A new modelling study in BMC Public Health [in press] examines how China can combine HPV vaccination and cervical cancer screening in the most cost-effective way, with a particular focus on the country’s domestically produced bivalent HPV vaccine. Using a Markov model, Zhang and colleagues evaluated 121 prevention strategies that mix three vaccine types (domestic bivalent, quadrivalent, and nine-valent) with different screening methods and intervals for women aged 15–26 years. From the health system perspective and compared with no intervention, the optimal strategy for each vaccine type was vaccination plus visual inspection with acetic acid (VIA) every three years. Under these optimal combinations, the incremental cost-effectiveness ratios (ICERs) were approximately US$145 per QALY gained for the domestic bivalent vaccine, US$644 per QALY for the quadrivalent vaccine, and US$583 per QALY for the nine-valent vaccine—well below commonly used thresholds for China and strongly supportive of scaled-up HPV prevention.
When the three optimal strategies are compared head-to-head, the domestic bivalent vaccine emerges as the best buy at current resource levels. At lower willingness-to-pay thresholds (below US$2,500 per QALY), the combination of domestic bivalent vaccination and three-yearly VIA dominates quadrivalent and nine-valent options, offering greater value for money. As willingness to pay rises above US$2,500 per QALY, a nine-valent vaccine plus VIA every three years becomes the preferred strategy, reflecting the higher price but broader serotype protection. The authors conclude that, for now, China should prioritise expanding coverage of its domestic bivalent HPV vaccine through immunization programmes while integrating affordable VIA screening—an approach that could be particularly relevant for other developing countries seeking economically viable pathways toward cervical cancer elimination.
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