Cost-effectiveness analysis of switching from a bivalent to a nonavalent HPV vaccination programme in China: a modelling study

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES The Lancet Regional Health: Western Pacific Pub Date : 2025-02-20 DOI:10.1016/j.lanwpc.2025.101499

Meng Gao , Shangying Hu , Xuelian Zhao , Tingting You , Yuting Hong , Yang Liu , Youlin Qiao , Mark Jit , Fanghui Zhao , Chen Wang

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Abstract

Background

Several domestically-manufactured nonavalent HPV vaccine candidates are in phase III clinical trials and their future availability may address the current dilemma of insufficient supply and high price of the overseas-manufactured nonavalent HPV vaccine in China. We compare the population-level effectiveness and cost-effectiveness of switching to nonavalent HPV vaccination in China.

Methods

We used a previously validated transmission model to project the lifetime costs and effectiveness of five same-vaccine and two mixed-vaccine strategies. Nonavalent HPV vaccines were assumed to be available and meet the production requirements for national vaccination between 2030 and 2050. All women living or projected to be born in China during 2023–2100 were considered. We adopted a societal perspective and determined optimal strategies using cost-effectiveness efficiency frontiers.

Findings

Under our pricing assumptions, switching to nonavalent vaccination was always cost-saving compared with maintaining the current bivalent vaccination programme, irrespective of the screening scenarios and the year when nonavalent vaccine was assumed to become available (status quo screening: net cost saving $2589–5211 million; improved screening: net cost saving $1852–3789 million). In the same-vaccine strategies, the optimal strategy changed from “routine nonavalent HPV vaccination with catch-up to age 18” to “switching from bivalent to nonavalent HPV vaccination” if nonavalent vaccination is available after 2035. Compared with the optimal same-vaccine strategy, adopting mixed schedules with bivalent and nonavalent vaccines would further save $1336–4280 million net costs and gain 87,000–833,000 QALYs, depending on the screening scenario and the year when nonavalent vaccine becomes available.

Interpretation

Switching from bivalent to nonavalent HPV vaccination is likely to be cost-saving and have a significant impact on reducing the cervical cancer burden in China.

Funding

Bill & Melinda Gates Foundation (INV-031449 and INV-003174) and CAMS Innovation Fund for Medical Sciences (CIFMS) (2021-I2M-1-004).

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背景几种国产无价HPV候选疫苗正处于III期临床试验阶段，它们的未来供应可能会解决目前中国海外生产的无价HPV疫苗供应不足且价格昂贵的窘境。我们比较了在中国改用无空洞 HPV 疫苗接种的人群效果和成本效益。方法我们使用之前验证过的传播模型来预测五种同种疫苗和两种混合疫苗策略的终生成本和效果。假定无价 HPV 疫苗可在 2030 年至 2050 年间获得并满足全国疫苗接种的生产要求。所有生活在中国或预计将于 2023 年至 2100 年期间在中国出生的女性都被考虑在内。研究结果根据我们的定价假设，与维持现有的二价疫苗接种计划相比，无论采用哪种筛查方案，也无论假定非二价疫苗在哪一年上市，改用非二价疫苗接种都能节省成本（维持筛查现状：净节省成本 2.58-52.11 亿美元；改进筛查：净节省成本 1.852-3.79 亿美元）。在同种疫苗策略中，如果 2035 年后可以接种非空洞疫苗，则最佳策略从 "常规接种非空洞 HPV 疫苗并补种至 18 岁 "变为 "从接种二价 HPV 疫苗转为接种非空洞 HPV 疫苗"。与最佳的同种疫苗策略相比，采用二价和无价疫苗混合接种计划将进一步节省 1.36-4.8 亿美元的净成本，并获得 87,000-833,000 QALYs，具体取决于筛查方案和无价疫苗上市的年份。解释从接种二价HPV疫苗转向接种无价HPV疫苗可能会节约成本，并对减轻中国宫颈癌负担产生重大影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

The Lancet Regional Health: Western Pacific Medicine-Pediatrics, Perinatology and Child Health

CiteScore

8.80

自引率

2.80%

发文量

305

审稿时长

11 weeks

期刊介绍： The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.