Cost-effectiveness analysis of prophylactic cervical cancer vaccination in Japanese women.
BACKGROUND
The incidence of cervical cancer (CC) is high in Japan and is further increasing among women younger than 30 years. This burden could be reduced by the implementation of a CC vaccine, but its cost-effectiveness is unknown.


METHODS
We quantified the clinical impact and assessed the cost-effectiveness of adding CC vaccination at age 12 to the current screening in place in Japan with a lifetime Markov model adapted to the Japanese setting. Transition probabilities and utility values were obtained from public databases. Direct costs for treatment and screening were estimated using Japanese medical fees. Annual costs and benefits were discounted at 3%. Sensitivity analyses were conducted on the age at vaccination, the vaccine characteristics, the discount rates, the proportion of human papillomavirus types 16/18 in cancer, and the screening coverage.


RESULTS
Vaccinating a 12-year-old cohort was predicted to reduce CC incidence and deaths from CC by 73%. These clinical effects were associated with an incremental cost-effectiveness ratio of yen1.8 million per quality-adjusted life year gained. The incremental cost-effectiveness ratio of vaccinating all 10- to 45-year-old women was yen2.8 million per quality-adjusted life year, still below the threshold value.


CONCLUSIONS
The implementation of a CC vaccination in Japan could reduce the CC burden in a very cost-effective manner for women up to 45 years.
Konno
Ryo
R
Department of Obstetrics and Gynecology, Saitama Medical Centre, Jichi Medical University, Saitama.
Sasagawa
Toshiyuki
T
Fukuda
Takashi
T
Van Kriekinge
Georges
G
Demarteau
Nadia
N
D000328:Adult; D044466:Asian People; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D052162:Human papillomavirus 16 / Q000302:isolation & purification; D006801:Humans; D008875:Middle Aged; D018803:Models, Economic; D009367:Neoplasm Staging; D030361:Papillomavirus Infections / Q000150:complications / Q000191:economics* / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000008:administration & dosage / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000191:economics* / Q000517:prevention & control / Q000821:virology; D014611:Vaccination / Q000191:economics*; D014626:Vaginal Smears / Q000191:economics*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000191:economics* / Q000517:prevention & control / Q000821:virology
D053918:Papillomavirus Vaccines