title: Cost-effectiveness analysis of AS04-adjuvanted human papillomavirus 16/18 vaccine compared with human papillomavirus 6/11/16/18 vaccine in the Philippines, with the new 2-dose schedule.
abstract: Cervical cancer (CC) is the second leading cause of cancer death among Filipino women. Human papillomavirus (HPV) vaccination protects against CC. Two vaccines (AS04-HPV-16/18 and 4vHPV) are approved in the Philippines; they were originally developed for a 3-dose (3D) administration and have recently been approved in a 2-dose schedule (2D). This study aims to evaluate the cost-effectiveness of HPV vaccination of 13-year-old Filipino girls, in addition to current screening, in the new 2D schedule. An existing static lifetime, one-year cycle Markov cohort model was adapted to the Philippine settings to simulate the natural history of low-risk and oncogenic HPV infection, the effects of screening and vaccination of a 13-year-old girls cohort vaccinated with either the 2D-AS04-HPV-16/18 or 2D-4vHPV assuming a 100% vaccination coverage. Incremental cost, quality-adjusted life year (QALY) and cost-effectiveness were derived from these estimates. Input data were obtained from published sources and Delphi panel, using country-specific data where possible. Sensitivity analyses were performed to assess the robustness of the model. The model estimated that 2D-AS04-HPV-16/18 prevented 986 additional CC cases and 399 CC deaths (undiscounted), as well as 555 increased QALY (discounted), and save 228.1 million Philippine pesos (PHP) compared with the 2D-4vHPV. In conclusion, AS04-HPV-16/18 is shown to be dominant over 4vHPV in the Philippines, with greater estimated health benefits and lower costs.
authors.affiliation: a University of the Philippines College of Medicine, Philippine General Hospital, Metro , Manila , Philippines.
authors.forename: Maria Julieta
authors.initials: MJ
authors.lastname: Germar
authors.affiliation: b St Martin De Porres Charity Hospital , San Juan, Mandaluyong City , Philippines.
authors.forename: Carrie
authors.initials: C
authors.lastname: Purugganan
authors.affiliation: c St Luke's Medical Center , Quezon City , Philippines.
authors.forename: Ma Socorro
authors.initials: MS
authors.lastname: Bernardino
authors.affiliation: d Jose R Reyes Memorial Medical Center , Tondo , Manila , Philippines.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Cuenca
authors.affiliation: e GSK , Singapore , Republic of Singapore.
authors.forename: Y-Chen
authors.initials: YC
authors.lastname: Chen
authors.affiliation: f GSK , Wavre , Belgium.
authors.forename: Xiao
authors.initials: X
authors.lastname: Li
authors.affiliation: f GSK , Wavre , Belgium.
authors.forename: Georges
authors.initials: G
authors.lastname: Van Kriekinge
authors.affiliation: e GSK , Singapore , Republic of Singapore.
authors.forename: I-Heng
authors.initials: IH
authors.lastname: Lee
mesh_terms: D000276:Adjuvants, Immunologic; D000293:Adolescent; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18 / Q000008:administration & dosage / Q000191:economics* / Q000276:immunology; D052162:Human papillomavirus 16 / Q000276:immunology; D052161:Human papillomavirus 18 / Q000276:immunology; D052163:Human papillomavirus 6 / Q000276:immunology; D006801:Humans; D007115:Immunization Schedule; D008390:Markov Chains; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000008:administration & dosage / Q000191:economics*; D010679:Philippines / Q000453:epidemiology; D019057:Quality-Adjusted Life Years; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control / Q000821:virology; D014611:Vaccination / Q000191:economics*
chemical_list: D000276:Adjuvants, Immunologic; D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18; D053918:Papillomavirus Vaccines; C510352:human papillomavirus vaccine, L1 type 16, 18
keywords: Cervarix™; Gardasil; Philippines; Two-dose; cervical cancer; cost-effectiveness; human papillomavirus; vaccination