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Background <p>In China, human papillomavirus (HPV) vaccination for girls has been included in the National Immunization Program (NIP), providing free 2-valent HPV vaccine (2vHPV) for 13-year-old girls. This study assessed the public health impact and cost-effectiveness of routine 2vHPV/9vHPV for girls aged 13 years, with/without a catch-up strategy for females aged ≤ 26 years, in six cities with free 2vHPV programs but differing socioeconomic development across China (Wuxi, Suzhou, Guangzhou, Yuxi, Chengdu, and Shijiazhuang).</p> Methods <p>A discrete-time Markov model was developed from the healthcare system perspective over a 100-year horizon. Routine (aged 13 years) and catch-up (aged ≤ 26 years) vaccination coverages were assumed at 90% and 70%, respectively. Model outputs included costs (2023 USD), quality-adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), and cases of HPV-related diseases averted. The willingness-to-pay (WTP) thresholds were set corresponding to 1 times the per capita GDP of each city. Scenario and sensitivity analyses were conducted to test robustness.</p> Results <p>Routine 9vHPV strategy prevented an additional 1921–9630 cases of cervical cancer, compared with the routine 2vHPV strategy. Furthermore, incorporating a catch-up strategy yielded a marginal additional reduction (29–176 cases by 9vHPV and 18–108 cases by 2vHPV) in cervical cancer. Under ideal pricing assumptions, the routine 9vHPV strategy was cost-saving and cost-effective across all six cities, compared with routine/routine plus catch-up 2vHPV strategies, with a cost saving of USD 1730–2792/1769–2817 per person, and a gain of 0.195–0.315/0.193–0.311 QALYs per person. Routine plus catch-up 2vHPV and 9vHPV strategies remained cost-effective in five and four cities, respectively. Notably, scenario analysis indicated at current domestic 9vHPV market price, the routine 9vHPV strategy remained cost-effective in six cities, while the catch-up strategy became cost-ineffective across all cities.</p> Conclusions <p>The routine 9vHPV strategy may be cost-effective compared with the 2vHPV strategy in China. However, a 9vHPV catch-up strategy varies in cost-effectiveness by regional socioeconomic development.</p>

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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

  • 期刊论文

  • 发表日期：

    2026年1月27日

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  • Xiaoya Fu,
  • Qian Zhang,
  • Abram L. Wagner,
  • Ye Yao,
  • Yilan Xia,
  • Fengge Wang,
  • Yihan Lu

摘要

Background

In China, human papillomavirus (HPV) vaccination for girls has been included in the National Immunization Program (NIP), providing free 2-valent HPV vaccine (2vHPV) for 13-year-old girls. This study assessed the public health impact and cost-effectiveness of routine 2vHPV/9vHPV for girls aged 13 years, with/without a catch-up strategy for females aged ≤ 26 years, in six cities with free 2vHPV programs but differing socioeconomic development across China (Wuxi, Suzhou, Guangzhou, Yuxi, Chengdu, and Shijiazhuang).

Methods

A discrete-time Markov model was developed from the healthcare system perspective over a 100-year horizon. Routine (aged 13 years) and catch-up (aged ≤ 26 years) vaccination coverages were assumed at 90% and 70%, respectively. Model outputs included costs (2023 USD), quality-adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), and cases of HPV-related diseases averted. The willingness-to-pay (WTP) thresholds were set corresponding to 1 times the per capita GDP of each city. Scenario and sensitivity analyses were conducted to test robustness.

Results

Routine 9vHPV strategy prevented an additional 1921–9630 cases of cervical cancer, compared with the routine 2vHPV strategy. Furthermore, incorporating a catch-up strategy yielded a marginal additional reduction (29–176 cases by 9vHPV and 18–108 cases by 2vHPV) in cervical cancer. Under ideal pricing assumptions, the routine 9vHPV strategy was cost-saving and cost-effective across all six cities, compared with routine/routine plus catch-up 2vHPV strategies, with a cost saving of USD 1730–2792/1769–2817 per person, and a gain of 0.195–0.315/0.193–0.311 QALYs per person. Routine plus catch-up 2vHPV and 9vHPV strategies remained cost-effective in five and four cities, respectively. Notably, scenario analysis indicated at current domestic 9vHPV market price, the routine 9vHPV strategy remained cost-effective in six cities, while the catch-up strategy became cost-ineffective across all cities.

Conclusions

The routine 9vHPV strategy may be cost-effective compared with the 2vHPV strategy in China. However, a 9vHPV catch-up strategy varies in cost-effectiveness by regional socioeconomic development.