title: Introducing HPV vaccine and scaling up screening procedures to prevent deaths from cervical cancer in Japan: a cost-effectiveness analysis.
abstract: OBJECTIVE
  To assess the cost-effectiveness of universal vaccination of 11-year-old girls against human papillomavirus (HPV) infection and increased screening coverage to prevent cervical cancer in Japan where the coverage of Papanicolaou smears is very low.
  
  
  METHODS
  A cost-utility analysis from a societal perspective.
  
  
  METHODS
  Japan, 2010.
  
  
  METHODS
  The female Japanese population aged 11 years or older.
  
  
  METHODS
  A Markov model of the natural history of cervical cancer was constructed to compare six strategies: i.e. a screening coverage rate of 20, 50 and 80% with and without routine vaccination at age 11.
  
  
  METHODS
  Cervical cancer incidence, quality-adjusted life years (QALYs), costs and incremental cost-effectiveness ratios.
  
  
  RESULTS
  Expanding the coverage of Papanicolaou smears from the current level of 20-50 and 80% yields a 45.5 and 63.1% reduction in cervical cancer incidence, respectively. Impact of combined strategies increases with coverage. Coverages of 20, 50 and 80% showed a 66.1, 80.9 and 86.8% reduction in disease, respectively. The costs of strategies with vaccination are four times higher than the cost of strategies without vaccination. Vaccinating all 11-year-old girls with bivalent vaccines with a Papanicolaou smear coverage rate of 50% is likely to be the most cost-effective option among the six strategies.
  
  
  CONCLUSIONS
  The introduction of HPV vaccination in Japan is cost-effective as in other countries. It is more cost-effective to increase the coverage of the Papanicolaou smear along with the universal administration of HPV vaccine.
authors.affiliation: Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Japan. nyamamoto@m.u-tokyo.ac.jp
authors.forename: N
authors.initials: N
authors.lastname: Yamamoto
authors.forename: R
authors.initials: R
authors.lastname: Mori
authors.forename: P
authors.initials: P
authors.lastname: Jacklin
authors.forename: Y
authors.initials: Y
authors.lastname: Osuga
authors.forename: K
authors.initials: K
authors.lastname: Kawana
authors.forename: K
authors.initials: K
authors.lastname: Shibuya
authors.forename: Y
authors.initials: Y
authors.lastname: Taketani
mesh_terms: D002648:Child; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D030361:Papillomavirus Infections / Q000191:economics* / Q000401:mortality / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000191:economics*; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000191:economics* / Q000401:mortality / Q000821:virology; D014611:Vaccination / Q000191:economics
chemical_list: D053918:Papillomavirus Vaccines