title: An extended cost-effectiveness analysis of publicly financed HPV vaccination to prevent cervical cancer in China.
abstract: BACKGROUND
  Cervical cancer screening and existing health insurance schemes in China fall short of reaching women with prevention and treatment services, especially in rural areas where the disease burden is greatest. We conducted an extended cost-effectiveness analysis (ECEA) to evaluate public financing of HPV vaccination to prevent cervical cancer, adding new dimensions to conventional cost-effectiveness analysis through an explicit inclusion of equity and impact on financial risk protection.
  
  
  METHODS
  We synthesized available epidemiological, clinical, and economic data from China using an individual-based Monte Carlo simulation model of cervical cancer to estimate the distribution of deaths averted by income quintile, comparing vaccination plus screening against current practice. We also estimated reductions in cervical cancer incidence, net costs to the government (HPV vaccination costs minus cervical cancer treatment costs averted), and patient cost savings, as well as the incremental government health care costs per death averted.
  
  
  RESULTS
  HPV vaccination is cost-effective across all income groups when the cost is less than US $50 per vaccinated girl. Compared to screening alone, adding preadolescent HPV vaccination followed by cervical cancer screening in adulthood could reduce cancer by 44 percent across all income groups, while providing relatively higher financial protection to the poorest women. The absolute numbers of cervical cancer deaths averted and the financial risk protection from HPV vaccination are highest among women in the lowest quintile; women in the bottom income quintiles received higher benefits than those in the upper wealth quintiles. Patient cost savings represent a large proportion of poor women's average per capita income, reaching 60 percent among women in the bottom income quintile and declining to 15 percent among women in the wealthiest quintile.
authors.affiliation: Department of Global Health, University of Washington, Seattle, United States. Electronic address: clevin@uw.edu.
authors.forename: Carol E
authors.initials: CE
authors.lastname: Levin
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, United States.
authors.forename: Monisha
authors.initials: M
authors.lastname: Sharma
authors.affiliation: Department of Global Health, University of Washington, Seattle, United States.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Olson
authors.affiliation: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Verguet
authors.affiliation: National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China.
authors.forename: Ju-Fang
authors.initials: JF
authors.lastname: Shi
authors.affiliation: National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China.
authors.forename: Shao-Ming
authors.initials: SM
authors.lastname: Wang
authors.affiliation: National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China.
authors.forename: You-Lin
authors.initials: YL
authors.lastname: Qiao
authors.affiliation: Department of Global Health, University of Washington, Seattle, United States.
authors.forename: Dean T
authors.initials: DT
authors.lastname: Jamison
authors.affiliation: Center for Health Decision Science, Department of Health Policy Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
authors.forename: Jane J
authors.initials: JJ
authors.lastname: Kim
mesh_terms: D002648:Child; D002681:China / Q000453:epidemiology; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics; D005260:Female; D005380:Financing, Government; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage / Q000191:economics*; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000517:prevention & control*; D014611:Vaccination / Q000191:economics / Q000706:statistics & numerical data
chemical_list: D053918:Papillomavirus Vaccines
keywords: Cervical cancer; China; Economic evaluation; Equity; Extended cost-effectiveness analysis; HPV vaccination