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KMID : 1143420190120522459
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Public Health Weekly Report
2019 Volume.12 No. 52 p.2459 ~ p.2469
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Study on the Expansion of HPV Vaccination for the Korean National Immunization Program
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Kim Geon-Hun
Kim Jong-Hee
Song Rok
Suh Jae-Kyung
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Abstract
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The human papilloma virus (HPV) vaccine was developed to prevent HPV infection. Furthermore, cervical cancer, the fourth most common form of cancer, is caused by certain types of HPV. To date, there are three vaccines (2, 4, and 9 valent) available. Since June 2016, HPV vaccination has been administered to children ages 12 and over as part of the Korean National Immunization Program (NIP). The vaccination includes 2-valent and 4-valent vaccines. In some countries, an HPV catch-up program is conducted in conjunction with the introduction of an HPV vaccination program. According to this study’s review of HPV vaccination worldwide, the Korean NIP needs to expand its coverage of the vaccine. The purpose of this study was to provide evidence to support the expansion of the national vaccination target age to females ages 9-26 based on economic evaluations. To indirectly identify the cost of expanding HPV national vaccinations to the male population of Korea, the costs of vaccination for 12 year old males and females were compared with the costs of HPV-related diseases. In 2018, when the HPV vaccine was administered to 12 year old males, the cost of injection was 4.5 billion won, while the cost of HPV-related diseases was estimated at 2 billion won, which was less than 50% of the injection cost. In the case of females, it is estimated that 4.2 billion won will be invested in the vaccination of 12 year old females to reduce up to 16 billion won in related disease costs; approximately four times the cost of the HPV vaccine. The effect of the HPV vaccine was confirmed by an HPV 16/18 12-month persistent infection rate. The HPV vaccine reduced the HPV 16/18 12-month persistence rate by 92% (RR=0.08, 95% CI: 0.06-0.12) with meta-analysis.
Based on the data from 2017 health insurance claims, the prevalence of HPV-related diseases in females was 5.7 times higher than in males. The prevalence of HPV-related diseases varied according to gender, and more than 85% of all patients were female. The most prevalent HPV-related disease among males was genital warts and the highest prevalence among females was cervical intraepithelial neoplasia (CIN). On average, CIN1 patients spent 130,000 won on medical cost annually, whereas CIN2/3 patients spent 360,000 won. In the case of cervical cancer, the average medical cost per patient in the first year of the diagnosis was approximately 3.56 million won, and the medical cost for the following year was 1.02 million won per patient. From a healthcare system perspective, this study performed a cost-effectiveness analysis based on the Markov model to expand the age group from 12 years and over, which is the current national immunization program, to 9-26 years of age. When comparing 12 year old non-vaccinated females with vaccinated females of the same age, the vaccinated females gained 1,494 quality-adjusted life-years (QALYs) and the non-vaccinated females spent about 7.2 billion won more. The incremental cost-utility benefit ratio (ICUR) was 4.8 million won and considering the cost-effectiveness threshold of 30 million Won/QALY (1 GDP), the current national HPV vaccination program was found to be cost-effective. As a result of examining the cost-effectiveness of individuals ages 9-12, 12-14, 12-18, 12-22, and 12-26 compared to individuals ages 12 and over, the current vaccination group, all ICURs were 6-13 million won/QALY. Thus, age-expanded groups were found to be cost-effective. From a sensitivity analysis, HPV infection to CIN1 transition probability, discount rate, and introduction of the 9-valent vaccine were sensitive to cost-effectiveness results. This study is recommended as a basis for policy decisions related to the expansion of HPV vaccine coverage in the future.
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KEYWORD
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Human papilloma virus, Human papilloma virus vaccine, National Immunization Program, Cost-effectiveness
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