The epidemiologic and economic impact of a quadrivalent human papillomavirus vaccine in Thailand

• DOI: 10.1371/journal.pone.0245894
• Publication Date: 2021-02-12T18:42:21Z
• Authors: Wichai Termrungru...; Nipon Khemapech; Apichai Vasuratna; Piyalamporn Havanond; Preyanuch Deebukkham; Amit Sharad Kulkarni; Andrew Pavelyev
• Keywords: Epidemiology; Science; Cost-Benefit Analysis; Human Papillomavirus and Cervical Cancer Epidemiology; Population; Immunology; Uterine Cervical Neoplasms; Pediatrics; Cost effectiveness; 03 medical and health sciences; 0302 clinical medicine; Sociology; Health Sciences; Humans; Mass Screening; Risk analysis (engineering); Papillomavirus Vaccines; Child; Internal medicine; Demography; Cancer; Hepatitis B Infection and Treatment; FOS: Clinical medicine; Q; Vaccination; R; Thailand; FOS: Sociology; 3. Good health; Models, Economic; Environmental health; Antigen; Cervical cancer; Medicine; Male Circumcision for HIV Prevention and Penile Health; Female; Surgery; Immunization; HPV Vaccination; Genital warts; Research Article

Background The human papillomavirus (HPV) vaccine was introduced into Thailand’s national immunization program in 2017 for 11–12 year old school girls. The objectives of this study were to examine the epidemiological consequences and cost-effectiveness of a routine quadrivalent HPV (4vHPV) vaccination and the routine 4vHPV vaccination plus 5-year catch-up vaccination by comparing with cervical cancer screening only (no vaccination) in Thailand.

Method A transmission dynamic model was used to assess the cost-effectiveness of the routine 4vHPV vaccination and the routine 4vHPV vaccination plus catch-up vaccination, compared with no vaccination (screening only) in Thai population. The vaccination coverage rate assumptions were 95% in 11-12-year-old girls for the routine vaccination and 70% in 13–24 year-old females for the 5-year catch-up vaccination. Vaccination costs, direct medical costs of HPV-related diseases, and the number of quality of life years (QALYs) gained were calculated for over a 100-year time horizon with discount rate of 3%.

Result The model indicated that the routine 4vHPV vaccination and the routine plus catch-up 4vHPV vaccination strategies could prevent approximately 434,130 and 472,502 cumulative cases of cervical cancer, 182,234 and 199,068 cumulative deaths from cervical cancer and 12,708,349 and 13,641,398 cumulative cases of HPV 6/11 related genital warts, respectively, when compared with no vaccination over 100 years. The estimated cost per QALY gained (ICER) when compared to no vaccination in Thailand was 8,370 THB/QALY for the routine vaccination and 9,650 THB/QALY for the routine with catch-up vaccination strategy.

Conclusion Considering the recommended threshold of 160,000 THB/QALY for Thailand, the implementation of the routine 4vHPV vaccination either alone or plus the catch-up vaccination was cost-effective as compared to the cervical cancer screening only.