Comparative Cost-Effectiveness Analysis of Two Different Two-Dose Human Papillomavirus Vaccines in Malaysia

摘要

Purpose: To comparatively evaluate the results of a 2-dose human papillomavirus (HPV) vaccination programmewith the AS04-adjuvanted HPV16/18 vaccine (AS04-HPV-16/18v) or HPV-6/11/16/18 vaccine (4vHPVv), in additionto cervical cancer (CC) screening, in Malaysia. Methods: A lifetime Markov model replicating the natural history ofHPV in 13-year-old girls was adapted to Malaysia to assess the impact of vaccination on pre-cancerous lesions, genitalwarts and CC cases, CC deaths, quality-adjusted life years (QALYs), and costs from the perspective of the MalaysianMinistry of Health. Vaccine effectiveness was based on efficacy and HPV type distribution. Both vaccines were assumedto have equal efficacy against vaccine-type HPV but differed for protection against non-vaccine types. Vaccine priceparity was used and health and cost outcomes were discounted at 3%/annum. Sensitivity analyses tested the robustnessof the results. Results: The model predicted that AS04-HPV-16/18v would result in 361 fewer CC cases and 115 fewerCC deaths than 4vHPVv, whereas 4vHPVv averted 4,241 cases of genital warts over the cohort’s lifetime. Discountedtotal costs showed savings of 18.50 million Malaysian Ringgits and 246 QALYs in favour of AS04-HPV-16/18v. Inone-way sensitivity analyses, the discount rate was the most influential variable for costs and QALYs, but AS04-HPV-16/18v remained dominant throughout. A two-way sensitivity analysis to assess the longevity of cross-protection for bothvaccines confirmed the base-case. Conclusions: In Malaysia, the use of AS04-HPV-16/18v, in addition to screening,was modelled to be dominant over 4vHPVv, with greater estimated CC benefits and lower costs.