title: Cost-effectiveness of a bivalent human papillomavirus vaccination program in Japan.
abstract: Background Human papillomavirus (HPV) vaccines and their widespread adoption have the potential to relieve a large part of the burden of cervical cancer morbidity and mortality, particularly in countries that have low screening rates or, like Japan, lack a cohesive universal screening program. An economic evaluation was conducted to assess the cost-effectiveness of introducing a bivalent HPV vaccination program in Japan from a healthcare perspective.
  
  
  METHODS
  A Markov model of the natural history of HPV infection that incorporates both vaccination and screening was developed for Japan. The modelled intervention, a bivalent HPV vaccine with a 100% lifetime vaccine efficacy and 80% vaccine coverage, given to a cohort of 12-year-old Japanese girls in conjunction with the current screening program, was compared with screening alone in terms of costs and effectiveness. A discount rate of 5% was applied to both costs and utilities where relevant.
  
  
  RESULTS
  Vaccination alongside screening compared with screening alone is associated with an incremental cost-effectiveness ratio (ICER) of US$20315 per quality-adjusted-life-year gained if 80% coverage is assumed. The ICER at 5% coverage with the vaccine plus screening, compared with screening alone, is US$1158.
  
  
  CONCLUSIONS
  The cost-effectiveness results suggest that the addition of a HPV vaccination program to Japan's cervical cancer screening program is highly likely to prove a cost-effective way to reduce the burden of cervical cancer, precancerous lesions and HPV16/18-related diseases.
authors.affiliation: The University of Queensland, Faculty of Health and Behavioural Sciences, Level 7, Oral Health Building, Herston, Qld 4006, Australia.
authors.forename: Luke B
authors.initials: LB
authors.lastname: Connelly
authors.affiliation: Deakin Health Economics, Population Health SRC, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Vic. 3125, Australia.
authors.forename: Ha N D
authors.initials: HN
authors.lastname: Le