Optimizing strategy for cervical cancer prevention in china: a comprehensive modeling analysis.

BACKGROUND

With the first domestic 9-valent human papillomavirus (HPV) vaccine soon to be introduced in China, alongside advancements in cervical cancer screening technologies, we aimed to evaluate and identify effective, cost-effective, and affordable cervical cancer prevention strategies suitable for China.

METHODS

We developed a Markov model from the healthcare system perspective, comprising 18 ages strata and 9 health states, to predict the effectiveness, cost-effectiveness, and affordability of 38 different cervical cancer prevention strategies over the next 30 years, compared with no intervention. The model parameters were calibrated using least-squares fitting against real-world data and simulation results for the no-intervention scenario. Strategies were assessed and selected based on the World Health Organization's (WHO) cervical cancer elimination target (incidence < 4 per 100,000), cost-effectiveness threshold (Incremental cost effectiveness ratio [ICER] < one-time China's 2023 per capita GDP), and current cervical cancer prevention budget in China. We conducted one-way and probabilistic sensitivity analyses, and considered potential price reductions from centralized procurement to assess the robustness of the results.

RESULTS

Compared with no intervention, 16 strategies could achieve cervical cancer elimination by 2050, 29 were highly cost-effective, and 11 were affordable. Overall, only screening women aged 35-64 using visual inspection with acetic acid (VIA) combined with bivalent vaccination for girls aged 9-14 met all criteria. This strategy could achieve cervical cancer elimination by 2041, with an ICER of US$2,543.91 per quality-adjusted life-year (QALY), and was deemed affordable. Sensitivity analysis indicated the results were robust. If price reductions from centralized procurement were considered, CareHPV, PAP, and 9-valent HPV vaccination could become attractive alternatives.

CONCLUSION

Screening women aged 35-64 with VIA and vaccinating girls aged 9-14 with the bivalent HPV vaccine is currently the most suitable cervical cancer prevention strategy for China. In scenarios with larger budgets, more accurate screening methods and the 9-valent HPV vaccine could be introduced. Our study provides crucial evidence for cervical cancer prevention and control policy in China.