| Summary: | 碩士 === 國立成功大學 === 公共衛生研究所 === 97 === Background: The incidence rate of cervical cancer is high in Taiwan, with about 1,900 incident cases and 800 deaths due to cervical cancer every year. Introduction of a human papillomavirus vaccine is expected to significantly reduce the burden of cervical cancer and HPV-related diseases. But, there is seldom cost-effectiveness analysis research related to the human papillomavirus vaccine in Taiwan.
Objective: To determine the cost effectiveness of providing a HPV vaccination program in adolescent females aged 12-year-old in addition to the existing cervical cancer screening program in Taiwan.
Methods: The analysis was conducted from the perspective of the healt hcare system. A Markov state-transition model was developed for Taiwan in order to evaluate the long-term impact of vaccinating a cohort of girls aged 12 years alongside the existing screening programme. We assumed the efficacy of HPV vaccine was 95%, with 10 years duration of immunity, the coverage rate was 85%. The model estimated lifetime risks and total lifetime healthcare costs for cervical cancer. Model outcomes mainly included incremental costs per QALY gained.
Results: A prophylactic vaccine against high-risk HPV types is more expensive than current screening practice but results in greater quality-adjusted life expectancy. HPV vaccination of 12-year-old girls in Taiwan improves their life expectancy by 0.0022 (about 0.8 days) or 0.0088 QALY (about 3.2 days) at a cost of NT$10,144 relative current screening practice. Furthermore, vaccinating the present Taiwan cohort of 12-year-old girls with such a ten years duration of immunity vaccine would avert 5,616 cases of CIN1, 3,425 cases of CIN2/3, 134 cases of cervical cancer, and 22 cervical-cancer deaths over the cohort’s lifetime.Prevention of one case of cervical cancer would require vaccination of 1,151 girls.
Conclusions: Given the duration of immunity is 10 years, introducing a HPV vaccination program in 12-year-old girls in Taiwan compared to current screening practice remained fairly cost-effectiveness (ICER of NT$1,152,727/QALY).And if vaccine could provide lifetime immunity, vaccination program would be very cost-effectiveness (ICER of NT$201,346/QALY).
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