Modeling the epidemiological impact and cost-effectiveness of a combined schoolgirl HPV vaccination and cervical cancer screening program among Chinese women

Xiaomeng Ma, Katherine Harripersaud, Kumi Smith, Christopher K. Fairley, Huachun Zou, Zhuoru Zou, Yueyun Wang, Guihua Zhuang, Lei Zhang

Research output: Contribution to journalArticlepeer-review


Human papillomavirus (HPV) infection is common in women and also the main cause of cervical cancer. Based on a dynamic compartmental model, we aimed to evaluate the population impact and cost-effectiveness of strategies that combined cervical cancer screening and HPV schoolgirl vaccination for Chinese women. The effectiveness of interventions was assessed by comparing modeled scenarios to the status quo, where a 3-y cervical cancer screening program remained at a 20% coverage and without a universal HPV vaccination program. Our study demonstrated that increasing screening coverage from 20% to 50% would reduce the high-risk HPV (HR-HPV) prevalence to 5.4%, whereas a universal schoolgirl vaccination program using the quadrivalent vaccine (qHPV) with a coverage of 50% would reduce the prevalence to 2.9% by 2069. Scaling-up the cervical screening coverage to 50% will prevent 16,012 (95% CI: 8,791 to 25,913) Disability-Adjusted Life-Years (DALYs) per year, with an incremental cost-effectiveness ratio (ICER) of US$ 10,958 (95% CI: $169 to $26,973)/DALY prevented. At the current qHPV price, vaccinating 50% of school girls will prevent 13,854 (95% CI: 8,355 to 20,776) DALYs/year, but the corresponding incremental cost-effectiveness ratio (ICER, US$ 83,043, 95% CI: $52,234 to $138,025) exceeds cost-effectiveness threshold (i.e., 3 times GDP per-capita of China: $30,792). The qHPV vaccine requires at least a 50% price reduction to be cost-effective. Vaccinating schoolgirls will result in a large population health benefit in the long term, but such a universal HPV vaccination program can only be cost-effective with a substantial price reduction.

Original languageEnglish (US)
Pages (from-to)1073-1082
Number of pages10
JournalHuman Vaccines and Immunotherapeutics
Issue number4
StatePublished - Apr 3 2021

Bibliographical note

Funding Information:
LZ is supported by the National Natural Science Foundation of China [Grant number: 81950410639]; Outstanding Young Scholars Funding [Grant number: 3111500001]; Xi?an Jiaotong University Basic Research and Profession Grant [Grant number: xtr022019003, xzy032020032]; Epidemiology modeling and risk assessment [Grant number: 20200344] and Xi?an Jiaotong University Young Talent Support Grant [Grant number: YX6J004].

Publisher Copyright:
© 2020 Taylor & Francis Group, LLC.


  • Human papillomavirus
  • cervical cancer
  • cost-effectiveness
  • economic evaluation
  • intervention
  • screening
  • vaccination

PubMed: MeSH publication types

  • Journal Article

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