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

Document Type : Research Articles


1 GSK, Avenue Fleming 20, 1300 Wavre, Belgium.

2 GSK, 23 Rochester Park, Singapore 139234, Singapore.

3 International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia.

4 Department of Health Policy and Management, Faculty of Public Health, Kuwait University, Kuwait City, Kuwait.

5 Hospital Wanita and Kanak-kanak Sabah, Kota Kinabalu, Sabah, Malaysia.

6 Hospital Ampang, Ampang, Malaysia,

7 Present Address, Gilead Sciences Hong Kong, Hong Kong, China.


Purpose: To comparatively evaluate the results of a 2-dose human papillomavirus (HPV) vaccination programme
with the AS04-adjuvanted HPV16/18 vaccine (AS04-HPV-16/18v) or HPV-6/11/16/18 vaccine (4vHPVv), in addition
to cervical cancer (CC) screening, in Malaysia. Methods: A lifetime Markov model replicating the natural history of
HPV in 13-year-old girls was adapted to Malaysia to assess the impact of vaccination on pre-cancerous lesions, genital
warts and CC cases, CC deaths, quality-adjusted life years (QALYs), and costs from the perspective of the Malaysian
Ministry of Health. Vaccine effectiveness was based on efficacy and HPV type distribution. Both vaccines were assumed
to have equal efficacy against vaccine-type HPV but differed for protection against non-vaccine types. Vaccine price
parity was used and health and cost outcomes were discounted at 3%/annum. Sensitivity analyses tested the robustness
of the results. Results: The model predicted that AS04-HPV-16/18v would result in 361 fewer CC cases and 115 fewer
CC deaths than 4vHPVv, whereas 4vHPVv averted 4,241 cases of genital warts over the cohort’s lifetime. Discounted
total costs showed savings of 18.50 million Malaysian Ringgits and 246 QALYs in favour of AS04-HPV-16/18v. In
one-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 both
vaccines 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.


Main Subjects