Cost-effectiveness of HPV vaccination in the prevention of cervical cancer in Malaysia.
BACKGROUND
Cervical cancers (CC) demonstrate the second highest incidence of female cancers in Malaysia. The costs of chronic management have a high impact on nation's health cost and patient's quality of life that can be avoided by better screening and HPV vaccination.


METHODS
Respondents were interviewed from six public Gynecology-Oncology hospitals. Methods include experts' panel discussions to estimate treatment costs by severity and direct interviews with respondents using costing and SF-36 quality of life (QOL) questionnaires. Three options were compared i.e. screening via Pap smear; quadrivalent HPV Vaccination and combined strategy (screening plus vaccination). Scenario based sensitivity analysis using screening population coverage (40-80%) and costs of vaccine (RM 300-400/dose) were calculated.


RESULTS
502 cervical pre invasive and invasive cervical cancer (ICC) patients participated in the study. Mean age was 53.3 +/- 11.2 years, educated till secondary level (39.4%), Malays (44.2%) and married for 27.73 +/- 12.1 years. Life expectancy gained from vaccination is 13.04 years and average Quality Adjusted Life Years saved (QALYs) is 24.4 in vaccinated vs 6.29 in unvaccinated. Cost/QALYs for Pap smear at base case is RM 1,214.96/QALYs and RM 1,100.01 at increased screening coverage; for HPV Vaccination base case is at RM 35,346.79 and RM 46,530.08 when vaccination price is higher. In combined strategy, base case is RM 11,289.58; RM 7,712.74 at best case and RM 14,590.37 at worst case scenario. Incremental cost-effectiveness ratio (ICER) showed that screening at 70% coverage or higher is highly cost effective at RM 946.74 per QALYs saved and this is followed by combined strategy at RM 35,346.67 per QALYs saved.


CONCLUSIONS
Vaccination increase life expectancy with better QOL of women when cancer can be avoided. Cost effective strategies will include increasing the Pap smear coverage to 70% or higher. Since feasibility and long term screening adherence is doubtful among Malaysian women, vaccination of young women is a more cost effective strategy against cervical cancers.
Ezat
Wan Puteh Sharifa
WP
Department of Community Health, UKM Medical Centre, Kuala Lumpur, Malaysia. sh_ezat@yahoo.com
Aljunid
Syed
S
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000191:economics / Q000517:prevention & control / Q000821:virology; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D017850:Economics, Pharmaceutical; D005260:Female; D006801:Humans; D008296:Malaysia; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000191:economics* / Q000517:prevention & control* / Q000821:virology; D053918:Papillomavirus Vaccines / Q000191:economics* / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000191:economics* / Q000517:prevention & control* / Q000821:virology; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000191:economics / Q000517:prevention & control / Q000821:virology
D053918:Papillomavirus Vaccines