Burden of Disease Associated with Cervical Cancer in Malaysia and Potential Costs and Consequences of HPV Vaccination

Background: An estimated 70% of cervical cancers worldwide are attributable to persistent infection withhuman papillomaviruses (HPV) 16 and 18. Vaccination against HPV 16/18 has been shown to dramatically reducethe incidence of associated precancerous and cancerous lesions. The aims of the present analyses were, firstly, toestimate the clinical and economic burden of disease attributable to HPV in Malaysia and secondly, to estimatelong-term outcomes associated with HPV vaccination using a prevalence-based modeling approach.
Methods:In the first part of the analysis costs attributable to cervical cancer and precancerous lesions were estimated;epidemiologic data were sourced from the WHO GLOBOCAN database and Malaysian national data sources.In the second part, a prevalence-based model was used to estimate the potential annual number of cases ofcervical cancer and precancerous lesions that could be prevented and subsequent HPV-related treatment costsaverted with the bivalent (HPV 16/18) and the quadrivalent (HPV 16/18/6/11) vaccines, at the population level, atsteady state. A vaccine efficacy of 98% was assumed against HPV types included in both vaccines. Effectivenessagainst other oncogenic HPV types was based on the latest results from each vaccine’s respective clinical trials.
Results: In Malaysia there are an estimated 4,696 prevalent cases of cervical cancer annually and 1,372 prevalentcases of precancerous lesions, which are associated with a total direct cost of RM 39.2 million with a furtherRM 12.4 million in indirect costs owing to lost productivity. At steady state, vaccination with the bivalent vaccinewas estimated to prevent 4,199 cervical cancer cases per year versus 3,804 cases for the quadrivalent vaccine.Vaccination with the quadrivalent vaccine was projected to prevent 1,721 cases of genital warts annually, whereasthe annual number of cases remained unchanged with the bivalent vaccine. Furthermore, vaccination with thebivalent vaccine was estimated to avert RM 45.4 million in annual HPV-related treatment costs (direct+indirect)compared with RM 42.9 million for the quadrivalent vaccine.
Conclusion: This analysis showed that vaccinationagainst HPV 16/18 can reduce the clinical and economic burden of cervical cancer and precancerous lesions inMalaysia. The greatest potential economic benefit was observed using the bivalent vaccine in preference to thequadrivalent vaccine.