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. 2021 Mar 3;19(1):62.
doi: 10.1186/s12916-021-01930-9.

Effectiveness and cost-effectiveness of eliminating cervical cancer through a tailored optimal pathway: a modeling study

Changfa Xia  1 , Xiaoqian Xu  1 , Xuelian Zhao  1 , Shangying Hu  1 , Youlin Qiao  1 , Yong Zhang  1 , Raymond Hutubessy  2 , Partha Basu  3 , Nathalie Broutet  4 , Mark Jit  5   6 , Fanghui Zhao  7
Affiliations

Effectiveness and cost-effectiveness of eliminating cervical cancer through a tailored optimal pathway: a modeling study

Changfa Xia et al. BMC Med. .

Abstract

Background: The World Health Assembly has adopted a global strategy to eliminate cervical cancer. However, neither the optimal pathway nor the corresponding economic and health benefits have been evaluated. We take China as an example to assess the optimal pathway towards elimination and the cost-effectiveness of tailored actions.

Methods: A validated hybrid model was used to assess the costs and benefits of alternative strategies combining human papillomavirus vaccination, cervical screening, and treatment of pre-invasive lesions and invasive cancer for females with different immunization history. All Chinese females living or projected to be born during 2015-2100, under projected trends in aging, urbanization, and sexual activity, were considered. Optimal strategies were determined by cost-effectiveness efficiency frontiers. Primary outcomes were cervical cancer cases and deaths averted and incremental cost-effectiveness ratios (ICERs). We employed a lifetime horizon from a societal perspective. One-way and probabilistic sensitivity analyses evaluate model uncertainty.

Results: The optimal pathway represents an integration of multiple tailored strategies from females with different immunization history. If China adopts the optimal pathway, the age-standardized incidence of cervical cancer is predicted to decrease to fewer than four new cases per 100,000 women (i.e., elimination) by 2047 (95% confidence interval 2043 to 2050). Compared to the status quo, the optimal pathway would avert a total of 7,509,192 (6,922,744 to 8,359,074) cervical cancer cases and 2,529,873 (2,366,826 to 2,802,604) cervical cancer deaths in 2021-2100, with the discounted ICER being $- 339 (- 687 to - 79) per quality-adjusted life-year.

Conclusions: By adopting an optimal pathway from 2021 (namely, the year of the first Chinese Centennial Goals) onwards, cervical cancer could be eliminated by the late 2040s (namely, ahead of the second Chinese Centennial Goals) while saving net economic costs in China.

Keywords: Cervical cancer; Cost-effectiveness; Elimination; Optimal pathway.

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Conflict of interest statement

Authors YQ and FZ have received grants through their institution from GlaxoSmithKline Biologicals SA, Merck & Co, Inc., and Xiamen Innovax Biotech Co, Ltd., to undertake clinical trials on the HPV vaccine. Neither YQ nor FZ have received any royalties and do not have intellectual property, patent, or stock holdings with vaccine or drug companies. Other authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Optimal pathway towards cervical cancer elimination. The percentages and background colors in each cell indicate the population coverages. HPV, human papillomavirus; CIN, cervical intraepithelial neoplasia
Fig. 2
Fig. 2
Age-standardized cervical cancer incidence and mortality for the optimal pathway. The solid line represents the base case estimates, and the shaded area represents the 95% confidence intervals based on 1000 simulations of probabilistic sensitivity analysis
Fig. 3
Fig. 3
Annual costs from each component of cervical cancer prevention and treatment. Total costs and cost components for scenarios of the optimal pathway (a) and status quo (b)
See this image and copyright information in PMC

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