biosimilar).

CONCLUSIONS: All catch-up vaccination programs in women from age of 13 to 24 years produce additional health benefits with reduction in overall healthcare costs. Vaccination with 9vHPV was considered the most cost-effective option with the current willingness-to-pay threshold of 160,000 THB (4,552.50USD) per QALY. (1 USD=33.67 THB).