Comparative cost-effectiveness of HPV vaccines in the prevention of cervical cancer in Malaysia

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Abstract

Objectives: Cervical cancer(CC) had the second highest incidence of female cancers in Malaysia in 2003-2006. Prevention is possible by both Pap smear screening and HPV vaccination with either the bivalent vaccine (BV) or the quadrivalent vaccine (QV). In the present study, cost effectiveness options were compared for three programs i.e. screening via Pap smear; modeling of HPV vaccination (QV and BV) and combined strategy (screening plus vaccination). A scenario based sensitivity analysis was conducted using screening population coverages (40-80%) and costs of vaccines (RM 100-200/dose) were calculated. Methods: This was an economic burden, cross sectional study in 2006-2009 respondents were interviewed from six public Gynecology-Oncology hospitals. Methods included expert panel discussions to estimate treatment costs of CC, Genital warts and Vulva Vagina Cancers by severity and direct interviews with respondents using costing and SF-36 quality of life questionnaires. Results: A total of 502 cervical cancer patients participated with a mean age at 53.3±11.2 years and a mean marriage length of 27.7±12.1 years, Malays accounting for 44.2%. Cost/quality adjusted life year (QALY) for Pap smear in the base case was RM 1,215 and RM 1,100 at increased screening coverage. With QV only, in base case it was RM 15,662 and RM 24,203 when the vaccination price was increased. With BV only, the respective figures were RM 1,359,057 and RM 2,530,018. For QV combined strategy cost/QALY in the base case it was RM 4,937, reducing to RM 3,395 in the best case and rising to RM 7,992 in the worst case scenario. With the BV combined strategy, these three cost/QALYs were RM 6,624, RM 4,033 and RM 10,543. Incremental cost-effectiveness ratio (ICER) showed that screening at 70% coverage or higher was highly cost effective at RM 946.74 per QALYs saved but this was preceded by best case combined strategy with QV at RM 515.29 per QALYs saved. Conclusions: QV is more cost effective than BV. The QV combined strategy was more CE than any method including Pap smear screening at high population coverage.

Original languageEnglish
Pages (from-to)943-951
Number of pages9
JournalAsian Pacific Journal of Cancer Prevention
Volume11
Issue number4
Publication statusPublished - 2010

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Papillomavirus Vaccines
Malaysia
Uterine Cervical Neoplasms
Cost-Benefit Analysis
Vaccines
Quality-Adjusted Life Years
Combined Vaccines
Papanicolaou Test
Costs and Cost Analysis
Vaccination
Vaginal Neoplasms
Vulvar Neoplasms
Condylomata Acuminata
Marriage
Gynecology
Health Care Costs
Population
Cross-Sectional Studies
Economics
Quality of Life

Keywords

  • Cervical cancer
  • Cost-effectiveness
  • HPV vaccinations
  • Pap smear screening
  • Quality of life

ASJC Scopus subject areas

  • Oncology
  • Cancer Research
  • Public Health, Environmental and Occupational Health
  • Epidemiology

Cite this

@article{f509dbeb77fa4af38fd11fba254ee8a7,
title = "Comparative cost-effectiveness of HPV vaccines in the prevention of cervical cancer in Malaysia",
abstract = "Objectives: Cervical cancer(CC) had the second highest incidence of female cancers in Malaysia in 2003-2006. Prevention is possible by both Pap smear screening and HPV vaccination with either the bivalent vaccine (BV) or the quadrivalent vaccine (QV). In the present study, cost effectiveness options were compared for three programs i.e. screening via Pap smear; modeling of HPV vaccination (QV and BV) and combined strategy (screening plus vaccination). A scenario based sensitivity analysis was conducted using screening population coverages (40-80{\%}) and costs of vaccines (RM 100-200/dose) were calculated. Methods: This was an economic burden, cross sectional study in 2006-2009 respondents were interviewed from six public Gynecology-Oncology hospitals. Methods included expert panel discussions to estimate treatment costs of CC, Genital warts and Vulva Vagina Cancers by severity and direct interviews with respondents using costing and SF-36 quality of life questionnaires. Results: A total of 502 cervical cancer patients participated with a mean age at 53.3±11.2 years and a mean marriage length of 27.7±12.1 years, Malays accounting for 44.2{\%}. Cost/quality adjusted life year (QALY) for Pap smear in the base case was RM 1,215 and RM 1,100 at increased screening coverage. With QV only, in base case it was RM 15,662 and RM 24,203 when the vaccination price was increased. With BV only, the respective figures were RM 1,359,057 and RM 2,530,018. For QV combined strategy cost/QALY in the base case it was RM 4,937, reducing to RM 3,395 in the best case and rising to RM 7,992 in the worst case scenario. With the BV combined strategy, these three cost/QALYs were RM 6,624, RM 4,033 and RM 10,543. Incremental cost-effectiveness ratio (ICER) showed that screening at 70{\%} coverage or higher was highly cost effective at RM 946.74 per QALYs saved but this was preceded by best case combined strategy with QV at RM 515.29 per QALYs saved. Conclusions: QV is more cost effective than BV. The QV combined strategy was more CE than any method including Pap smear screening at high population coverage.",
keywords = "Cervical cancer, Cost-effectiveness, HPV vaccinations, Pap smear screening, Quality of life",
author = "{Wan Puteh}, {Sharifa Ezat} and {Syed Junid}, {Syed Mohamed Al-Junid}",
year = "2010",
language = "English",
volume = "11",
pages = "943--951",
journal = "Asian Pacific Journal of Cancer Prevention",
issn = "1513-7368",
publisher = "Asian Pacific Organization for Cancer Prevention",
number = "4",

}

TY - JOUR

T1 - Comparative cost-effectiveness of HPV vaccines in the prevention of cervical cancer in Malaysia

AU - Wan Puteh, Sharifa Ezat

AU - Syed Junid, Syed Mohamed Al-Junid

PY - 2010

Y1 - 2010

N2 - Objectives: Cervical cancer(CC) had the second highest incidence of female cancers in Malaysia in 2003-2006. Prevention is possible by both Pap smear screening and HPV vaccination with either the bivalent vaccine (BV) or the quadrivalent vaccine (QV). In the present study, cost effectiveness options were compared for three programs i.e. screening via Pap smear; modeling of HPV vaccination (QV and BV) and combined strategy (screening plus vaccination). A scenario based sensitivity analysis was conducted using screening population coverages (40-80%) and costs of vaccines (RM 100-200/dose) were calculated. Methods: This was an economic burden, cross sectional study in 2006-2009 respondents were interviewed from six public Gynecology-Oncology hospitals. Methods included expert panel discussions to estimate treatment costs of CC, Genital warts and Vulva Vagina Cancers by severity and direct interviews with respondents using costing and SF-36 quality of life questionnaires. Results: A total of 502 cervical cancer patients participated with a mean age at 53.3±11.2 years and a mean marriage length of 27.7±12.1 years, Malays accounting for 44.2%. Cost/quality adjusted life year (QALY) for Pap smear in the base case was RM 1,215 and RM 1,100 at increased screening coverage. With QV only, in base case it was RM 15,662 and RM 24,203 when the vaccination price was increased. With BV only, the respective figures were RM 1,359,057 and RM 2,530,018. For QV combined strategy cost/QALY in the base case it was RM 4,937, reducing to RM 3,395 in the best case and rising to RM 7,992 in the worst case scenario. With the BV combined strategy, these three cost/QALYs were RM 6,624, RM 4,033 and RM 10,543. Incremental cost-effectiveness ratio (ICER) showed that screening at 70% coverage or higher was highly cost effective at RM 946.74 per QALYs saved but this was preceded by best case combined strategy with QV at RM 515.29 per QALYs saved. Conclusions: QV is more cost effective than BV. The QV combined strategy was more CE than any method including Pap smear screening at high population coverage.

AB - Objectives: Cervical cancer(CC) had the second highest incidence of female cancers in Malaysia in 2003-2006. Prevention is possible by both Pap smear screening and HPV vaccination with either the bivalent vaccine (BV) or the quadrivalent vaccine (QV). In the present study, cost effectiveness options were compared for three programs i.e. screening via Pap smear; modeling of HPV vaccination (QV and BV) and combined strategy (screening plus vaccination). A scenario based sensitivity analysis was conducted using screening population coverages (40-80%) and costs of vaccines (RM 100-200/dose) were calculated. Methods: This was an economic burden, cross sectional study in 2006-2009 respondents were interviewed from six public Gynecology-Oncology hospitals. Methods included expert panel discussions to estimate treatment costs of CC, Genital warts and Vulva Vagina Cancers by severity and direct interviews with respondents using costing and SF-36 quality of life questionnaires. Results: A total of 502 cervical cancer patients participated with a mean age at 53.3±11.2 years and a mean marriage length of 27.7±12.1 years, Malays accounting for 44.2%. Cost/quality adjusted life year (QALY) for Pap smear in the base case was RM 1,215 and RM 1,100 at increased screening coverage. With QV only, in base case it was RM 15,662 and RM 24,203 when the vaccination price was increased. With BV only, the respective figures were RM 1,359,057 and RM 2,530,018. For QV combined strategy cost/QALY in the base case it was RM 4,937, reducing to RM 3,395 in the best case and rising to RM 7,992 in the worst case scenario. With the BV combined strategy, these three cost/QALYs were RM 6,624, RM 4,033 and RM 10,543. Incremental cost-effectiveness ratio (ICER) showed that screening at 70% coverage or higher was highly cost effective at RM 946.74 per QALYs saved but this was preceded by best case combined strategy with QV at RM 515.29 per QALYs saved. Conclusions: QV is more cost effective than BV. The QV combined strategy was more CE than any method including Pap smear screening at high population coverage.

KW - Cervical cancer

KW - Cost-effectiveness

KW - HPV vaccinations

KW - Pap smear screening

KW - Quality of life

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