Cost-Utility of a Two-Dose Human Papillomavirus Vaccination Programme Added to Cervical Cancer Screening Compared with Cervical Cancer Screening Alone in Korea

Background: Cervical cancer is caused by the human papillomavirus and is a leading cause of cancer death amongyoung Korean women. Current screening programmes could benefit from the addition of HPV vaccination into theirschedule to help reduce disease burden. Two-dose vaccination schedules targeting HPV types 16 and 18, which areresponsible for most cervical cancer cases, have recently been approved. Of the two available vaccines, AS04-adjuvantedHPV16/18 vaccine (AS04-HPV16/18v) provides greater protection against non-vaccine oncogenic HPV, whileHPV-6/11/16/18 vaccine (4vHPVv) provides protection against genital warts. Methods: The health and economicconsequences of introducing a two-dose HPV vaccination programme in 12-year-old girls together with screening wereassessed in the Korean healthcare setting using a previously-published Markov model. Results: Compared with screeningalone, AS04-HPV16/18v was cost-effective (incremental cost-effectiveness ratio below and within the Korean Won[KRW] 20-30 million treshold). When comparing the two vaccines, at 3% discount rate, AS04-HPV16/18v dominated4vHPVv (i.e., provided 174 more quality-adjusted life-years (QALYs), 304 more life-years (LYs) and cost-savings ofKRW 980 million). At a 5% discount rate, AS04-HPV16/18v provided comparable QALYs (albeit 5 fewer), 105 moreLYs and cost-savings of KRW 292 million compared with 4vHPVv. Results were particularly sensitive to the discountrate used, as the health benefits of preventing cervical cancer are observed much later than those of preventing genitalwarts. Conclusion: For the Korean setting, HPV vaccination with a two-dose schedule is a cost-effective option, andAS04-HPV16/18v is likely to offer better health outcomes at a cost-saving compared with 4vHPVv.