OBJECTIVES

: Human papillomavirus (HPV) is the main cause of cervical cancer (CC), the third most common cancer for females in Malaysia. With low cytology screening rate (22%) in Malaysia, the disease burden of cervical cancer is substantial.To assess the public health impact and cost-effectiveness of vaccination with a nine-valent HPV (6/11/16/18/31/33/45/52/58) vaccine (9vHPV) program for adolescent females in Malaysia.

METHODS

: Using Malaysian data, a validated HPV dynamic transmission model was used to evaluate the public health impact, disease management cost, and cost-effectiveness of school-based vaccination programs with 90% coverage among 13-year-old female students. We evaluated the following strategies (combined with CC screening): vaccination with 9vHPV compared to vaccination with quadrivalent HPV vaccine (4vHPV), or vaccination with bivalent vaccine (2vHPV). We considered HPV-related cervical intraepithelial neoplasia (CIN) , CC, lesions, and genital warts, a 100 year time-horizon, a 3% discount rate and a cost-effectiveness threshold of RM$125,886 (3xRM41,962 (2017 GDP-per-capita)).

RESULTS

: Vaccination of 13-year old female students with 9vHPV resulted in 293, 099 and 40,922 fewer cases of CIN2/3 and CC, respectively, compared with vaccination with 4vHPV or with 2vHPV. Vaccination with 9vHPV resulted in 142,944 and 346,252 fewer cases of CIN1 compared with vaccination with 4vHPV or 2vHPV, respectively, and 2,460,758 fewer cases of genital warts compared to 2vHPV. It also resulted in disease management costs reductions of RM$89,580,555 and RM$1,201,631,851 compared with vaccination with 4vHPV or vaccination with 2vHPV, respectively. The incremental cost-effectiveness ratio (ICER) of vaccination with 9vHPV compared to vaccination with 4vHPV and vaccination or 2vHPV was RM$25,777/QALY-gained, and RM$13,038/QALY-gained, respectively.

CONCLUSIONS

: Vaccinating 13-year old female students with 9vHPV had a better public health impact, and lower disease management costs, compared with vaccinating females with 4vHPV or 2vHPV. Vaccination of 13-year-old females in Malaysia with 9vHPV is very cost-effective regardless of the comparator.