Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2010

Open Access 01-12-2010 | Research article

Cost-effectiveness of human papillomavirus vaccination for prevention of cervical cancer in Taiwan

Authors: Pang-Hsiang Liu, Fu-Chang Hu, Ping-Ing Lee, Song-Nan Chow, Chao-Wan Huang, Jung-Der Wang

Published in: BMC Health Services Research | Issue 1/2010

Login to get access

Abstract

Background

Human papillomavirus (HPV) infection has been shown to be a major risk factor for cervical cancer. Vaccines against HPV-16 and HPV-18 are highly effective in preventing type-specific HPV infections and related cervical lesions. There is, however, limited data available describing the health and economic impacts of HPV vaccination in Taiwan. The objective of this study was to assess the cost-effectiveness of prophylactic HPV vaccination for the prevention of cervical cancer in Taiwan.

Methods

We developed a Markov model to compare the health and economic outcomes of vaccinating preadolescent girls (at the age of 12 years) for the prevention of cervical cancer with current practice, including cervical cytological screening. Data were synthesized from published papers or reports, and whenever possible, those specific to Taiwan were used. Sensitivity analyses were performed to account for important uncertainties and different vaccination scenarios.

Results

Under the assumption that the HPV vaccine could provide lifelong protection, the massive vaccination among preadolescent girls in Taiwan would lead to reduction in 73.3% of the total incident cervical cancer cases and would result in a life expectancy gain of 4.9 days or 8.7 quality-adjusted life days at a cost of US$324 as compared to the current practice. The incremental cost-effectiveness ratio (ICER) was US$23,939 per life year gained or US$13,674 per quality-adjusted life year (QALY) gained given the discount rate of 3%. Sensitivity analyses showed that this ICER would remain below US$30,000 per QALY under most conditions, even when vaccine efficacy was suboptimal or when vaccine-induced immunity required booster shots every 13 years.

Conclusions

Although gains in life expectancy may be modest at the individual level, the results indicate that prophylactic HPV vaccination of preadolescent girls in Taiwan would result in substantial population benefits with a favorable cost-effectiveness ratio. Nevertheless, we should not overlook the urgency to improve the compliance rate of cervical screening, particularly for older individuals.
Appendix
Available only for authorised users
Literature
1.
Pap Smear Screening Registry System Annual Report, 2007. 2008, Taipei: Bureau of Health Promotion, Department of Health, Taiwan
2.
Tay SK, Ngan HY, Chu TY, Cheung AN, Tay EH: Epidemiology of human papillomavirus infection and cervical cancer and future perspectives in Hong Kong, Singapore and Taiwan. Vaccine. 2008, 26 (Suppl 12): M60-70. 10.1016/j.vaccine.2008.05.042.CrossRefPubMed
3.
4.
Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, Snijders PJ, Peto J, Meijer CJ, Munoz N: Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999, 189 (1): 12-19. 10.1002/(SICI)1096-9896(199909)189:1<12::AID-PATH431>3.0.CO;2-F.CrossRefPubMed
5.
Franco EL, Rohan TE, Villa LL: Epidemiologic evidence and human papillomavirus infection as a necessary cause of cervical cancer. J Natl Cancer Inst. 1999, 91 (6): 506-511. 10.1093/jnci/91.6.506.CrossRefPubMed
6.
Jeng CJ, Phdl , Ko ML, Ling QD, Shen J, Lin HW, Tzeng CR, Ho CM, Chien TY, Chen SC: Prevalence of cervical human papillomavirus in Taiwanese women. Clin Invest Med. 2005, 28 (5): 261-266.PubMed
7.
Lin H, Ma YY, Moh JS, Ou YC, Shen SY, ChangChien CC: High prevalence of genital human papillomavirus type 52 and 58 infection in women attending gynecologic practitioners in South Taiwan. Gynecol Oncol. 2006, 101 (1): 40-45. 10.1016/j.ygyno.2005.09.028.CrossRefPubMed
8.
Chao A, Hsu KH, Lai CH, Huang HJ, Hsueh S, Lin SR, Jung SM, Chao FY, Huang SL, Huang CC, et al: Cervical cancer screening program integrating Pap smear and HPV DNA testing: a population-based study. Int J Cancer. 2008, 122 (12): 2835-2841. 10.1002/ijc.23441.CrossRefPubMed
9.
Ding DC, Hsu HC, Huang RL, Lai HC, Lin CY, Yu MH, Chu TY: Type-specific distribution of HPV along the full spectrum of cervical carcinogenesis in Taiwan: an indication of viral oncogenic potential. Eur J Obstet Gynecol Reprod Biol. 2008, 140 (2): 245-251. 10.1016/j.ejogrb.2008.03.014.CrossRefPubMed
10.
Paavonen J, Jenkins D, Bosch FX, Naud P, Salmeron J, Wheeler CM, Chow SN, Apter DL, Kitchener HC, Castellsague X, et al: Efficacy of a prophylactic adjuvanted bivalent L1 virus-like-particle vaccine against infection with human papillomavirus types 16 and 18 in young women: an interim analysis of a phase III double-blind, randomised controlled trial. Lancet. 2007, 369 (9580): 2161-2170. 10.1016/S0140-6736(07)60946-5.CrossRefPubMed
11.
Paavonen J, Naud P, Salmeron J, Wheeler CM, Chow SN, Apter D, Kitchener H, Castellsague X, Teixeira JC, Skinner SR, et al: Efficacy of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA): final analysis of a double-blind, randomised study in young women. Lancet. 2009, 374 (9686): 301-314. 10.1016/S0140-6736(09)61248-4.CrossRefPubMed
12.
Villa LL, Costa RL, Petta CA, Andrade RP, Ault KA, Giuliano AR, Wheeler CM, Koutsky LA, Malm C, Lehtinen M, et al: Prophylactic quadrivalent human papillomavirus (types 6, 11, 16, and 18) L1 virus-like particle vaccine in young women: a randomised double-blind placebo-controlled multicentre phase II efficacy trial. Lancet Oncol. 2005, 6 (5): 271-278. 10.1016/S1470-2045(05)70101-7.CrossRefPubMed
13.
14.
Goldie SJ, Kohli M, Grima D, Weinstein MC, Wright TC, Bosch FX, Franco E: Projected clinical benefits and cost-effectiveness of a human papillomavirus 16/18 vaccine. J Natl Cancer Inst. 2004, 96 (8): 604-615. 10.1093/jnci/djh104.CrossRefPubMed
15.
16.
Brisson M, Velde Van de N, De Wals P, Boily MC: The potential cost-effectiveness of prophylactic human papillomavirus vaccines in Canada. Vaccine. 2007, 25 (29): 5399-5408. 10.1016/j.vaccine.2007.04.086.CrossRefPubMed
17.
Elbasha EH, Dasbach EJ, Insinga RP: Model for assessing human papillomavirus vaccination strategies. Emerg Infect Dis. 2007, 13 (1): 28-41. 10.3201/eid1301.060438.CrossRefPubMedPubMedCentral
18.
Insinga RP, Dasbach EJ, Elbasha EH, Puig A, Reynales-Shigematsu LM: Cost-effectiveness of quadrivalent human papillomavirus (HPV) vaccination in Mexico: a transmission dynamic model-based evaluation. Vaccine. 2007, 26 (1): 128-139. 10.1016/j.vaccine.2007.10.056.CrossRefPubMed
19.
Kulasingam S, Connelly L, Conway E, Hocking JS, Myers E, Regan DG, Roder D, Ross J, Wain G: A cost-effectiveness analysis of adding a human papillomavirus vaccine to the Australian National Cervical Cancer Screening Program. Sex Health. 2007, 4 (3): 165-175. 10.1071/SH07043.CrossRefPubMed
20.
Bergeron C, Largeron N, McAllister R, Mathevet P, Remy V: Cost-effectiveness analysis of the introduction of a quadrivalent human papillomavirus vaccine in France. Int J Technol Assess Health Care. 2008, 24 (1): 10-19. 10.1017/S0266462307080026.CrossRefPubMed
21.
Chesson HW, Ekwueme DU, Saraiya M, Markowitz LE: Cost-effectiveness of human papillomavirus vaccination in the United States. Emerg Infect Dis. 2008, 14 (2): 244-251. 10.3201/eid1402.070499.CrossRefPubMedPubMedCentral
22.
23.
Kim JJ, Goldie SJ: Health and economic implications of HPV vaccination in the United States. N Engl J Med. 2008, 359 (8): 821-832. 10.1056/NEJMsa0707052.CrossRefPubMedPubMedCentral
24.
Kulasingam SL, Benard S, Barnabas RV, Largeron N, Myers ER: Adding a quadrivalent human papillomavirus vaccine to the UK cervical cancer screening programme: A cost-effectiveness analysis. Cost Eff Resour Alloc. 2008, 6: 4-10.1186/1478-7547-6-4.CrossRefPubMedPubMedCentral
25.
Ginsberg GM, Fisher M, Ben-Shahar I, Bornstein J: Cost-utility analysis of vaccination against HPV in Israel. Vaccine. 2007, 25 (37-38): 6677-6691. 10.1016/j.vaccine.2007.07.018.CrossRefPubMed
26.
de Kok IM, van Ballegooijen M, Habbema JD: Cost-effectiveness analysis of human papillomavirus vaccination in the Netherlands. J Natl Cancer Inst. 2009, 101 (15): 1083-1092. 10.1093/jnci/djp183.CrossRefPubMed
27.
Puig-Junoy J, Lopez-Valcarcel BG: Economic evaluations of massive HPV vaccination: within-study and between study variations in incremental cost per QALY gained. Prev Med. 2009, 48 (5): 444-448. 10.1016/j.ypmed.2009.02.011.CrossRefPubMed
28.
Dasbach EJ, Insinga RP, Yang YC, Pwu RF, Lac C, Elbasha EH: The cost-effectiveness of a quadrivalent human papillomavirus vaccine in Taiwan. Asian Pac J Cancer Prev. 2008, 9 (3): 459-466.PubMed
29.
Debicki D, Ferko N, Demarteau N, Gallivan S, Bauch C, Anonychuk A, Mantovani L, Capri S, Chou CY, Standaert B, et al: Comparison of detailed and succinct cohort modelling approaches in a multi-regional evaluation of cervical cancer vaccination. Vaccine. 2008, 26 (Suppl 5): F16-28. 10.1016/j.vaccine.2008.02.040.CrossRefPubMed
30.
Sonnenberg FA, Beck JR: Markov models in medical decision making: a practical guide. Med Decis Making. 1993, 13 (4): 322-338. 10.1177/0272989X9301300409.CrossRefPubMed
31.
Cuzick J, Szarewski A, Terry G, Ho L, Hanby A, Maddox P, Anderson M, Kocjan G, Steele ST, Guillebaud J: Human papillomavirus testing in primary cervical screening. Lancet. 1995, 345 (8964): 1533-1536. 10.1016/S0140-6736(95)91086-7.CrossRefPubMed
32.
Fahey MT, Irwig L, Macaskill P: Meta-analysis of Pap test accuracy. Am J Epidemiol. 1995, 141 (7): 680-689.PubMed
33.
Goodman MT, Shvetsov YB, McDuffie K, Wilkens LR, Zhu X, Thompson PJ, Ning L, Killeen J, Kamemoto L, Hernandez BY: Prevalence, acquisition, and clearance of cervical human papillomavirus infection among women with normal cytology: Hawaii Human Papillomavirus Cohort Study. Cancer Res. 2008, 68 (21): 8813-8824. 10.1158/0008-5472.CAN-08-1380.CrossRefPubMedPubMedCentral
34.
Rodriguez AC, Burk R, Herrero R, Hildesheim A, Bratti C, Sherman ME, Solomon D, Guillen D, Alfaro M, Viscidi R, et al: The natural history of human papillomavirus infection and cervical intraepithelial neoplasia among young women in the Guanacaste cohort shortly after initiation of sexual life. Sex Transm Dis. 2007, 34 (7): 494-502.PubMed
35.
Moscicki AB, Shiboski S, Broering J, Powell K, Clayton L, Jay N, Darragh TM, Brescia R, Kanowitz S, Miller SB, et al: The natural history of human papillomavirus infection as measured by repeated DNA testing in adolescent and young women. J Pediatr. 1998, 132 (2): 277-284. 10.1016/S0022-3476(98)70445-7.CrossRefPubMed
36.
Ho GY, Bierman R, Beardsley L, Chang CJ, Burk RD: Natural history of cervicovaginal papillomavirus infection in young women. N Engl J Med. 1998, 338 (7): 423-428. 10.1056/NEJM199802123380703.CrossRefPubMed
37.
Hildesheim A, Schiffman MH, Gravitt PE, Glass AG, Greer CE, Zhang T, Scott DR, Rush BB, Lawler P, Sherman ME, et al: Persistence of type-specific human papillomavirus infection among cytologically normal women. J Infect Dis. 1994, 169 (2): 235-240.CrossRefPubMed
38.
Franco EL, Villa LL, Sobrinho JP, Prado JM, Rousseau MC, Desy M, Rohan TE: Epidemiology of acquisition and clearance of cervical human papillomavirus infection in women from a high-risk area for cervical cancer. J Infect Dis. 1999, 180 (5): 1415-1423. 10.1086/315086.CrossRefPubMed
39.
Koong SL, Yen AM, Chen TH: Efficacy and cost-effectiveness of nationwide cervical cancer screening in Taiwan. J Med Screen. 2006, 13 (Suppl 1): S44-47.PubMed
40.
Stratton KR, Durch JS, Lawrence RS, Eds: Vaccines for the 21st Century: A Tool for Decisionmaking. 2000, Washington: National Academy Press
41.
Tang CH, Pwu RF, Tsai IC, Wang HI, You SL, Chen CA, Scuffham PA, Hsieh CY, Chou CY, Lin SR, et al: Costs of cervical cancer and precancerous lesions treatment in a publicly financed health care system. Arch Gynecol Obstet.
42.
Liaw KL, Hsing AW, Schiffman MH, You SL, Zhang T, Burk R, Chen CJ: Human papillomavirus types 52 and 58 are prevalent in cervical cancer from Chinese women. Int J Cancer. 1997, 73 (5): 775-776. 10.1002/(SICI)1097-0215(19971127)73:5<775::AID-IJC27>3.0.CO;2-3.CrossRefPubMed
43.
Making choices in health: WHO guide to cost-effectiveness analysis. 2003, Geneva: World Health Organisation
44.
Newall AT, Beutels P, Wood JG, Edmunds WJ, MacIntyre CR: Cost-effectiveness analyses of human papillomavirus vaccination. Lancet Infect Dis. 2007, 7 (4): 289-296. 10.1016/S1473-3099(07)70083-X.CrossRefPubMed
45.
Brisson M, Edmunds WJ: Economic evaluation of vaccination programs: the impact of herd-immunity. Med Decis Making. 2003, 23 (1): 76-82. 10.1177/0272989X02239651.CrossRefPubMed
46.
Harper DM, Franco EL, Wheeler CM, Moscicki AB, Romanowski B, Roteli-Martins CM, Jenkins D, Schuind A, Costa Clemens SA, Dubin G: Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised control trial. Lancet. 2006, 367 (9518): 1247-1255. 10.1016/S0140-6736(06)68439-0.CrossRefPubMed
47.
Villa LL, Costa RL, Petta CA, Andrade RP, Paavonen J, Iversen OE, Olsson SE, Hoye J, Steinwall M, Riis-Johannessen G, et al: High sustained efficacy of a prophylactic quadrivalent human papillomavirus types 6/11/16/18 L1 virus-like particle vaccine through 5 years of follow-up. Br J Cancer. 2006, 95 (11): 1459-1466. 10.1038/sj.bjc.6603469.CrossRefPubMedPubMedCentral
48.
Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. 2007, 356 (19): 1915-1927. 10.1056/NEJMoa061741.
49.
Markowitz LE, Dunne EF, Saraiya M, Lawson HW, Chesson H, Unger ER: Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2007, 56 (RR-2): 1-24.PubMed
50.
Liaw KL, Hsing AW, Chen CJ, Schiffman MH, Zhang TY, Hsieh CY, Greer CE, You SL, Huang TW, Wu TC, et al: Human papillomavirus and cervical neoplasia: a case-control study in Taiwan. Int J Cancer. 1995, 62 (5): 565-571. 10.1002/ijc.2910620513.CrossRefPubMed
51.
Liaw KL, Glass AG, Manos MM, Greer CE, Scott DR, Sherman M, Burk RD, Kurman RJ, Wacholder S, Rush BB, et al: Detection of human papillomavirus DNA in cytologically normal women and subsequent cervical squamous intraepithelial lesions. J Natl Cancer Inst. 1999, 91 (11): 954-960. 10.1093/jnci/91.11.954.CrossRefPubMed
52.
Chen CA, Liu CY, Chou HH, Chou CY, Ho CM, Twu NF, Kan YY, Chuang MH, Chu TY, Hsieh CY: The distribution and differential risks of human papillomavirus genotypes in cervical preinvasive lesions: A Taiwan Cooperative Oncologic Group Study. Int J Gynecol Cancer. 2006, 16 (5): 1801-1808. 10.1111/j.1525-1438.2006.00655.x.CrossRefPubMed
53.
Herrero R, Castle PE, Schiffman M, Bratti MC, Hildesheim A, Morales J, Alfaro M, Sherman ME, Wacholder S, Chen S, et al: Epidemiologic profile of type-specific human papillomavirus infection and cervical neoplasia in Guanacaste, Costa Rica. J Infect Dis. 2005, 191 (11): 1796-1807. 10.1086/428850.CrossRefPubMed
54.
Myers ER, McCrory DC, Nanda K, Bastian L, Matchar DB: Mathematical model for the natural history of human papillomavirus infection and cervical carcinogenesis. Am J Epidemiol. 2000, 151 (12): 1158-1171.CrossRefPubMed
55.
Ostor AG: Natural history of cervical intraepithelial neoplasia: a critical review. Int J Gynecol Pathol. 1993, 12 (2): 186-192. 10.1097/00004347-199304000-00018.CrossRefPubMed
56.
Melnikow J, Nuovo J, Willan AR, Chan BK, Howell LP: Natural history of cervical squamous intraepithelial lesions: a meta-analysis. Obstet Gynecol. 1998, 92 (4 Pt 2): 727-735. 10.1016/S0029-7844(98)00245-2.PubMed
57.
Holowaty P, Miller AB, Rohan T, To T: Natural history of dysplasia of the uterine cervix. J Natl Cancer Inst. 1999, 91 (3): 252-258. 10.1093/jnci/91.3.252.CrossRefPubMed
58.
Schlecht NF, Platt RW, Duarte-Franco E, Costa MC, Sobrinho JP, Prado JC, Ferenczy A, Rohan TE, Villa LL, Franco EL: Human papillomavirus infection and time to progression and regression of cervical intraepithelial neoplasia. J Natl Cancer Inst. 2003, 95 (17): 1336-1343.CrossRefPubMed
59.
Moscicki AB, Hills N, Shiboski S, Powell K, Jay N, Hanson E, Miller S, Clayton L, Farhat S, Broering J, et al: Risks for incident human papillomavirus infection and low-grade squamous intraepithelial lesion development in young females. JAMA. 2001, 285 (23): 2995-3002. 10.1001/jama.285.23.2995.CrossRefPubMed
60.
Nobbenhuis MA, Helmerhorst TJ, Brule van den AJ, Rozendaal L, Voorhorst FJ, Bezemer PD, Verheijen RH, Meijer CJ: Cytological regression and clearance of high-risk human papillomavirus in women with an abnormal cervical smear. Lancet. 2001, 358 (9295): 1782-1783. 10.1016/S0140-6736(01)06809-X.CrossRefPubMed
61.
Janerich DT, Hadjimichael O, Schwartz PE, Lowell DM, Meigs JW, Merino MJ, Flannery JT, Polednak AP: The screening histories of women with invasive cervical cancer, Connecticut. Am J Public Health. 1995, 85 (6): 791-794. 10.2105/AJPH.85.6.791.CrossRefPubMedPubMedCentral
62.
Schwartz PE, Hadjimichael O, Lowell DM, Merino MJ, Janerich D: Rapidly progressive cervical cancer: the Connecticut experience. Am J Obstet Gynecol. 1996, 175 (4 Pt 2): 1105-1109. 10.1016/S0002-9378(96)70012-1.CrossRefPubMed
63.
Oyesanya OA, Amerasinghe CN, Manning EA: Outpatient excisional management of cervical intraepithelial neoplasia. A prospective, randomized comparison between loop diathermy excision and laser excisional conization. Am J Obstet Gynecol. 1993, 168 (2): 485-488.CrossRefPubMed
64.
Wright TC, Koulos J, Schnoll F, Swanbeck J, Ellerbrock TV, Chiasson MA, Richart RM: Cervical intraepithelial neoplasia in women infected with the human immunodeficiency virus: outcome after loop electrosurgical excision. Gynecol Oncol. 1994, 55 (2): 253-258. 10.1006/gyno.1994.1286.CrossRefPubMed
Metadata
Title
Cost-effectiveness of human papillomavirus vaccination for prevention of cervical cancer in Taiwan
Authors
Pang-Hsiang Liu
Fu-Chang Hu
Ping-Ing Lee
Song-Nan Chow
Chao-Wan Huang
Jung-Der Wang
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2010
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-10-11

Other articles of this Issue 1/2010

BMC Health Services Research 1/2010 Go to the issue

Research article

Application of a theoretical model to evaluate COPD disease management

Study protocol

Get screened: a pragmatic randomized controlled trial to increase mammography and colorectal cancer screening in a large, safety net practice

Research article

Job satisfaction and its modeling among township health center employees: a quantitative study in poor rural China

Research article

Clinicians' caseload management behaviours as explanatory factors in patients' length of time on caseloads: a predictive multilevel study in paediatric community occupational therapy

Research article

The failure of routine rapid HIV testing: a case study of improving low sensitivity in the field

Research article

Recruitment of multiple stakeholders to health services research: Lessons from the front lines