The Cost-Effectiveness of a Quadrivalent Human Papillomavirus Vaccine in Taiwan

Background: A quadrivalent human papillomavirus (HPV 6/11/16/18) vaccine has recently received regulatoryapproval in Taiwan for the prevention of cervical carcinoma, high-grade cervical dysplasia (cervical intraepithelialneoplasia 2/3 [CIN 2/3]), low-grade cervical dysplasia (CIN 1), high-grade vulvar and vaginal dysplasia, andexternal genital warts.
Objective: To examine the potential long-term epidemiologic and economic consequencesof a quadrivalent HPV (6/11/16/18) vaccination program in Taiwan.
Methods: A transmission dynamic modelwas used to estimate the long-term epidemiologic and economic consequences of quadrivalent HPV vaccination.Two vaccination strategies were evaluated in conjunction with current cervical cancer screening: 1) vaccinationof 12-year-old girls and 2) vaccination of 12-year-old girls with a temporary 5-year catch-up vaccination offemales aged 12–24 years (catch-up).
Results: From an epidemiologic perspective, both vaccination strategiesreduce the overall incidence of HPV 16/18–related cervical cancer relative to no vaccination by 91% duringyear 100 following vaccine introduction. Likewise, both vaccination strategies reduce the incidence of CIN 2/3,CIN 1, and genital warts by ~90%, 86%, and 94%, respectively, at this time point. However, the catch-upprogram consistently achieves greater benefit earlier than the 12-year-old program. The catch-up strategy isboth more effective and efficient than the strategy that vaccinates 12-year-old girls only, with an incrementalcost-effectiveness ratio of New Taiwan dollars (NT$) 410,477 per quality-adjusted life-year gained.
Conclusions:The results from this model suggest that in Taiwan, prophylactic HPV 6/11/16/18 vaccination of females can 1)substantially reduce genital warts, CIN, and cervical cancer, 2) improve quality of life and survival, and 3) becost-effective when implemented as a vaccination strategy that includes a temporary catch-up program.