To examine cost effectiveness of quadrivalent human papillomavirus (HPV) vaccine compared with a cervical cancer screening only program in Thailand.
Previously published dynamic transmission model was adapted and calibrated for Thailand. The natural history of cervical cancer and genital warts in Thailand was simulated by the HPV model. The model was assessed under the assumption that the HPV vaccination program would be combined with current cervical cancer screening in Thailand. The model assumed that 95% of girls 11-12 years would receive two doses of HPV vaccine. The relative effectiveness of two doses of the quadrivalent HPVvaccine was assumed to be the same as three doses. Only the impact of HPV types 6/11/16/18 was considered for this model. The quadrivalent HPV vaccination program (combined with cervical cancer screening) was compared with a cervical cancer screening only program. Life-long duration of protection was assumed for the quadrivalent HPV vaccine.
The quadrivalent HPV vaccines resulted in the reduction of HPV types 6/11 related genital warts in females (85%) and males (82%),CIN1 (82%); HPV 16/18 related cervical cancer (61%), CIN2/3 (74%), and CIN1 (74%) over a 100 year time horizon. Considering the recommended threshold of 1.2 GNI or 185,898 THB/QALY (4,712 Euro/QALY) for Thailand, the implementation of the quadrivalent vaccination program was cost effective as compared to the cervical cancer screening only program with discounted incremental cost-effectiveness ratios (ICER) of 26,901 THB/QALY (682 EURO/QALY).
In Thailand, vaccinating11-12 year old girls with the quadrivalent HPV vaccine has additional public health impact and is cost effective as compared with the cervical cancer screening only program. The results support decision-making process to include HPV vaccine to the national vaccination program.