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PR048/#466  Cost-effectiveness analysis of single-dose or 2-dose of bivalent, quadrivalent, or nonavalent HPV vaccine in a low/middle income country setting
  1. Wichai Termrungruanglert1,
  2. Apichai Vasuratna1,
  3. Nipon Khemapech1,
  4. Piyalamporn Havanond Havanond1 and
  5. Tanitra Tantitamit2
  1. 1Chulalongkorn University, Department of Obstetrics and Gynecology, Bangkok, Thailand
  2. 2Srinakharinwirot University, Obstetrics and Gynecology, Nakhonnayok, Thailand


Introduction To evaluate the health impact and economic benefits of one dose or two doses of 2-valent (2vHPV), 4-valent (4vHPV), or 9-valent (9vHPV) HPV vaccine compared to no vaccination along with primary HPV testing in a low/middle income country setting, specifically in Thailand.

Methods A Markov model was used to simulate HPV infection and cervical cancer in a cohort of 100,000 12-year-old HPV-naive girls. The study compared nine strategies: one dose and two doses of 2vHPV (Cervarix®), 2vHPV (Cecolin®), 4vHPV (Gardasil®), 9vHPV vaccine (Gardasil9®), and no vaccination. Main outcome measure was quality-adjusted life year (QALY) of each strategy. Incremental cost-effectiveness ratios (ICER) were estimated over a lifetime horizon, univariate and probabilistic sensitivity analyses were conducted for uncertain variables in different scenarios.

Results In the base case scenario, all vaccination programs resulted in 41,298–71,057 QALYs gained with a cost saving of 14,914,186–19,821,655 USD compared to no vaccination. Based on the incremental analysis, two doses of 9vHPV vaccine was the most cost-effective strategy with an ICER of 406 USD/QALY. Sensitivity analysis showed that the probability of being cost-effective for two doses of 9vHPV vaccine was 80%, and uncertainty around the costs of vaccination and vaccine efficacy caused the largest variation in the cost-effectiveness findings.

Conclusion/Implications Two doses of 9vHPV vaccine along with a primary HPV test for screening program represent the most cost-effective option for school-based HPV vaccination of 12-year-old girls in Thailand, with a lower willingness to pay of one time the per-capita GDP. This finding provides important evidence to policymakers for cervical cancer prevention.

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