Cost-Effectiveness Analysis of Human Papillomavirus Vaccination in Adolescent Girls in Taiwan

Document Type : Research Articles


1 School of Health Care Administration, Taipei Medical University, Taipei, Taiwan.

2 Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.

3 Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.

4 Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan.

5 School of Medicine, College of Medicine, Big Data Research Centre, Fu-Jen Catholic University, New Taipei City, Taiwan.

6 Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.

7 GSK, Taipei, Taiwan.

8 GSK, Singapore, Singapore.

9 GSK, Wavre, Belgium.


Objective: Three vaccines are available to Taiwanese young girls for cervical cancer (CC) prevention. Here
we evaluate the cost-effectiveness of the two-dose (2D) AS04-adjuvanted HPV-16/18 vaccine (2D-AS04-HPV-
16/18v)+screening compared with a screening programme alone, with 2D human papillomavirus 6/11/16/18 vaccine
(2D-4vHPVv)+screening, and with 2D/three-dose (3D) human papillomavirus 6/11/16/18/31/33/45/52/58 vaccine
(9vHPVv)+screening, for Taiwan universal mass vaccination. Methods: A static Markov cohort model simulated the
natural history of human papillomavirus (HPV) infection and CC screening for a 12-year-old cohort of Taiwanese girls
(N=120,000). The model ran in 1-year cycles over the cohort’s lifetime. Vaccine efficacy irrespective of HPV type
was considered in the analysis for each vaccine. Input data were obtained from published literature, local databases,
government reports and websites, and expert opinion. The analysis incorporated direct medical costs only, with an
annual discount rate of 3.0%. The threshold was determined as 1 Gross Domestic Product per capita (New Taiwan
dollar [NT$] 727,818; year 2016). Results: The 2D-AS04-HPV-16/18v+screening yielded 0.0365 quality-adjusted life
year (QALY) gained at an additional cost of NT$ 5,770 per person compared with the screening programme alone. This
resulted in an incremental cost-effectiveness ratio well below the threshold. Compared with 2D-4vHPVv+screening and
2D/3D-9vHPVv+screening, discounted results demonstrated additional QALYs gained at lower cost for 2D-AS04-HPV-
16/18v+screening, making it dominant over both 2D-4vHPVv+screening and 2D/3D-9vHPVv+screening. Conclusions:
Vaccinating Taiwanese girls with 2D-AS04-HPV-16/18v in addition to screening to prevent CC is cost-effective
compared with using a screening programme alone and the dominant option compared with 2D-4vHPVv+screening
and 2D/3D-9vHPVv+screening.


Main Subjects