Optimizing strategy for cervical cancer prevention in china: a comprehensive modeling analysis

Area of Science:

• Public Health
• Epidemiology
• Health Economics

Background:

• China is preparing to introduce its first domestic 9-valent human papillomavirus (HPV) vaccine.
• Advancements in cervical cancer screening technologies are also emerging.
• There is a need to identify optimal cervical cancer prevention strategies for China.

Purpose of the Study:

• To evaluate and identify effective, cost-effective, and affordable cervical cancer prevention strategies for China.
• To assess strategies against the World Health Organization's (WHO) cervical cancer elimination target.
• To consider the current budget and potential price reductions for interventions.

Main Methods:

• A Markov model was developed from a healthcare system perspective.
• The model included 18 age strata and 9 health states, simulating 38 prevention strategies over 30 years.
• Model parameters were calibrated using real-world data; strategies were evaluated based on WHO targets, cost-effectiveness thresholds, and budget constraints.

Main Results:

• 16 strategies could achieve cervical cancer elimination by 2050; 29 were highly cost-effective; 11 were affordable.
• Screening women aged 35-64 with visual inspection with acetic acid (VIA) combined with bivalent HPV vaccination for girls aged 9-14 met all criteria.
• This optimal strategy could achieve elimination by 2041 with an ICER of $2,543.91/QALY and was deemed affordable. Sensitivity analyses confirmed robustness.

Conclusions:

• Screening women aged 35-64 with VIA and vaccinating girls aged 9-14 with the bivalent HPV vaccine is the most suitable cervical cancer prevention strategy for China.
• More advanced screening methods and the 9-valent HPV vaccine could be viable with increased budgets.
• The study provides critical evidence for China's cervical cancer prevention and control policies.