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Economic Evaluation of Policy Options for Prevention and Control of Cervical Cancer in Thailand

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  • Naiyana Praditsitthikorn
  • Yot Teerawattananon
  • Sripen Tantivess
  • Supon Limwattananon
  • Arthorn Riewpaiboon
  • Saibua Chichareon
  • Nantakan Ieumwananonthachai
  • Viroj Tangcharoensathien

Abstract

Background: The Thai healthcare setting has seen patients with cervical cancer experience an increasing burden of morbidity and mortality, a stagnation in the performance of cervical screening programmes and the introduction of a vaccine for the prevention of human papillomavirus (HPV) infection. Objective: This study aims to identify the optimum mix of interventions that are cost effective, from societal and healthcare provider perspectives, for the prevention and control of cervical cancer. Methods: A computer-based Markov model of the natural history of cervical cancer was used to simulate an age-stratified cohort of women in Thailand. The strategy comparators, including both control and prevention programmes, were (i) conventional cytology screening (Pap smears); (ii) screening by visual inspection with acetic acid (VIA); and (iii) HPV-16, -18 vaccination. Input parameters (e.g. age-specific incidence of HPV infection, progression and regression of the infection, test performance of screening methods and efficacy of vaccine) were synthesized from a systematic review and metaanalysis. Costs (year 2007 values) and outcomes were evaluated separately, and compared for each combination. The screening strategies were started from the age of 30–40 years and repeated at 5- and 10-year intervals. In addition, HPV vaccines were introduced at age 1560 years. Results: All of the screening strategies showed certain benefits due to a decreased number of women developing cervical cancer versus no intervention. Moreover, the most cost-effective strategy from the societal perspective was the combination of VIA and sequential Pap smear (i.e. VIA every 5 years for women aged 3045 years, followed by Pap smear every 5 years for women aged 5060 years). This strategy was dominant, with a QALY gain of 0.01 and a total cost saving of Baht (Bt)800, compared with doing nothing. From the societal perspective, universal HPV vaccination for girls aged 15 years without screening resulted in a QALY gain of 0.06 at an additional cost of Bt8800, based on the cost of Bt15 000 for a full immunization schedule. The incremental cost-effectiveness ratio, comparing HPV vaccinations for girls aged 15 years with the current national policy of Pap smears for women aged 3560 years every 5 years, was approximately Bt181 000 per QALY gained. This figure was relatively high for the Thai setting. Conclusions: The results suggest that controlling cervical cancer by increasing the numbers of women accepting the VIA and Pap smear screening as routine and by improving the performance of the existing screening programmes is the most cost-effective policy option in Thailand. Copyright Adis Data Information BV 2011

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  • Naiyana Praditsitthikorn & Yot Teerawattananon & Sripen Tantivess & Supon Limwattananon & Arthorn Riewpaiboon & Saibua Chichareon & Nantakan Ieumwananonthachai & Viroj Tangcharoensathien, 2011. "Economic Evaluation of Policy Options for Prevention and Control of Cervical Cancer in Thailand," PharmacoEconomics, Springer, vol. 29(9), pages 781-806, September.
    • Handle: RePEc:spr:pharme:v:29:y:2011:i:9:p:781-806
    DOI: 10.2165/11586560-000000000-00000
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    References listed on IDEAS

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    1. Briggs, Andrew & Sculpher, Mark & Claxton, Karl, 2006. "Decision Modelling for Health Economic Evaluation," OUP Catalogue, Oxford University Press, number 9780198526629.
    2. Niklas Zethraeus & Magnus Johannesson & Bengt Jönsson & Mickael Löthgren & Magnus Tambour, 2003. "Advantages of Using the Net-Benefit Approach for Analysing Uncertainty in Economic Evaluation Studies," PharmacoEconomics, Springer, vol. 21(1), pages 39-48, January.
    3. Nancy Devlin & David Parkin, 2004. "Does NICE have a cost‐effectiveness threshold and what other factors influence its decisions? A binary choice analysis," Health Economics, John Wiley & Sons, Ltd., vol. 13(5), pages 437-452, May.
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    1. Yot Teerawattananon & Pritaporn Kingkaew & Tanunya Koopitakkajorn & Sitaporn Youngkong & Nattha Tritasavit & Patsri Srisuwan & Sripen Tantivess, 2016. "Development of a Health Screening Package Under the Universal Health Coverage: The Role of Health Technology Assessment," Health Economics, John Wiley & Sons, Ltd., vol. 25(S1), pages 162-178, February.
    2. Elizabeth Roger & Oguchi Nwosu, 2014. "Diagnosing Cervical Dysplasia Using Visual Inspection of the Cervix with Acetic Acid in a Woman in Rural Haiti," IJERPH, MDPI, vol. 11(12), pages 1-8, November.
    3. Didik Setiawan & Nikolaos Kotsopoulos & Jan C Wilschut & Maarten J Postma & Mark P Connolly, 2016. "Assessment of the Broader Economic Consequences of HPV Prevention from a Government-Perspective: A Fiscal Analytic Approach," PLOS ONE, Public Library of Science, vol. 11(8), pages 1-12, August.

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