title: Cost and effectiveness evaluation of prophylactic HPV vaccine in developing countries.
abstract: BACKGROUND
  Approximately 80% of cervical cancer cases occur in developing countries. In Thailand, cervical cancer has been the leading cancer in females, with an incidence of 24.7 cases per 100,000 individuals per year.
  
  
  OBJECTIVE
  We constructed a decision model to simulate the lifetime economic impact for women in the context of human papillomavirus (HPV) infection prevention. HPV-related diseases were of interest: cervical cancer, cervical intraepithelial neoplasia, and genital warts. The two strategies used were 1) current practice and 2) prophylactic quadrivalent vaccine against HPV types 6, 11, 16, and 18.
  
  
  METHODS
  We developed a Markov simulation model to evaluate the incremental cost-effectiveness ratio of prophylactic HPV vaccine. Women transition through a model either healthy or developing HPV or its related diseases, or die from cervical cancer or from other causes according to transitional probabilities under the Thai health-care context. Costs from a provider perspective were obtained from King Chulalongkorn Memorial Hospital. Costs and benefits were discounted at 3% annually.
  
  
  RESULTS
  Compared with no prophylactic HPV vaccine, the incremental cost-effectiveness ratio was 160,649.50 baht per quality-adjusted life-year. The mortality rate was reduced by 54.8%. The incidence of cervical cancer, cervical intraepithelial neoplasia grade 1, cervical intraepithelial neoplasia grade 2/3, and genital warts was reduced by up to 55.1%.
  
  
  CONCLUSIONS
  Compared with commonly accepted standard thresholds recommended by the World Health Organization Commission on Macroeconomics and Health, the nationwide coverage of HPV vaccination in girls is likely to be cost-effective in Thailand.
authors.affiliation: Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Wichai
authors.initials: W
authors.lastname: Termrungruanglert
authors.forename: Piyalamporn
authors.initials: P
authors.lastname: Havanond
authors.forename: Nipon
authors.initials: N
authors.lastname: Khemapech
authors.forename: Somrat
authors.initials: S
authors.lastname: Lertmaharit
authors.forename: Sathirakorn
authors.initials: S
authors.lastname: Pongpanich
authors.forename: Chonlakiet
authors.initials: C
authors.lastname: Khorprasert
authors.forename: Surasak
authors.initials: S
authors.lastname: Taneepanichskul
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003218:Condylomata Acuminata / Q000191:economics / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000191:economics*; D019057:Quality-Adjusted Life Years; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000517:prevention & control; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000191:economics / Q000517:prevention & control
chemical_list: D053918:Papillomavirus Vaccines