Cost-effectiveness analysis of AS04-adjuvanted human papillomavirus 16/18 vaccine compared with human papillomavirus 6/11/16/18 vaccine in the Philippines, with the new 2-dose schedule

Abstract

Cervical cancer (CC) is the second leading cause of cancer death among Filipino women. Human papillomavirus (HPV) vaccination protects against CC. Two vaccines (AS04-HPV-16/18 and 4vHPV) are approved in the Philippines; they were originally developed for a 3-dose (3D) administration and have recently been approved in a 2-dose schedule (2D). This study aims to evaluate the cost-effectiveness of HPV vaccination of 13-year-old Filipino girls, in addition to current screening, in the new 2D schedule. An existing static lifetime, one-year cycle Markov cohort model was adapted to the Philippine settings to simulate the natural history of low-risk and oncogenic HPV infection, the effects of screening and vaccination of a 13-year-old girls cohort vaccinated with either the 2D-AS04-HPV-16/18 or 2D-4vHPV assuming a 100% vaccination coverage. Incremental cost, quality-adjusted life year (QALY) and cost-effectiveness were derived from these estimates. Input data were obtained from published sources and Delphi panel, using country-specific data where possible. Sensitivity analyses were performed to assess the robustness of the model. The model estimated that 2D-AS04-HPV-16/18 prevented 986 additional CC cases and 399 CC deaths (undiscounted), as well as 555 increased QALY (discounted), and save 228.1 million Philippine pesos (PHP) compared with the 2D-4vHPV. In conclusion, AS04-HPV-16/18 is shown to be dominant over 4vHPV in the Philippines, with greater estimated health benefits and lower costs.

Inclusion of Additional Unintended Consequences in Economic Evaluation: A Systematic Review of Immunization and Tuberculosis Cost-Effectiveness Analyses

“…HPV: We identified four HPV vaccine CEAs that included cross-protection. Setiawan et al [ 68 ], Bardach et al [ 69 ], Germar et al [ 70 ], and Van Kriekinge et al [ 71 ] assumed an effect of cross-protection against HPV types at various percentages of vaccine efficacy.…”

Current Status of Human Papillomavirus Infection and Cervical Cancer in the Philippines

“…There are limited studies assessing the implementation of the national HPV immunization program. A cost-effectiveness analysis done in 2017, which has yet to be taken into consideration by the implementing health agency, found that the 2-dose bivalent HPV vaccine administration to 13-year-old Filipino girls prevented additional 986 cervical cancer cases and 399 deaths from cervical cancer, with 555 additional quality-adjusted life-year compared to the 2-dose quadrivalent vaccine ( 121 ). It also would result in lower health costs, saving PHP 228.1 million (approximately USD 4.4 million).…”

Estimating the EQ-5D-5L value set for the Philippines

“…In the absence of its country-specific value set, it has been a common practice for cost-effectiveness analyses (CEAs) in the Philippines to use either the Thai value set or the disability adjusted life years (DALY) [19][20][21][22]. The practice weakens the validity of these CEAs as there are socio-cultural differences between Thailand and the Philippines, which in turn could make the Thai value set an inappropriate proxy for the Philippine value set.…”