AS04-HPV-16/18v most cost-effective option for reducing cervical cancer in SG
It appears that the two-dose AS04-adjuvanted HPV-16/18 vaccine (AS04-HPV-16/18v) is the most cost-effective choice for lowering the burden of cervical cancer through universal mass vaccination for 12-year-old girls in Singapore from the perspective of the healthcare payer (MOH Singapore), according to a recent study.
In addition, AS04-HPV-16/18v is better than the HPV-6/11/16/18 vaccine (4vHPV) in generating more quality-adjusted life years (QALYs) at a lower cost.
Compared with screening alone, AS04-HPV-16/18v prevented 137 cervical cancer cases and 48 cervical cancer deaths in Singapore, leading to an incremental cost-effectiveness ratio of SGD 12,645 per QALY gained. Such ratio is cost-effective based on the World Health Organization threshold for Singapore. [Singapore Med J 2018;59:370-382]
AS04-HPV-16/18v appeared to prevail over 4vHPV when discounted at 3 percent, with cost savings of SGD 80,559 and 28 additional QALYs gained. One-way sensitivity analysis further showed that AS04-HPV-16/18v was cost effective compared with screening alone and leading compared with 4vHPV.
These results support those reported by Lee and colleagues for a three-dose vaccination schedule, but the latter differed in concluding that 4vHPV was dominant over AS04-HPV-16/18v as regards cost per QALY gained. [BMC Public Health 2011;11:203]
“However, when the [incremental cost-effectiveness ratio] was calculated in terms of cost per LY gained, Lee [and colleagues] found AS04-HPV-16/18v to be more cost-effective when compared with 4vHPV, due to the focus on LYs and the exclusion of [genital warts]-associated QALY changes,” researchers said.
Currently, the Medisave programme covers this vaccination, relying on voluntary or parental initiation, which partly explains the current low uptake rate (13.6 percent). [Sage Open 2014;4:1-10]
“Official recommendation from relevant medical societies, endorsement of the AS04-HPV-16/18v from MOH Singapore and the Health Promotion Board, and dissemination of these recommendations through public awareness campaigns could contribute to higher uptake rates,” researchers said.
The addition of AS04-HPV-16/18v to the school-based vaccination programme for 12-year-old girls and the inclusion of AS04-HPV-16/18v in the National Immunisation Registry in Singapore could further boost coverage, as this would deliver an organized immunization as well as reminders to parents if a child misses a vaccine dose. [Vaccine 2013;31:1673-1679]
Furthermore, considering catch-up vaccination policies may improve the coverage in the overall population. [PLoS One 2016;11:e0149857]
“By building public awareness about HPV immunization and improving the HPV vaccination coverage, the burden and suffering associated with cervical precancer, cervical cancer and cancer death could be alleviated in the future,” researchers said.
The present study utilized a lifetime Markov cohort model to assess the cost-effectiveness of introducing the AS04-HPV-16/18v to the current cervical screening programme in Singapore. The cost-effectiveness of AS04-HPV-16/18v was also compared with 4vHPV. Finally, model inputs were derived from local data and validated by clinical experts.