Background and aims: Cervical cancer is one of the main causes of death in women in low- and middle-income countries. Despite technological and scientific advances that allow an early detection of precancerous lesions and curative treatment of cervical cancer, Mexico and other Latin American countries have only been able to obtain a small decrease in the mortality rates for this kind of cancer. How to implement and sustain effective public health strategies for cervical cancer prevention, such as increasing cytology-based screening program coverage and implementing HPV-DNA testing and vaccination, are important questions. The aim of this study is to perform a cost-effectiveness analysis of the introduction of a quadrivalent (HPV 6/11/16/18) HPV vaccine into the public health system and evaluate the epidemiological and economic benefits on prevention of cervical cancer in Mexico.
Methods: A Markov model is used to simulate the natural history of HPV infection in a cohort of Mexican women to evaluate the cost-effectiveness of the cervical cancer screening strategy used in Mexico as well as the benefits of other potential strategies such as 1) vaccination only, 2) conventional cytology-based screening program only and 3) vaccination followed by screening. For the strategies that involve screening we have chosen screening intervals of 3 and 5 years. The model produces results that are reasonably close to the epidemiological data related to HPV and cervical cancer in Mexico.
Results: The quadrivalent HPV vaccine could reduce the probability of persistent HPV-16/18 infection by at least 60%, which would result in a near-proportional reduction in HPV-16/18-associated invasive cervical cancer and CIN 3.
Conclusions: The strategy of using only vaccination ($45 USD for three doses) as a preventive measure was a very cost-effective strategy in Mexico ($68USD/LYS). The strategy of vaccination with traditional screening of Pap test every 3 years produced higher cost by a lower performance of cervical cytology in Mexico, at a cost of $15,935 USD per life-year. The cost-effectiveness of the vaccination strategy was highly sensitive to age of vaccination, duration of vaccine efficacy, and cost of vaccination. The Mexican model predicts that a quadrivalent HPV vaccine will reduce the incidence of high- and low-risk-associated cervical cancer. A program of vaccination as a preventive strategy is likely cost effective. The results of this study could be of great value in decision-making for the implementation of an HPV vaccine as a public health policy in Mexico provided that the cost of each dose will be, at most, $15 dollars (USD) dollars, combined with HPV testing, the new strategy of national secondary prevention program.