Abstract
BACKGROUND: The World Health Organization (WHO) released the Global Strategy for Accelerated Elimination of Cervical Cancer (GSAICC), which points out that low- and middle-income countries are in a difficult situation in terms of the cervical cancer prevention challenge, and that the focus should be on the economics of prevention strategies. In the context of cervical cancer screening, it is unclear whether China's self-developed, domestically produced bivalent HPV vaccine is economical compared to quadrivalent and nine-valent HPV vaccines. OBJECTIVES: To evaluate the cost-effectiveness of bivalent HPV vaccine compared with quadrivalent and nine-valent HPV vaccines in China in the context of cervical cancer screening in China, and to provide a basis for the development of cervical cancer prevention policies in China and other developing countries. METHODS: A Markov model was developed to evaluate 121 prevention strategies consisting of different HPV vaccines (bivalent, quadrivalent, and nine-valent) combined with different screening methods and screening frequencies from the perspective of the health care system, and to screen for the optimal prevention strategy that best suits the current situation of women aged 15-26 years in China. Probabilistic sensitivity analysis was used to assess the robustness of the model results. RESULTS: Compared with no intervention, vaccination with a domestic bivalent HPV vaccine combined with three years of visual inspection with acetic acid (VIA) screening (ICER= $144.94/QALYs), vaccination with a quadrivalent HPV vaccine combined with three years of visual inspection (ICER= $643.53/QALYs), and vaccination with a nine-valent HPV vaccine combined with three early VIA screenings (ICER = 582.847 $/QALYs) were the optimal prevention strategies for each of the three valent vaccine types. Comparison of the three optimal prevention strategies showed that for Chinese women aged 15-26 years, vaccination with domestic bivalent HPV vaccine combined with three-year VIA screening was the most cost-effective strategy. Probabilistic sensitivity analyses showed that when willingness to pay was low (WTP < $2,500), the cost-effectiveness of the bivalent HPV vaccination combined with three-year VIA screening strategy was superior to the other strategies, and as willingness to pay increased (WTP >$2,500), the cost-effectiveness of the nine-valent HPV vaccination combined with three-year VIA screening strategy became the most cost-effective prevention strategy. CONCLUSIONS: The cost-effective strategy for each vaccine type was vaccination combined with three-year VIA screening compared with the current situation. Comparing the three optimal strategies, it was found that bivalent HPV vaccine combined with three-year VIA screening is the most cost-effective prevention strategy at this stage when the willingness to pay is low, and with the gradual increase in willingness to pay, the nine-valent HPV vaccine combined with three-year VIA screening will become the optimal prevention strategy. It is recommended that the Chinese government consider gradually increasing the vaccination coverage of domestically produced bivalent HPV vaccines through immunization programs, while promoting preventive measures that combine VIA screening with vaccination. This approach will help developing countries, including China, achieve the goal of eliminating cervical cancer.