Public Health Impact and Cost-Effectiveness of Routine and Catch-Up Human Papillomavirus Vaccination in Girls and Women in Selected Regions of China: A Model-Based Study.
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BACKGROUND: In China, human papillomavirus (HPV) vaccination for girls has been included in the National Immunization Program (NIP), providing free 2-valent HPV vaccine (2vHPV) for 13-year-old girls. This study assessed the public health impact and cost-effectiveness of routine 2vHPV/9vHPV for girls aged 13 years, with/without a catch-up strategy for females aged ≤ 26 years, in six cities with free 2vHPV programs but differing socioeconomic development across China (Wuxi, Suzhou, Guangzhou, Yuxi, Chengdu, and Shijiazhuang). METHODS: A discrete-time Markov model was developed from the healthcare system perspective over a 100-year horizon. Routine (aged 13 years) and catch-up (aged ≤ 26 years) vaccination coverages were assumed at 90% and 70%, respectively. Model outputs included costs (2023 USD), quality-adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), and cases of HPV-related diseases averted. The willingness-to-pay (WTP) thresholds were set corresponding to 1 times the per capita GDP of each city. Scenario and sensitivity analyses were conducted to test robustness. RESULTS: Routine 9vHPV strategy prevented an additional 1921-9630 cases of cervical cancer, compared with the routine 2vHPV strategy. Furthermore, incorporating a catch-up strategy yielded a marginal additional reduction (29-176 cases by 9vHPV and 18-108 cases by 2vHPV) in cervical cancer. Under ideal pricing assumptions, the routine 9vHPV strategy was cost-saving and cost-effective across all six cities, compared with routine/routine plus catch-up 2vHPV strategies, with a cost saving of USD 1730-2792/1769-2817 per person, and a gain of 0.195-0.315/0.193-0.311 QALYs per person. Routine plus catch-up 2vHPV and 9vHPV strategies remained cost-effective in five and four cities, respectively. Notably, scenario analysis indicated at current domestic 9vHPV market price, the routine 9vHPV strategy remained cost-effective in six cities, while the catch-up strategy became cost-ineffective across all cities. CONCLUSIONS: The routine 9vHPV strategy may be cost-effective compared with the 2vHPV strategy in China. However, a 9vHPV catch-up strategy varies in cost-effectiveness by regional socioeconomic development.