Yihan Lu

Cost-effectiveness and epidemiological impact of gender-neutral vaccination against human papillomavirus in economically developed metropolises of Beijing, Shanghai, and Guangzhou, China

Human papillomavirus (HPV) causes multiple diseases in both sexes. This study evaluates the cost-effectiveness and epidemiological impact - defined as reductions in HPV-related disease cases - of a gender-neutral vaccination (GNV) strategy in China's economically developed metropolises: Beijing, Shanghai, and Guangzhou. A discrete-time Markov model simulated no vaccination, female-only vaccination (FOV), and GNV strategies among 12-year-olds. The cost matrix included vaccine procurement, administration, and treatment costs from Chinese data and literature. The case matrix translated model-estimated reductions in HPV infections into decreases in disease incidence by applying baseline incidence rates adjusted for HPV genotype attribution, relative risk reductions, and disease-specific lag times. Outcomes assessed were costs (2023 USD), quality-adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), and cases averted. Compared to FOV, the ICERs for GNV were USD 323,134/QALY (Beijing), USD 305,816/QALY (Shanghai), and USD 251,853/QALY (Guangzhou), exceeding local willingness-to-pay thresholds, indicating cost-ineffectiveness. The GNV strategy averted 3.9%, 4.7%, and 3.9% more HPV-related cases over 30 years in Beijing, Shanghai, and Guangzhou, respectively. Sensitivity analyses showed that GNV became cost-effective when the 9vHPV uptake rate was below 20% in girls (Shanghai) or below 10% in girls (Beijing and Guangzhou), regardless of the uptake rate (≤80%) in boys. It was also cost-effective if vaccine price dropped to USD 21.4 (Shanghai), USD 18.9 (Beijing), or USD 19.1 (Guangzhou). Price thresholds rose substantially with decreasing female uptake but changed little with male uptake variation. The GNV strategy may be cost-effective when the 9vHPV uptake rate remains low in girls or the vaccine price significantly decreases.

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

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). 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. 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. 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.

Discrepancy of human papillomavirus vaccine uptake and intent between girls 9–14 and their mothers in a pilot region of Shanghai, China

Human papillomavirus (HPV) vaccine uptake remains low in China, especially among girls. Recently, China has initiated a pilot program on HPV immunization for girls aged 9-14 years. We conducted a cross-sectional online survey in Minhang district of Shanghai, a pilot region for the program, to investigate HPV vaccination status among mothers and their daughters 9-14. A total of 1031 parents and 1122 daughters 9-14 were included. Of them, 18.6% of mothers and 4.5% of daughters had been vaccinated with HPV vaccines or made an appointment; additionally, 62.7% and 78.4% intended to receive vaccination but did not make an appointment. Notably, 6.2% of parents did not intend to receive vaccination for themselves (or their wives) but intended to vaccinate their daughters. Moreover, we calculated parental knowledge and awareness scores toward HPV infection and vaccination. Both scores were significantly higher among the parents who had received HPV vaccination than those who intended to across mothers' vaccination status (