Zhou Dachuang, Zhang Di, Wang Yi, Zhou Kejia, Tang Wenxi
School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China.
Center for Pharmacoeconomics and Outcomes Research, Department of Public Affairs Management, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, Jiangsu, China.
Cost Eff Resour Alloc. 2025 May 14;23(1):20. doi: 10.1186/s12962-025-00630-y.
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.
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.
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.
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.
随着国内首款九价人乳头瘤病毒（HPV）疫苗即将在中国上市，以及宫颈癌筛查技术的进步，我们旨在评估并确定适合中国的有效、具有成本效益且可负担得起的宫颈癌预防策略。
我们从医疗系统的角度开发了一个马尔可夫模型，该模型包含18个年龄层和9种健康状态，以预测未来30年38种不同宫颈癌预防策略与不干预相比的有效性、成本效益和可负担性。模型参数通过对无干预情景的实际数据和模拟结果进行最小二乘法拟合来校准。根据世界卫生组织（WHO）的宫颈癌消除目标（发病率<10万分之4）、成本效益阈值（增量成本效益比[ICER]<中国2023年人均GDP的一次性数值）以及中国当前的宫颈癌预防预算，对策略进行评估和选择。我们进行了单因素和概率敏感性分析，并考虑了集中采购带来的潜在价格降低，以评估结果的稳健性。
与不干预相比，16种策略到2050年可实现宫颈癌消除，29种具有高度成本效益，11种可负担得起。总体而言，只有对35 - 64岁女性采用醋酸目视检查（VIA）筛查，并对9 - 14岁女孩进行二价疫苗接种符合所有标准。该策略到2041年可实现宫颈癌消除，每质量调整生命年（QALY）的ICER为2543.91美元，且被认为具有可负担性。敏感性分析表明结果具有稳健性。如果考虑集中采购带来的价格降低，CareHPV、PAP和九价HPV疫苗接种可能成为有吸引力的替代方案。
对35 - 64岁女性采用VIA筛查，并对9 - 14岁女孩接种二价HPV疫苗是目前中国最适合的宫颈癌预防策略。在预算较多的情况下，可以引入更精确的筛查方法和九价HPV疫苗。我们的研究为中国宫颈癌防控政策提供了关键证据。
