Human papillomavirus vaccination at the national and provincial levels in China: a cost-effectiveness analysis using the PRIME model

Abstract

Background Human papillomavirus (HPV) vaccines have been proven effective against cervical cancer. However, HPV vaccination is not included in the Chinese immunization program. This study aimed to assess the cost-effectiveness of incorporating different HPV vaccines into immunization programs at the Chinese national and provincial levels. Methods The Papillomavirus Rapid Interface for Modeling and Economics model was used to estimate the possible cost and social and economic benefits of adopting various HPV vaccination immunization strategies in 31 provinces in Mainland China in 2019. Demographic and regional economic data were obtained from the national and provincial Statistical Yearbook. The cost of vaccines was gathered from the centralized procurement information platform of all Chinese provinces. Treatment costs, epidemiological data, and other model parameters were obtained from published literature. The cost of vaccination, treatment costs saved, net costs, cases and deaths averted, life years saved, disability-adjusted life years (DALYs) prevented, and incremental cost-effectiveness ratios were predicted both provincially and nationally. Deterministic sensitivity analyses were used to explore model uncertainty. Results The net cost of vaccinating with the domestic bivalent HPV vaccine was the lowest. At the national level, after bivalent or quadrivalent HPV vaccination, the number of cases and deaths averted due to cervical cancer were 12,545 and 5109, respectively, whereas the 9-valent HPV vaccine averted 28,140 cases and 11,459 deaths. HPV vaccines were cost-effective at a national level (maximum cost US$ 18,165 per DALY gained.) compared to the 3 times GDP per capita (US$ 30,837). Bivalent HPV vaccines were cost-effective in all 31 provinces. Imported quadrivalent and 9-valent HPV vaccines were cost-effective in 29 provinces, except Heilongjiang and Gansu. The univariate sensitivity analysis showed that the results were robust when the model parameters were changed, and that the discount rate was the main factor affecting the baseline results. Conclusions This study provides evidence that the inclusion of HPV vaccination in the immunization program would be cost-effective at a national level and in most provinces. Provinces with a higher population have more prevented cases, deaths, and DALYs. The economics of HPV vaccination at the provincial level differs from that at the national level, and provinces with an inability to pay should seek help from state subsidies.

Extended human papillomavirus genotype distribution in cervical intraepithelial neoplasia and cancer: Analysis of 40 352 cases from a large academic gynecologic center in China

“…Although several HPV vaccines are available in China, they have not yet been officially included in the national vaccination program 15–18 . Additionally, financial and psychosocial barriers inevitably exist for those interested in electing to receive the vaccine in different regions and provinces 17,19–21 . In our large cohort, we identified 80.3% of patients with SCC, ADC, ADSQ, or SNEC who were positive for HPV genotypes 16/18 and 89.6% of patients who were positive for genotypes 16/18/31/33/45/52/58.…”

“…[12][13][14] Although HPV vaccines are available in China and have been approved by the Chinese Food and Drug Administration (CFDA), including several foreign HPV vaccines (Cervarix, Gardasil ® , and Gardasil-9 ® ) and two domestic bivalent HPV vaccines (Cecolin, Xiamen Innovax Biotech Co, Ltd; Walrinvax, Yuxi Walvax Biotech Co, Ltd.), they have not yet been included in the official national vaccination program. 11,[15][16][17][18] In some experimental cities, the HPV vaccines have been added to the vaccination program only for young girls (e.g., 13-14-year-old girls in Chengdu) recently. Financial and psychosocial barriers have limited implementing more widespread vaccination.…”

“…17,[19][20][21] In our large cohort, we identified 80.3% of patients with SCC, ADC, ADSQ, or SNEC who were positive for HPV genotypes 16/18 and 89.6% of patients who were positive for genotypes 16/18/31/33/45/52/58. Cervical cancer in 80%-90% of these patients could theoretically have been prevented by the…”

FIGO guidance for sustainable implementation of vaccination programs for women: Pregnancy and HPV

“…There are currently five types of HPV vaccine available for Chinese women, including two independently developed bivalent vaccines with national approval 15 . However, HPV vaccination is not currently included in the national immunization program 21 . According to a 2021 survey, only 3% of all women and less than 2% of girls aged 9–14 years in China received the HPV vaccine 22 .…”

“…15 However, HPV vaccination is not currently included in the national immunization program. 21 According to a 2021 survey, only 3% of all women and less than 2% of girls aged 9-14 years in China received the HPV vaccine. 22 Research suggests that uptake in China could be improved by the integration of HPV vaccination for girls into the national immunization program, as well as the consideration of a one-dose schedule in supply-constrained contexts (and multi-age cohort vaccination for catch-up of older age groups).…”