Cost and effectiveness evaluation of prophylactic HPV vaccine in developing countries

Value Health. Jan-Feb 2012;15(1 Suppl):S29-34. doi: 10.1016/j.jval.2011.11.007.


Background: Approximately 80% of cervical cancer cases occur in developing countries. In Thailand, cervical cancer has been the leading cancer in females, with an incidence of 24.7 cases per 100,000 individuals per year.

Objectives: We constructed a decision model to simulate the lifetime economic impact for women in the context of human papillomavirus (HPV) infection prevention. HPV-related diseases were of interest: cervical cancer, cervical intraepithelial neoplasia, and genital warts. The two strategies used were 1) current practice and 2) prophylactic quadrivalent vaccine against HPV types 6, 11, 16, and 18.

Methods: We developed a Markov simulation model to evaluate the incremental cost-effectiveness ratio of prophylactic HPV vaccine. Women transition through a model either healthy or developing HPV or its related diseases, or die from cervical cancer or from other causes according to transitional probabilities under the Thai health-care context. Costs from a provider perspective were obtained from King Chulalongkorn Memorial Hospital. Costs and benefits were discounted at 3% annually.

Results: Compared with no prophylactic HPV vaccine, the incremental cost-effectiveness ratio was 160,649.50 baht per quality-adjusted life-year. The mortality rate was reduced by 54.8%. The incidence of cervical cancer, cervical intraepithelial neoplasia grade 1, cervical intraepithelial neoplasia grade 2/3, and genital warts was reduced by up to 55.1%.

Conclusion: Compared with commonly accepted standard thresholds recommended by the World Health Organization Commission on Macroeconomics and Health, the nationwide coverage of HPV vaccination in girls is likely to be cost-effective in Thailand.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cervical Intraepithelial Neoplasia / economics
  • Cervical Intraepithelial Neoplasia / prevention & control
  • Child
  • Condylomata Acuminata / economics
  • Condylomata Acuminata / prevention & control
  • Cost-Benefit Analysis
  • Developing Countries
  • Female
  • Health Care Costs
  • Humans
  • Markov Chains
  • Middle Aged
  • Papillomavirus Infections / complications
  • Papillomavirus Infections / prevention & control*
  • Papillomavirus Vaccines / economics*
  • Quality-Adjusted Life Years
  • Uterine Cervical Neoplasms / economics
  • Uterine Cervical Neoplasms / prevention & control
  • Young Adult


  • Papillomavirus Vaccines