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

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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.

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Acknowledgements

This study was conducted with funding from the World Bank’s Population and Reproductive Health Capacity Building Program. The authors’ gratitude goes to experts and representatives from the TGOC and Clinical Research Collaboration Network (CRCN) who participated in the gathering of epidemiology and costing parameters.

The Health Intervention and Technology Assessment Program (HITAP) is supported by the Thai Health Promotion Foundation, the Health Systems Research Institute, the Bureau of Policy and Strategy and the Thai Health-Global Link Initiative Project. The findings and opinions in this report have not been endorsed by the above funding agencies and do not reflect the policy stance of these organizations.

N. Praditsitthikorn is currently doing her PhD at Mahidol University and this study is also a part of her PhD thesis. She also works as a researcher at HITAP.

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Authors and Affiliations

  1. Health Intervention and Technology Assessment Program, Ministry of Public Health, Tiwanon Rd, Muang, Nonthaburi, Thailand

    Naiyana Praditsitthikorn, Yot Teerawattananon & Sripen Tantivess

  2. Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand

    Naiyana Praditsitthikorn & Arthorn Riewpaiboon

  3. International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand

    Yot Teerawattananon, Sripen Tantivess, Supon Limwattananon & Viroj Tangcharoensathien

  4. Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand

    Saibua Chichareon

  5. Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Nantakan Ieumwananonthachai

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  1. Naiyana Praditsitthikorn
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Correspondence to Naiyana Praditsitthikorn.

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Praditsitthikorn, N., Teerawattananon, Y., Tantivess, S. et al. Economic Evaluation of Policy Options for Prevention and Control of Cervical Cancer in Thailand. Pharmacoeconomics 29, 781–806 (2011). https://doi.org/10.2165/11586560-000000000-00000

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