title: The cost-effectiveness of a quadrivalent human papillomavirus vaccine in Taiwan.
abstract: BACKGROUND
  A quadrivalent human papillomavirus (HPV 6/11/16/18) vaccine has recently received regulatory approval in Taiwan for the prevention of cervical carcinoma, high-grade cervical dysplasia (cervical intraepithelial neoplasia 2/3 [CIN 2/3]), low-grade cervical dysplasia (CIN 1), high-grade vulvar and vaginal dysplasia, and external genital warts.
  
  
  OBJECTIVE
  To examine the potential long-term epidemiologic and economic consequences of a quadrivalent HPV (6/11/16/18) vaccination program in Taiwan.
  
  
  METHODS
  A transmission dynamic model was used to estimate the long-term epidemiologic and economic consequences of quadrivalent HPV vaccination. Two vaccination strategies were evaluated in conjunction with current cervical cancer screening: 1) vaccination of 12-year-old girls and 2) vaccination of 12-year-old girls with a temporary 5-year catch-up vaccination of females aged 12-24 years (catch-up).
  
  
  RESULTS
  From an epidemiologic perspective, both vaccination strategies reduce the overall incidence of HPV 16/18-related cervical cancer relative to no vaccination by 91% during year 100 following vaccine introduction. Likewise, both vaccination strategies reduce the incidence of CIN 2/3, CIN 1, and genital warts by approximately 90%, 86%, and 94%, respectively, at this time point. However, the catch-up program consistently achieves greater benefit earlier than the 12-year-old program. The catch-up strategy is both more effective and efficient than the strategy that vaccinates 12-year-old girls only, with an incremental cost-effectiveness ratio of New Taiwan dollars (NT$) 410,477 per quality-adjusted life-year gained.
  
  
  CONCLUSIONS
  The results from this model suggest that in Taiwan, prophylactic HPV 6/11/16/18 vaccination of females can: 1) substantially reduce genital warts, CIN, and cervical cancer; 2) improve quality of life and survival; and 3) be cost-effective when implemented as a vaccination strategy that includes a temporary catch-up program.
authors.affiliation: Health Economic Statistics, Biostatistics and Research Decision Sciences, Merck Research Laboratories, North Wales, PA 19454-1099, USA. erik_dasbach@merck.com
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Dasbach
authors.forename: Ralph P
authors.initials: RP
authors.lastname: Insinga
authors.forename: Yuh Cheng
authors.initials: YC
authors.lastname: Yang
authors.forename: Raoh-Fang
authors.initials: RF
authors.lastname: Pwu
authors.forename: Christina
authors.initials: C
authors.lastname: Lac
authors.forename: Elamin H
authors.initials: EH
authors.lastname: Elbasha
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D032541:Mass Vaccination / Q000191:economics*; D018803:Models, Economic; D030361:Papillomavirus Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage / Q000191:economics*; D015203:Reproducibility of Results; D018570:Risk Assessment; D013624:Taiwan; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D014611:Vaccination / Q000191:economics*; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines