Domestic HPV vaccine price and economic returns for cervical cancer prevention in China: a cost-effectiveness analysis

Abstract

Background Coinciding with the release of the first Chinese domestic human papillomavirus (HPV) vaccine Cecolin in 2019, and the substantial advancements in cervical cancer screening technology, we aimed to evaluate the costeffectiveness of the combined strategies of cervical cancer screening programmes and universal vaccination of girls (aged 9-14 years) with Cecolin in China.Methods We did a cost-effectiveness analysis in China, in which we developed a Markov model of cervical cancer to evaluate the incremental cost-effectiveness ratios of 61 intervention strategies, including a combination of various screening methods at different frequencies with and without vaccination, and also vaccination alone, from a healthcare system perspective. We did univariate and probabilistic sensitivity analyses to assess the robustness of the model's findings.Findings Compared with no intervention, various combined screening and vaccination strategies would incur an additional cost of US$6 157 000-22 146 000 and result in 691-970 quality-adjusted life-years (QALYs) gained in a designated cohort of 100 000 girls aged 9-14 years over a lifetime. With a willingness-to-pay threshold of three times the Chinese per-capita gross domestic product (GDP), careHPV screening (a rapid HPV test) once every 5 years with vaccination would be the most cost-effective strategy with an incremental cost-effectiveness ratio of $21 799 per QALY compared with the lower-cost non-dominated strategy on the cost-effectiveness frontier, and the probability of it being cost-effective (44%) outperformed other strategies. Strategies that combined screening and vaccination would be more cost-effective than screening alone strategies when the vaccination cost was less than $50 for two doses, even with a lower willingness-to-pay of one times the per-capita GDP.Interpretation careHPV screening once every 5 years with vaccination is the most cost-effective strategy for cervical cancer prevention in China. A reduction in the domestic HPV vaccine price is necessary to ascertain a good economic return for the future vaccination programme. The findings provide important evidence that informs health policies for cervical cancer prevention in China.

Human papillomavirus vaccination uptake in low-and middle-income countries: a meta-analysis

“…Among the studies, only two from China reported the use of Gardasil-9 which is relatively costlier given its protection against nine types of HPV while the rest reported using the bivalent or quadrivalent vaccines [54,55]. Beginning in 2020, the fourth HPV vaccine product Cecolin was approved by the Chinese Food and Drug Administration and was found cost-effective in cervical cancer prevention in China [4] where the Cecolin is priced at US dollar 47.7 per dose while the imported Cervarix is priced at US dollar 262 for three doses, Gardasil at US dollar 360 for three doses and Gardasil-9 at US dollar 586 for three doses [4].…”

“…There are four vaccines against the HPV: the quadrivalent (4vHPV) Gardasil approved in 2006, bivalent (2vHPV) Cervarix approved in Abbreviations: 2vHPV, bivalent HPV vaccine; 4vHPV, quadrivalent HPV vaccine; 9vHPV, 9-valent HPV vaccine; CENTRAL, cochrane central register of controlled trials; CI, confidence interval; CIN2+, cervical intra-epithelial neoplasia grade II; EMBASE, excerpta medica dataBASE; GNI, gross national income; HPV, human papillomavirus; LMICs, Low-and middle-income countries; MSM, men having sex with men; RR, relative risk; STROBE, strengthening the reporting of observational studies in epidemiology; US, United States; WHO, World Health Organization 2010, 9-valent (9vHPV) Gardasil-9 approved in 2014 and the bivalent Cecolin approved in China in 2019 [3,4]. All vaccines are effective against the high-risk HPV 16/18 while Gardasil has additional coverage against HPV 6/11 and Gardasil-9 against HPV 6/11/31/33/45/52/ 58 [3].…”

Willingness to Accept Human Papillomavirus Vaccination and its Influencing Factors Using Information–Motivation–Behavior Skills Model: A Cross-Sectional Study of Female College Freshmen in Mainland China

“… 43 Recently, as the first Chinese domestic-made 2-valent HPV vaccine (Cecolin, Innovax, Xiamen, China) was approved by Chinese FDA, additional efforts should be taken to relieve hesitation regarding the vaccine and use the opportunity to expand vaccine supply and reduce vaccine prices. 44 , 45 If feasible, HPV vaccines for young girls should be guaranteed initially, followed by a “catch-up” vaccination program for young women, and the government should finally integrate HPV vaccination into the national immunization program.…”

Advantages of 3PLs as healthcare supply chain orchestrators

“…In each model, the retailer confronts a random demand sales season, which is highly dependent on the pricing factor, noting that this assumption is consistent with the reality of many situations, such as over-the-counter medicines and self-funded vaccines (e.g., HPV vaccines) ( Zou et al, 2020 ). As discussed in Sarmah, De Giovanni, and De Giovanni (2020) and analyzed by Ching (2010) , the price swings between patented and generic drugs are a key driving force of consumers’ buying decisions in the pharmaceutical industry.…”