Public Health Impact and Cost-Effectiveness of Routine and Catch-Up Human Papillomavirus Vaccination in Girls and Women in Selected Regions of China: A Model-Based Study

This peer-reviewed article, evaluates the public health impact and cost-effectiveness of routine 2-valent (2vHPV) and 9-valent (9vHPV) human papillomavirus vaccination strategies for 13-year-old girls in China, with and without a catch-up strategy for females aged ≤26 years. The study focuses on six cities with free 2vHPV programs but differing levels of socioeconomic development (Wuxi, Suzhou, Guangzhou, Yuxi, Chengdu, and Shijiazhuang).

Using a discrete-time Markov model from the healthcare system perspective over a 100-year time horizon, the authors estimated costs (2023 USD), quality-adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), and HPV-related disease cases averted. Routine vaccination coverage was assumed at 90%, and catch-up coverage at 70%. Cost-effectiveness was assessed against willingness-to-pay thresholds set at one times per capita GDP for each city, with scenario and sensitivity analyses conducted to test robustness.

Key findings

• Routine 9vHPV vaccination prevented an additional 1,921–9,630 cervical cancer cases compared with routine 2vHPV vaccination across the six cities.
• Adding a catch-up strategy yielded only marginal additional reductions in cervical cancer cases (29–176 additional cases prevented with 9vHPV; 18–108 with 2vHPV).
• Under ideal pricing assumptions, routine 9vHPV was cost-saving and cost-effective in all six cities compared with both routine and routine plus catch-up 2vHPV strategies.
• Routine 9vHPV generated cost savings of USD 1,730–2,792 (routine comparison) and USD 1,769–2,817 (routine plus catch-up comparison) per person, alongside gains of 0.195–0.315 and 0.193–0.311 QALYs per person, respectively.
• Routine plus catch-up 2vHPV strategies were cost-effective in five cities, while routine plus catch-up 9vHPV strategies were cost-effective in four cities.
• At current domestic 9vHPV market prices, routine 9vHPV remained cost-effective in all six cities; however, the catch-up strategy became cost-ineffective across all cities.
• Cost-effectiveness of catch-up 9vHPV strategies varied by regional socioeconomic development.

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