Introducing HPV vaccine and scaling up screening procedures to prevent deaths from cervical cancer in Japan: a cost‐effectiveness analysis

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Abstract
Please cite this paper as: Yamamoto N, Mori R, Jacklin P, Osuga Y, Kawana K, Shibuya K, Taketani Y. Introducing HPV vaccine and scaling up screening procedures to prevent deaths from cervical cancer in Japan: a cost‐effectiveness analysis. BJOG 2012;119:177–186. Objective To assess the cost‐effectiveness of universal vaccination of 11‐year‐old girls against human papillomavirus (HPV) infection and increased screening coverage to prevent cervical cancer in Japan where the coverage of Papanicolaou smears is very low. Design A cost–utility analysis from a societal perspective. Setting Japan, 2010. Population The female Japanese population aged 11 years or older. Methods A Markov model of the natural history of cervical cancer was constructed to compare six strategies: i.e. a screening coverage rate of 20, 50 and 80% with and without routine vaccination at age 11. Main outcome measures Cervical cancer incidence, quality‐adjusted life years (QALYs), costs and incremental cost‐effectiveness ratios. Results Expanding the coverage of Papanicolaou smears from the current level of 20–50 and 80% yields a 45.5 and 63.1% reduction in cervical cancer incidence, respectively. Impact of combined strategies increases with coverage. Coverages of 20, 50 and 80% showed a 66.1, 80.9 and 86.8% reduction in disease, respectively. The costs of strategies with vaccination are four times higher than the cost of strategies without vaccination. Vaccinating all 11‐year‐old girls with bivalent vaccines with a Papanicolaou smear coverage rate of 50% is likely to be the most cost‐effective option among the six strategies. Conclusions The introduction of HPV vaccination in Japan is cost‐effective as in other countries. It is more cost‐effective to increase the coverage of the Papanicolaou smear along with the universal administration of HPV vaccine.

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