Skip to main content
Erschienen in: BMC Health Services Research 1/2010

Open Access 01.12.2010 | Research article

Cost-effectiveness of human papillomavirus vaccination for prevention of cervical cancer in Taiwan

verfasst von: Pang-Hsiang Liu, Fu-Chang Hu, Ping-Ing Lee, Song-Nan Chow, Chao-Wan Huang, Jung-Der Wang

Erschienen in: BMC Health Services Research | Ausgabe 1/2010

Abstract

Background

Human papillomavirus (HPV) infection has been shown to be a major risk factor for cervical cancer. Vaccines against HPV-16 and HPV-18 are highly effective in preventing type-specific HPV infections and related cervical lesions. There is, however, limited data available describing the health and economic impacts of HPV vaccination in Taiwan. The objective of this study was to assess the cost-effectiveness of prophylactic HPV vaccination for the prevention of cervical cancer in Taiwan.

Methods

We developed a Markov model to compare the health and economic outcomes of vaccinating preadolescent girls (at the age of 12 years) for the prevention of cervical cancer with current practice, including cervical cytological screening. Data were synthesized from published papers or reports, and whenever possible, those specific to Taiwan were used. Sensitivity analyses were performed to account for important uncertainties and different vaccination scenarios.

Results

Under the assumption that the HPV vaccine could provide lifelong protection, the massive vaccination among preadolescent girls in Taiwan would lead to reduction in 73.3% of the total incident cervical cancer cases and would result in a life expectancy gain of 4.9 days or 8.7 quality-adjusted life days at a cost of US$324 as compared to the current practice. The incremental cost-effectiveness ratio (ICER) was US$23,939 per life year gained or US$13,674 per quality-adjusted life year (QALY) gained given the discount rate of 3%. Sensitivity analyses showed that this ICER would remain below US$30,000 per QALY under most conditions, even when vaccine efficacy was suboptimal or when vaccine-induced immunity required booster shots every 13 years.

Conclusions

Although gains in life expectancy may be modest at the individual level, the results indicate that prophylactic HPV vaccination of preadolescent girls in Taiwan would result in substantial population benefits with a favorable cost-effectiveness ratio. Nevertheless, we should not overlook the urgency to improve the compliance rate of cervical screening, particularly for older individuals.
Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-6963-10-11) contains supplementary material, which is available to authorized users.

Competing interests

S-NC has served on advisory boards for GlaxoSmithKline, and has been the Principal Investigator at National Taiwan University Hospital for GlaxoSmithKline clinical trial (HPV-008 Study) since 2004 up to now. All the other authors declare that they have no interests which might be perceived as giving rise to any form of bias or conflict of interest.

Authors' contributions

All of the authors formulated the research question and design of the study. P-HL extracted the data and carried out the analyses. F-CH, P-IL, S-NC and J-DW provided intellectual input into the analyses and/or interpretation of data. C-WH participated in the analyses. P-HL and J-DW prepared the first draft of the manuscript. F-CH, P-IL, and S-NC provided content expertise and contributed to the final version of the manuscript. All authors have read and approved the submission of the manuscript to BMC Health Services Research in its present form.

Background

Cervical cancer is one of the most common female malignancies worldwide. The cervical cancer rate has declined in Taiwan over the last decade, an effect largely attributed to widespread screening for cervical cancer. Nonetheless, the compliance with cervical screening in Taiwan remains suboptimal that the annual screening rate was 28.6% for women aged over 30 years [1], and the incidence of cervical cancer is consistently higher than those in neighboring countries [2]. In 2006, there was an annual incidence rate of 16.2 per 100,000 people for invasive cervical cancer and a mortality rate of 7.8 per 100,000 people in comparison with breast cancer incidence and mortality of 61.1 and 12.8 per 100,000 people, respectively [3].
Genital infection with human papillomavirus (HPV) has been well established to be the determining cause of cervical cancer [4, 5]. Researchers reported the HPV prevalence in Taiwan was around 10-20% [69]. While HPV comprises a wide range of genotypes, several types are defined as high-risk, or oncogenic, for their strong carcinogenicity. A primary preventive measure involving prophylactic vaccination against these oncogenic HPVs has thus been developed, and there are two vaccines that are currently available. One is the bivalent vaccine [10, 11], and the other is the quadrivalent vaccine [12], which commonly target the HPV-16 and HPV-18. Safety and satisfactory efficacy against type-specific HPV infection and related precancerous lesions have been demonstrated for both vaccines. Although their efficacy for preventing cervical cancer has not been comprehensively proven yet, it seems reasonable to expect such an outcome.
A number of studies have been conducted to evaluate the potential cost-effectiveness for prevention of cervical cancer through HPV vaccination, with a range of results [1326]. Indeed, the cost-effectiveness of HPV vaccination varies between regions by many factors including different epidemiology of HPV infection and cervical screening efforts; Puig-Junoy and Lopez-Valcarcel reported that large variations existed in the cost-effectiveness results of different studies even for the same country [27]. Currently, there are still limited data evaluating the economic impact of cervical cancer vaccination in Taiwan [28, 29]. The aim of this study was therefore to assess the cost-effectiveness of prophylactic HPV vaccination on the prevention of cervical cancer in Taiwan.

Methods

Decision model

We developed a Markov model [30] to assess the cost-effectiveness of the prophylactic vaccine against high-risk HPV infections and related cervical cancers in Taiwan (Figure 1) using the TreeAge software (TreeAge Software, Inc., Williamstown, MA, USA). The perspective of analysis considered in this study was that of the healthcare payers. The target population for our analysis included all adolescent girls in Taiwan; the time horizon was lifetime.
Our model simulated the natural history of a hypothetical cohort of 12-year-old girls who were either administered the cervical cancer vaccine or who received the current standard of care from adolescence to death. For each strategy, the model incorporated probabilities of occurrence and progression of high-risk HPV, of squamous intraepithelial lesions (SIL) and of cervical cancer, as well as the probability of death, quality of life and costs associated with the corresponding health states. Every year, each person is at risk of developing high-risk HPV, SIL or cervical cancer. Over time, an infected woman's HPV infection can regress, persist or progress into SIL. High-grade SIL may possibly progress to cervical cancer. In addition to being at risk for death caused by cervical cancer, all women are still at risk for age-specific death that is unrelated to cervical cancer.
We assumed that girls with and without vaccination would receive the same standard of care that is currently being implemented, which includes routine papanicolaou (Pap) tests for compliant women every year starting from 30 years of age. At each screening event, cervical lesions are detected based on the sensitivity of the screening test [31, 32]. Follow-up and/or treatment will take place depending on the type of detected lesion with a certain probability of success.

Model parameters and base case assumptions

Transition probabilities for the hypothetical cohort from one clinical state to another over time were derived from published papers, reports or expert opinions. Whenever possible, data specific to Taiwan were used. Detailed information is provided in Table 1 which depicts the base case value, range for sensitivity analysis and data source for input parameters. The base case value represents our best estimate for each variable.
Table 1
Input parameters and sources*
Parameters
Base case value
Range for sensitivity analysis
Data source
Vaccine variables
   
Vaccine efficacy, %
75
50-100
[10, 12, 4648]
Vaccine coverage, %
100
30-100
Assumed
Age for starting vaccination, year
12
12-36
[49]
Immunity duration, year
lifetime
10-lifetime
[46, 47]
Booster shot compliance, %
70
30-100
Assumed
Screening variables
   
Age for starting cervical screening, year
30
 
[1, 39]
Screening interval, year
1
1-5
[1, 39]
Screening compliance, %
15-30
0-70
[1, 39]
Pap test sensitivity for SIL
0.60
0.40-0.80
[31, 32]
Pap test specificity for SIL
0.97
0.95-0.98
[31, 32]
Costs, US$
   
Vaccine cost (3 doses)
364
273-455
Assumed
Booster shot cost
121
91-152
Assumed
Cost of Pap test
16
12-20
[41]
Cost for a false-positive SIL
66
50-83
[41]
Cost of treatment for cervical cancer
10 000
7 500-12 500
[41]
Cost of treatment for high-grade SIL
245
183-306
[41]
Utilities
   
Normal population
1
 
Assumed
Diagnosed SIL for 1-year
0.97
0.80-1
[13, 40]
Cervical cancer
0.70
0.25-1
Assumed
Cervical cancer, follow-up
0.95
0.90-1
Assumed
Transition probabilities
   
Incidence of high-risk HPV infection
0-0.09
0.5-2 × base case
[69]
HPV infection resolving
0.03-0.46
0.67-1.5 × base case
[3338]
Developing low-grade SIL from high-risk HPV infection
0.065
0.05-0.08
[5059]
Low-grade SIL regressing
0.027-0.142
0.67-1.5 × base case
[13, 5458, 60]
Low-grade SIL regressing to previous HPV infection state, given regression occurs
0.10
0-0.20
[13, 54]
Developing high-grade SIL from low-grade SIL
0.005-0.400
0.67-1.5 × base case
[5058]
High-grade SIL regressing
0.037-0.058
0.67-1.5 × base case
[13, 5458, 60]
High-grade SIL regressing to well state, given regression occurs
0.45
0.40-0.50
[13, 54]
High-grade SIL regressing to previous HPV infection state, given regression occurs
0.05
0-0.10
[13, 54]
High-grade SIL regressing to low-grade SIL, given regression occurs
0.50
0.40-0.60
[13, 54]
Developing cervical cancer from high-grade SIL
0.038
0.03-0.06
[5058]
Annual probability of developing symptoms with undiagnosed cervical cancer
0-1
 
[13, 54, 61, 62]
Cervical cancer mortality
0.0024-0.3334
0.67-1.5 × base case
Estimated by the National Cancer Registry of Taiwan
Treatment variables
   
Treatment efficacy, given high-grade SIL, %
95
90-100
[13, 63, 64]
HPV infection persists, given effective treatment of high-grade SIL, %
10
0-25
[13]
Other variables
   
Discount rate, %
3
0-5
[43]
Cycle length, year
1
 
Assumed
*HPV denotes human papillomavirus; SIL, squamous intraepithelial lesion. All probabilities are annual unless otherwise noted.

HPV infection

The natural history of HPV infection is complex, and clearance or persistence of infection, together with progression to SIL, differ depending on the genotype of HPV, patient characteristics and study design. To simplify the procedure, we only classified the HPV genotypes into high- and low-risk. Our age-specific estimates for incidence, progression and regression were averages for all types of oncogenic HPV (such as HPV-16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 68 and 70) based on the population prevalence data [69]. In our base case analysis, the annual incidence infection began at age 15, peaked at age 20 and dropped off after age 35. Given HPV infection, regression rates were highest for women < 25 years (46%/yr) and lowest for women > 50 years (3%/yr), reflecting an observation of more persistent infections in the older age group [3338].

Cervical cancer

In the model calibration process, the transition probabilities for progression from high-risk HPV infection to low-grade SIL, from low-grade to high-grade SIL and from high-grade SIL to cervical cancer varied within valid ranges derived from published papers to fit the model-predicted incidence rates of cervical cancer with data taken from the National Cancer Registry of Taiwan
The probability of diagnosing asymptomatic cervical lesions is a function of a woman's likelihood of receiving a cervical screening and on the sensitivity and specificity of this test [31, 32]. The Taiwanese government launched a nationwide cervical screening program in July of 1995, in which annual Pap smear screenings were offered to women aged over 30 years. According to current reports in Taiwan, the annual compliance rate for Pap testing is approximately 30% by age 60, which proportionately declines to 15% at age 70 or older [1, 39].
The National Cancer Registry of Taiwan provided us with the average survival function of invasive cervical cancer, which does not differentiate at different clinical stages. From 1990 to 2005, the registry collected a total of 39,470 cases, which were linked with our National Mortality Registry between 1990 and 2007 to determine if the patient was still alive. These follow-up data provided us with detailed survival rates up to 18 years and were used in this simulation, and if a patient survived more than 15 years, we assumed that she was in a remission state and would not die of cervical cancer.

Quality of life

Utilities are a measure of the quality of life rated on a scale from 0 to 1, where 0 represents death and 1 represents ideal health. Undiagnosed HPV infection and cervical lesions were considered to be asymptomatic with no decrease in utility. Diagnosed low- and high-grade SIL were assigned a lower utility (namely, 0.97) for a 1-year duration [40]. Oncogenic HPV infection can remarkably affect the quality of life for a woman with cervical cancer. For invasive cervical carcinoma, a woman's utility was assumed to reduce down to 0.70 after diagnosis to reflect the severity of her disease and its effects on her quality of life. Follow-up of cervical cancer was assigned a moderate utility (0.95) once cancer went into remission. The chosen values responded to our expert criteria.

Costs

Only direct medical costs are considered in this study, which include the costs associated with the health care items reimbursed by the National Health Insurance (NHI) and the out-of-pocket payments such as outpatient registration fees, some drug charges or medical equipment expenses not covered by the NHI. Pap testing costs were US$16 per test. The cost of treatment for SIL or cervical cancer was based on cost of initial colposcopy and biopsy, therapy, and subsequent follow-up. These costs were estimated by published literature of Tang et al. (2009) [41], expert opinions and official tariff lists of the NHI. The vaccination cost for three doses was assumed to be US$364, which include the cost of the HPV vaccine itself, personnel, and administration. All costs were reported in 2009 US dollars with the exchange rate of 33 New Taiwan dollars to US$1.

Vaccine characteristics

We initially assumed the vaccine coverage rate to be 100% in the base case situation, i.e., all women received the required three doses within 1 year. Moreover, for our base case analysis, the vaccine was assumed to confer lifetime immunity against acquiring new infections by HPV-16 and HPV-18. Because vaccine longevity is uncertain, the waning of vaccine protection over time becomes an important factor that could not be avoided. We evaluated the diverse waning scenarios that required booster shots with different compliance rates in sensitivity analysis. In the base case setting, vaccine efficacy against oncogenic types was estimated at 75%. We examined a wide range of vaccine efficacy (from 50% to 100%) to allow for further development of HPV vaccines and to deal with the possibility of lower coverage in Taiwan, where the prevalence of HPV-16 and HPV-18 infection in cervical cancer could be lower than 70% [9, 42].

Outcome measures

We expressed our results in terms of the number of cervical cancer cases prevented and deaths avoided, as well as the life-years and quality-adjusted life-years (QALY) gained over a lifetime. The incremental cost-effectiveness ratio (ICER) was calculated as the accumulated total cost difference divided by the QALY gained per woman by adding vaccination to existing screening. The economic analysis adopted a 3% annual discount rate for future costs and outcomes, which converts values that will occur in the future to their present value.

Sensitivity analysis

Sensitivity analyses were performed to account for important model assumptions and uncertainties including the vaccine characteristics, adherence to cervical screening, costs or health utilities for various conditions, parameters related to the natural history of disease, discount rate, etc; we also examined the impact of starting vaccination at different ages on the cost-effectiveness ratio for HPV vaccine in sensitivity analysis. The ranges for costs were varied from minus 25% to plus 25% of the base case estimate. For clinical variables, our ranges for sensitivity analysis represented our judgment of the uncertainties and/or variations likely to be encountered in clinical practice, based on both the literature and the opinions of experts (Table 1).

Results

Model validation

Due to the main interests of this study and the certainty of data sources, cervical cancer incidence and mortality were chosen as primary endpoints for the model calibration process of matching the outputs in the current practice arm without vaccination of the model to observed cancer statistics. The model predicted the incidence rate for cervical cancer would be 21.1 per 100,000 females 12 or older, given the assumption that women would receive cervical screening with compliance rates of the current practice. Predicted cervical cancer incidence showed good correspondence with observed data from the National Cancer Registry of Taiwan between 2001 and 2005 that the overall incidence of cervical cancer cases was 22.7 per 100,000 females aged over 10 years (Figure 2). Moreover, the predicted HPV prevalence and cervical cancer mortality were also fit reasonably well to the observed epidemiological data, with the exception of a slightly lower mortality for ages over 65. The predicted cervical cancer mortality would be 7.2 per 100,000 females 12 or older, while the observed overall cervical cancer mortality was 7.8 per 100,000 people for women aged over 10 years.

Base case analysis

In our base case analysis, the administration of HPV vaccine could reduce 73.3% of the total incident cervical cancer cases from 1,773 to 473 per 100,000 women and lessen 73.4% of cancer deaths from 710 to 189 per 100,000 women over the lifetime of the cohort of 12-year-old girls. On average, their life expectancy would be improved by 4.9 days or 0.024 QALY. Adding an HPV vaccine was more expensive than current practice, with an overall increase in estimated lifetime discounted cost of US$324. The incremental cost-effectiveness ratio based on this model was US$13,674 per QALY gained (Table 2).
Table 2
Health and economic outcomes of HPV vaccination, discounted
Outcome
No vaccination
HPV vaccination
Cost, US$
129
453
Incremental cost, US$
 
324
Life expectancy, years
28.830
28.844
Incremental life expectancy, days
 
4.9
Quality-adjusted life expectancy, years
28.816
28.840
Incremental quality-adjusted life expectancy, days
 
8.7
Incremental cost-effectiveness ratio
  
   US$/life year
 
23 939
   US$/quality-adjusted life year
 
13 674
HPV denotes human papillomavirus

Sensitivity analysis

On the basis of our sensitivity analyses of various parameters, the model suggested that the ICER of adding vaccination strategy, as compared to the current practice, is most sensitive to variations in discount rate, vaccine immunity longevity or booster frequency, incidence of high-risk HPV infection, compliance with Pap testing, vaccine efficacy and in quality of life for cervical cancer. Changes in these parameters could result in wider variations of the ICER, as depicted in Figure 3.
The incremental cost of vaccination would be usually less than US$30,000/QALY relative to the current practice when the efficacy was greater than 37%. If vaccination required a one-shot booster every 10 years, then the ICER would increase to US$37,150/QALY which multiplied by 2.7 the base case outcome under lifelong immunization (Figure 4). The ICER would remain below US$30,000/QALY if the interval of booster shots needed to maintain the immunity was over 13 years.
Vaccination cost-effectiveness, however, would be US$37,480/QALY at a discounted rate of 5% since higher discount rates augment the relative weight of the initial vaccination costs.
If every woman in Taiwan obtained a Pap test every 3 years from the age of 30, the ICER of vaccination would slightly increase to US$17,199/QALY.

Discussion

Our analysis demonstrated that under most assumptions, the prophylactic vaccination against HPV-16 and HPV-18 had an ICER between US$7,000 and US$27,000 per QALY gained in the vaccinated adolescent girls in Taiwan. The ICER would remain below US$30,000 per QALY unless the vaccine efficacy declined to less than 38% or if the immunity waned and required booster shots every 10 years (Figure 4). If the vaccination cost could be reduced to below US$277, then the HPV vaccination would cost less than US$10,000 per QALY gained, indicating a potential for further enhancement of cost-effectiveness. Although there has been no domestic consensus on the threshold of the cost-effectiveness ratio for the National Health Insurance system to decide whether to reimburse a new medical intervention, the results of our analysis suggest that prophylactic vaccination against oncogenic HPV administered in preadolescent girls in Taiwan would be usually cost-effective based on the World Health Organization proposed criteria of 1-3 times the gross domestic product (GDP) per capita being cost-effective or less than GDP per capita being very cost-effective [43] since the GDP per capita of Taiwan was approximately US$17,082 in 2008.
In addition to the discount rate, the duration of the vaccine immunity accounted for the most influential source of variations in the ICER of incorporating HPV vaccination within our investigation (Figure 3), which is consistent with other studies [27]. Compared to the previous studies mostly performed in Western countries [16, 2226], the HPV vaccination strategy in our study appeared to be attractive in terms of a lower ICER. However, this figure of cost-effectiveness in Taiwan could be largely owing to the high prevalence of HPV infection [69] and lower compliance rate with cervical cytological screening [1] that resulted in higher background incidence of cervical cancer, since we employed similar assumptions of time horizon, discount rate, vaccine efficacy and lifelong vaccine protection as most of those studies. For example, as the projected incidence of cervical cancer under the current screening practice in a study from the Netherlands [26] was lower than that in our study by 3.5 times and the vaccination costs were 1.5 times more expensive, the ICER reported by them was much higher than the figure in our study (approximately 5.8 times).
Methodological differences may also account for variations in the results of different cost-effectiveness evaluations [27, 44]. Although dynamic transmission model has been developed and applied [17, 18, 22, 23, 25, 28], it generally requires investigators to make more assumptions on putting into parameter values related to viral transmission. As the sexual behavior in adolescents and young people in Taiwan may be different from that in western countries and the relevant data were insufficient, we took an alternative approach to adapt a simpler Markov model as previous studies [13, 14, 24], but more delicately adjusted the model with existing clinical and epidemiological data of cervical cancer in Taiwan. Our approach did not consider the herd immunity and the protection by HPV vaccination for genital warts or other HPV related cancers. Thus, we would underestimate the overall effectiveness of the vaccination program, which would generally make the cost-effectiveness of the HPV vaccine even more favorable if herd immunity or protection for other diseases existed [21, 45].
The relatively high risk level of invasive cervical cancer in Taiwan implies the urgency to improve the compliance rate of cervical screening to the early detection of SIL and cervical cancer, even though the ICER of prophylactic vaccination would rise accordingly because the marginal effectiveness of vaccination would be diminished as improvement in cytological screening would decrease the baseline incidence of invasive cervical cancer without adding HPV vaccination. Moreover, during the model calibration process, we discovered an upward trend of cervical cancer incidence by age that reflected inadequate compliance with cervical screening among older women, particularly those older than 60 years (Figure 2). Had the cervical screening compliance for older women improved to be comparable with those of younger women, the cumulative incident cases with cervical cancer would have decreased in both cohorts with or without vaccination, while the ICER of HPV vaccine would go up slightly to US$14,120 per QALY gained.
The impact of discounting is very complex in the context of HPV vaccination. As in any economic assessment of a preventive measure with later-onset effects, the initial intervention costs and the choice of discount rate have a significant influence on the cost-effectiveness results. In general, higher discount rates would make the prophylactic vaccination strategy seem less attractive, given that the costs of the intervention are paid immediately while the benefits come back many years later. Indeed, we found the undiscounted ICER of vaccination on 12-year-old girls was US$1,820 per QALY gained, whereas the ICER significantly increased to US$37,480 per discounted QALY gained at a discounted rate of 5%.
There are limitations in this study. First, herd immunity effects were not taken into account in our model as discussed above. Second, women adherent to previous cervical screening tests tended to have better compliance with subsequent tests [1]. The preventive effects of screening could therefore be overestimated particularly for those at older ages, which in turn would underestimate the effectiveness of vaccination. Thus, the current ICER of HPV vaccine would be a conservative estimation, as the ICER should further decline if the actual compliance rates of cervical screening were adjusted with a lower coverage. Nonetheless, the conservative assessment for the ICER of HPV vaccine in our study, together with the results of other relevant research [28, 29], would increase the credibility of the cost-effectiveness for a prophylactic HPV vaccination program in Taiwan.

Conclusions

Our analysis suggested that vaccination of adolescent girls with an HPV vaccine seems to be cost-effective in Taiwan where the HPV infection rate and the incidence as well as the mortality of cervical cancer are relatively higher than those in other developed countries. Although there are still some uncertainties regarding the HPV vaccine and cervical cytological screening, our estimation of the cost-effectiveness for a prophylactic vaccine against high-risk HPV, however, appears to be robust. We have demonstrated that the ICER would usually fall below US$30,000 per QALY gained under most assumptions, which also covers a wide range of vaccination strategies and vaccine characteristics. Even in the case of favorable cost-effectiveness ratio of prophylactic vaccination against oncogenic HPV, there is still room for improvement of the compliance with Pap screening tests in Taiwan, especially for older women, because vaccination should not yet be regarded as the substitute for cytological screening. It calls attention to the importance of continuing research that investigates primary and secondary preventive measures against cervical cancer.

Acknowledgements

This study was supported by a grant from the Department of Health, Executive Yuan of Taiwan to establish the National Clinical Trial and Research Center at the National Taiwan University Hospital (DOH97-TD-B-111-001 and DOH98-TD-B-111-001). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Department of Health.
The authors are grateful to Chang-Chuan Chan, Pau-Chung Chen, Yue-Leon Guo and Jin-Tan Liu for their important recommendations. We would also like to acknowledge the peer-reviewers, Anna Garcia-Altes and Jaume Puig-Junoy, for their valuable comments and critiques.
Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution License ( https://​creativecommons.​org/​licenses/​by/​2.​0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Competing interests

S-NC has served on advisory boards for GlaxoSmithKline, and has been the Principal Investigator at National Taiwan University Hospital for GlaxoSmithKline clinical trial (HPV-008 Study) since 2004 up to now. All the other authors declare that they have no interests which might be perceived as giving rise to any form of bias or conflict of interest.

Authors' contributions

All of the authors formulated the research question and design of the study. P-HL extracted the data and carried out the analyses. F-CH, P-IL, S-NC and J-DW provided intellectual input into the analyses and/or interpretation of data. C-WH participated in the analyses. P-HL and J-DW prepared the first draft of the manuscript. F-CH, P-IL, and S-NC provided content expertise and contributed to the final version of the manuscript. All authors have read and approved the submission of the manuscript to BMC Health Services Research in its present form.
Anhänge

Authors’ original submitted files for images

Literatur
1.
Zurück zum Zitat Pap Smear Screening Registry System Annual Report, 2007. 2008, Taipei: Bureau of Health Promotion, Department of Health, Taiwan Pap Smear Screening Registry System Annual Report, 2007. 2008, Taipei: Bureau of Health Promotion, Department of Health, Taiwan
2.
Zurück zum Zitat Tay SK, Ngan HY, Chu TY, Cheung AN, Tay EH: Epidemiology of human papillomavirus infection and cervical cancer and future perspectives in Hong Kong, Singapore and Taiwan. Vaccine. 2008, 26 (Suppl 12): M60-70. 10.1016/j.vaccine.2008.05.042.CrossRefPubMed Tay SK, Ngan HY, Chu TY, Cheung AN, Tay EH: Epidemiology of human papillomavirus infection and cervical cancer and future perspectives in Hong Kong, Singapore and Taiwan. Vaccine. 2008, 26 (Suppl 12): M60-70. 10.1016/j.vaccine.2008.05.042.CrossRefPubMed
4.
Zurück zum Zitat Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, Snijders PJ, Peto J, Meijer CJ, Munoz N: Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999, 189 (1): 12-19. 10.1002/(SICI)1096-9896(199909)189:1<12::AID-PATH431>3.0.CO;2-F.CrossRefPubMed Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, Snijders PJ, Peto J, Meijer CJ, Munoz N: Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999, 189 (1): 12-19. 10.1002/(SICI)1096-9896(199909)189:1<12::AID-PATH431>3.0.CO;2-F.CrossRefPubMed
5.
Zurück zum Zitat Franco EL, Rohan TE, Villa LL: Epidemiologic evidence and human papillomavirus infection as a necessary cause of cervical cancer. J Natl Cancer Inst. 1999, 91 (6): 506-511. 10.1093/jnci/91.6.506.CrossRefPubMed Franco EL, Rohan TE, Villa LL: Epidemiologic evidence and human papillomavirus infection as a necessary cause of cervical cancer. J Natl Cancer Inst. 1999, 91 (6): 506-511. 10.1093/jnci/91.6.506.CrossRefPubMed
6.
Zurück zum Zitat Jeng CJ, Phdl , Ko ML, Ling QD, Shen J, Lin HW, Tzeng CR, Ho CM, Chien TY, Chen SC: Prevalence of cervical human papillomavirus in Taiwanese women. Clin Invest Med. 2005, 28 (5): 261-266.PubMed Jeng CJ, Phdl , Ko ML, Ling QD, Shen J, Lin HW, Tzeng CR, Ho CM, Chien TY, Chen SC: Prevalence of cervical human papillomavirus in Taiwanese women. Clin Invest Med. 2005, 28 (5): 261-266.PubMed
7.
Zurück zum Zitat Lin H, Ma YY, Moh JS, Ou YC, Shen SY, ChangChien CC: High prevalence of genital human papillomavirus type 52 and 58 infection in women attending gynecologic practitioners in South Taiwan. Gynecol Oncol. 2006, 101 (1): 40-45. 10.1016/j.ygyno.2005.09.028.CrossRefPubMed Lin H, Ma YY, Moh JS, Ou YC, Shen SY, ChangChien CC: High prevalence of genital human papillomavirus type 52 and 58 infection in women attending gynecologic practitioners in South Taiwan. Gynecol Oncol. 2006, 101 (1): 40-45. 10.1016/j.ygyno.2005.09.028.CrossRefPubMed
8.
Zurück zum Zitat Chao A, Hsu KH, Lai CH, Huang HJ, Hsueh S, Lin SR, Jung SM, Chao FY, Huang SL, Huang CC, et al: Cervical cancer screening program integrating Pap smear and HPV DNA testing: a population-based study. Int J Cancer. 2008, 122 (12): 2835-2841. 10.1002/ijc.23441.CrossRefPubMed Chao A, Hsu KH, Lai CH, Huang HJ, Hsueh S, Lin SR, Jung SM, Chao FY, Huang SL, Huang CC, et al: Cervical cancer screening program integrating Pap smear and HPV DNA testing: a population-based study. Int J Cancer. 2008, 122 (12): 2835-2841. 10.1002/ijc.23441.CrossRefPubMed
9.
Zurück zum Zitat Ding DC, Hsu HC, Huang RL, Lai HC, Lin CY, Yu MH, Chu TY: Type-specific distribution of HPV along the full spectrum of cervical carcinogenesis in Taiwan: an indication of viral oncogenic potential. Eur J Obstet Gynecol Reprod Biol. 2008, 140 (2): 245-251. 10.1016/j.ejogrb.2008.03.014.CrossRefPubMed Ding DC, Hsu HC, Huang RL, Lai HC, Lin CY, Yu MH, Chu TY: Type-specific distribution of HPV along the full spectrum of cervical carcinogenesis in Taiwan: an indication of viral oncogenic potential. Eur J Obstet Gynecol Reprod Biol. 2008, 140 (2): 245-251. 10.1016/j.ejogrb.2008.03.014.CrossRefPubMed
10.
Zurück zum Zitat Paavonen J, Jenkins D, Bosch FX, Naud P, Salmeron J, Wheeler CM, Chow SN, Apter DL, Kitchener HC, Castellsague X, et al: Efficacy of a prophylactic adjuvanted bivalent L1 virus-like-particle vaccine against infection with human papillomavirus types 16 and 18 in young women: an interim analysis of a phase III double-blind, randomised controlled trial. Lancet. 2007, 369 (9580): 2161-2170. 10.1016/S0140-6736(07)60946-5.CrossRefPubMed Paavonen J, Jenkins D, Bosch FX, Naud P, Salmeron J, Wheeler CM, Chow SN, Apter DL, Kitchener HC, Castellsague X, et al: Efficacy of a prophylactic adjuvanted bivalent L1 virus-like-particle vaccine against infection with human papillomavirus types 16 and 18 in young women: an interim analysis of a phase III double-blind, randomised controlled trial. Lancet. 2007, 369 (9580): 2161-2170. 10.1016/S0140-6736(07)60946-5.CrossRefPubMed
11.
Zurück zum Zitat Paavonen J, Naud P, Salmeron J, Wheeler CM, Chow SN, Apter D, Kitchener H, Castellsague X, Teixeira JC, Skinner SR, et al: Efficacy of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA): final analysis of a double-blind, randomised study in young women. Lancet. 2009, 374 (9686): 301-314. 10.1016/S0140-6736(09)61248-4.CrossRefPubMed Paavonen J, Naud P, Salmeron J, Wheeler CM, Chow SN, Apter D, Kitchener H, Castellsague X, Teixeira JC, Skinner SR, et al: Efficacy of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA): final analysis of a double-blind, randomised study in young women. Lancet. 2009, 374 (9686): 301-314. 10.1016/S0140-6736(09)61248-4.CrossRefPubMed
12.
Zurück zum Zitat Villa LL, Costa RL, Petta CA, Andrade RP, Ault KA, Giuliano AR, Wheeler CM, Koutsky LA, Malm C, Lehtinen M, et al: Prophylactic quadrivalent human papillomavirus (types 6, 11, 16, and 18) L1 virus-like particle vaccine in young women: a randomised double-blind placebo-controlled multicentre phase II efficacy trial. Lancet Oncol. 2005, 6 (5): 271-278. 10.1016/S1470-2045(05)70101-7.CrossRefPubMed Villa LL, Costa RL, Petta CA, Andrade RP, Ault KA, Giuliano AR, Wheeler CM, Koutsky LA, Malm C, Lehtinen M, et al: Prophylactic quadrivalent human papillomavirus (types 6, 11, 16, and 18) L1 virus-like particle vaccine in young women: a randomised double-blind placebo-controlled multicentre phase II efficacy trial. Lancet Oncol. 2005, 6 (5): 271-278. 10.1016/S1470-2045(05)70101-7.CrossRefPubMed
14.
Zurück zum Zitat Goldie SJ, Kohli M, Grima D, Weinstein MC, Wright TC, Bosch FX, Franco E: Projected clinical benefits and cost-effectiveness of a human papillomavirus 16/18 vaccine. J Natl Cancer Inst. 2004, 96 (8): 604-615. 10.1093/jnci/djh104.CrossRefPubMed Goldie SJ, Kohli M, Grima D, Weinstein MC, Wright TC, Bosch FX, Franco E: Projected clinical benefits and cost-effectiveness of a human papillomavirus 16/18 vaccine. J Natl Cancer Inst. 2004, 96 (8): 604-615. 10.1093/jnci/djh104.CrossRefPubMed
15.
16.
Zurück zum Zitat Brisson M, Velde Van de N, De Wals P, Boily MC: The potential cost-effectiveness of prophylactic human papillomavirus vaccines in Canada. Vaccine. 2007, 25 (29): 5399-5408. 10.1016/j.vaccine.2007.04.086.CrossRefPubMed Brisson M, Velde Van de N, De Wals P, Boily MC: The potential cost-effectiveness of prophylactic human papillomavirus vaccines in Canada. Vaccine. 2007, 25 (29): 5399-5408. 10.1016/j.vaccine.2007.04.086.CrossRefPubMed
17.
Zurück zum Zitat Elbasha EH, Dasbach EJ, Insinga RP: Model for assessing human papillomavirus vaccination strategies. Emerg Infect Dis. 2007, 13 (1): 28-41. 10.3201/eid1301.060438.CrossRefPubMedPubMedCentral Elbasha EH, Dasbach EJ, Insinga RP: Model for assessing human papillomavirus vaccination strategies. Emerg Infect Dis. 2007, 13 (1): 28-41. 10.3201/eid1301.060438.CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Insinga RP, Dasbach EJ, Elbasha EH, Puig A, Reynales-Shigematsu LM: Cost-effectiveness of quadrivalent human papillomavirus (HPV) vaccination in Mexico: a transmission dynamic model-based evaluation. Vaccine. 2007, 26 (1): 128-139. 10.1016/j.vaccine.2007.10.056.CrossRefPubMed Insinga RP, Dasbach EJ, Elbasha EH, Puig A, Reynales-Shigematsu LM: Cost-effectiveness of quadrivalent human papillomavirus (HPV) vaccination in Mexico: a transmission dynamic model-based evaluation. Vaccine. 2007, 26 (1): 128-139. 10.1016/j.vaccine.2007.10.056.CrossRefPubMed
19.
Zurück zum Zitat Kulasingam S, Connelly L, Conway E, Hocking JS, Myers E, Regan DG, Roder D, Ross J, Wain G: A cost-effectiveness analysis of adding a human papillomavirus vaccine to the Australian National Cervical Cancer Screening Program. Sex Health. 2007, 4 (3): 165-175. 10.1071/SH07043.CrossRefPubMed Kulasingam S, Connelly L, Conway E, Hocking JS, Myers E, Regan DG, Roder D, Ross J, Wain G: A cost-effectiveness analysis of adding a human papillomavirus vaccine to the Australian National Cervical Cancer Screening Program. Sex Health. 2007, 4 (3): 165-175. 10.1071/SH07043.CrossRefPubMed
20.
Zurück zum Zitat Bergeron C, Largeron N, McAllister R, Mathevet P, Remy V: Cost-effectiveness analysis of the introduction of a quadrivalent human papillomavirus vaccine in France. Int J Technol Assess Health Care. 2008, 24 (1): 10-19. 10.1017/S0266462307080026.CrossRefPubMed Bergeron C, Largeron N, McAllister R, Mathevet P, Remy V: Cost-effectiveness analysis of the introduction of a quadrivalent human papillomavirus vaccine in France. Int J Technol Assess Health Care. 2008, 24 (1): 10-19. 10.1017/S0266462307080026.CrossRefPubMed
21.
Zurück zum Zitat Chesson HW, Ekwueme DU, Saraiya M, Markowitz LE: Cost-effectiveness of human papillomavirus vaccination in the United States. Emerg Infect Dis. 2008, 14 (2): 244-251. 10.3201/eid1402.070499.CrossRefPubMedPubMedCentral Chesson HW, Ekwueme DU, Saraiya M, Markowitz LE: Cost-effectiveness of human papillomavirus vaccination in the United States. Emerg Infect Dis. 2008, 14 (2): 244-251. 10.3201/eid1402.070499.CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Jit M, Choi YH, Edmunds WJ: Economic evaluation of human papillomavirus vaccination in the United Kingdom. BMJ. 2008, 337: a769-10.1136/bmj.a769.CrossRefPubMedPubMedCentral Jit M, Choi YH, Edmunds WJ: Economic evaluation of human papillomavirus vaccination in the United Kingdom. BMJ. 2008, 337: a769-10.1136/bmj.a769.CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Kim JJ, Goldie SJ: Health and economic implications of HPV vaccination in the United States. N Engl J Med. 2008, 359 (8): 821-832. 10.1056/NEJMsa0707052.CrossRefPubMedPubMedCentral Kim JJ, Goldie SJ: Health and economic implications of HPV vaccination in the United States. N Engl J Med. 2008, 359 (8): 821-832. 10.1056/NEJMsa0707052.CrossRefPubMedPubMedCentral
24.
Zurück zum Zitat Kulasingam SL, Benard S, Barnabas RV, Largeron N, Myers ER: Adding a quadrivalent human papillomavirus vaccine to the UK cervical cancer screening programme: A cost-effectiveness analysis. Cost Eff Resour Alloc. 2008, 6: 4-10.1186/1478-7547-6-4.CrossRefPubMedPubMedCentral Kulasingam SL, Benard S, Barnabas RV, Largeron N, Myers ER: Adding a quadrivalent human papillomavirus vaccine to the UK cervical cancer screening programme: A cost-effectiveness analysis. Cost Eff Resour Alloc. 2008, 6: 4-10.1186/1478-7547-6-4.CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Ginsberg GM, Fisher M, Ben-Shahar I, Bornstein J: Cost-utility analysis of vaccination against HPV in Israel. Vaccine. 2007, 25 (37-38): 6677-6691. 10.1016/j.vaccine.2007.07.018.CrossRefPubMed Ginsberg GM, Fisher M, Ben-Shahar I, Bornstein J: Cost-utility analysis of vaccination against HPV in Israel. Vaccine. 2007, 25 (37-38): 6677-6691. 10.1016/j.vaccine.2007.07.018.CrossRefPubMed
26.
Zurück zum Zitat de Kok IM, van Ballegooijen M, Habbema JD: Cost-effectiveness analysis of human papillomavirus vaccination in the Netherlands. J Natl Cancer Inst. 2009, 101 (15): 1083-1092. 10.1093/jnci/djp183.CrossRefPubMed de Kok IM, van Ballegooijen M, Habbema JD: Cost-effectiveness analysis of human papillomavirus vaccination in the Netherlands. J Natl Cancer Inst. 2009, 101 (15): 1083-1092. 10.1093/jnci/djp183.CrossRefPubMed
27.
Zurück zum Zitat Puig-Junoy J, Lopez-Valcarcel BG: Economic evaluations of massive HPV vaccination: within-study and between study variations in incremental cost per QALY gained. Prev Med. 2009, 48 (5): 444-448. 10.1016/j.ypmed.2009.02.011.CrossRefPubMed Puig-Junoy J, Lopez-Valcarcel BG: Economic evaluations of massive HPV vaccination: within-study and between study variations in incremental cost per QALY gained. Prev Med. 2009, 48 (5): 444-448. 10.1016/j.ypmed.2009.02.011.CrossRefPubMed
28.
Zurück zum Zitat Dasbach EJ, Insinga RP, Yang YC, Pwu RF, Lac C, Elbasha EH: The cost-effectiveness of a quadrivalent human papillomavirus vaccine in Taiwan. Asian Pac J Cancer Prev. 2008, 9 (3): 459-466.PubMed Dasbach EJ, Insinga RP, Yang YC, Pwu RF, Lac C, Elbasha EH: The cost-effectiveness of a quadrivalent human papillomavirus vaccine in Taiwan. Asian Pac J Cancer Prev. 2008, 9 (3): 459-466.PubMed
29.
Zurück zum Zitat Debicki D, Ferko N, Demarteau N, Gallivan S, Bauch C, Anonychuk A, Mantovani L, Capri S, Chou CY, Standaert B, et al: Comparison of detailed and succinct cohort modelling approaches in a multi-regional evaluation of cervical cancer vaccination. Vaccine. 2008, 26 (Suppl 5): F16-28. 10.1016/j.vaccine.2008.02.040.CrossRefPubMed Debicki D, Ferko N, Demarteau N, Gallivan S, Bauch C, Anonychuk A, Mantovani L, Capri S, Chou CY, Standaert B, et al: Comparison of detailed and succinct cohort modelling approaches in a multi-regional evaluation of cervical cancer vaccination. Vaccine. 2008, 26 (Suppl 5): F16-28. 10.1016/j.vaccine.2008.02.040.CrossRefPubMed
30.
Zurück zum Zitat Sonnenberg FA, Beck JR: Markov models in medical decision making: a practical guide. Med Decis Making. 1993, 13 (4): 322-338. 10.1177/0272989X9301300409.CrossRefPubMed Sonnenberg FA, Beck JR: Markov models in medical decision making: a practical guide. Med Decis Making. 1993, 13 (4): 322-338. 10.1177/0272989X9301300409.CrossRefPubMed
31.
Zurück zum Zitat Cuzick J, Szarewski A, Terry G, Ho L, Hanby A, Maddox P, Anderson M, Kocjan G, Steele ST, Guillebaud J: Human papillomavirus testing in primary cervical screening. Lancet. 1995, 345 (8964): 1533-1536. 10.1016/S0140-6736(95)91086-7.CrossRefPubMed Cuzick J, Szarewski A, Terry G, Ho L, Hanby A, Maddox P, Anderson M, Kocjan G, Steele ST, Guillebaud J: Human papillomavirus testing in primary cervical screening. Lancet. 1995, 345 (8964): 1533-1536. 10.1016/S0140-6736(95)91086-7.CrossRefPubMed
32.
Zurück zum Zitat Fahey MT, Irwig L, Macaskill P: Meta-analysis of Pap test accuracy. Am J Epidemiol. 1995, 141 (7): 680-689.PubMed Fahey MT, Irwig L, Macaskill P: Meta-analysis of Pap test accuracy. Am J Epidemiol. 1995, 141 (7): 680-689.PubMed
33.
Zurück zum Zitat Goodman MT, Shvetsov YB, McDuffie K, Wilkens LR, Zhu X, Thompson PJ, Ning L, Killeen J, Kamemoto L, Hernandez BY: Prevalence, acquisition, and clearance of cervical human papillomavirus infection among women with normal cytology: Hawaii Human Papillomavirus Cohort Study. Cancer Res. 2008, 68 (21): 8813-8824. 10.1158/0008-5472.CAN-08-1380.CrossRefPubMedPubMedCentral Goodman MT, Shvetsov YB, McDuffie K, Wilkens LR, Zhu X, Thompson PJ, Ning L, Killeen J, Kamemoto L, Hernandez BY: Prevalence, acquisition, and clearance of cervical human papillomavirus infection among women with normal cytology: Hawaii Human Papillomavirus Cohort Study. Cancer Res. 2008, 68 (21): 8813-8824. 10.1158/0008-5472.CAN-08-1380.CrossRefPubMedPubMedCentral
34.
Zurück zum Zitat Rodriguez AC, Burk R, Herrero R, Hildesheim A, Bratti C, Sherman ME, Solomon D, Guillen D, Alfaro M, Viscidi R, et al: The natural history of human papillomavirus infection and cervical intraepithelial neoplasia among young women in the Guanacaste cohort shortly after initiation of sexual life. Sex Transm Dis. 2007, 34 (7): 494-502.PubMed Rodriguez AC, Burk R, Herrero R, Hildesheim A, Bratti C, Sherman ME, Solomon D, Guillen D, Alfaro M, Viscidi R, et al: The natural history of human papillomavirus infection and cervical intraepithelial neoplasia among young women in the Guanacaste cohort shortly after initiation of sexual life. Sex Transm Dis. 2007, 34 (7): 494-502.PubMed
35.
Zurück zum Zitat Moscicki AB, Shiboski S, Broering J, Powell K, Clayton L, Jay N, Darragh TM, Brescia R, Kanowitz S, Miller SB, et al: The natural history of human papillomavirus infection as measured by repeated DNA testing in adolescent and young women. J Pediatr. 1998, 132 (2): 277-284. 10.1016/S0022-3476(98)70445-7.CrossRefPubMed Moscicki AB, Shiboski S, Broering J, Powell K, Clayton L, Jay N, Darragh TM, Brescia R, Kanowitz S, Miller SB, et al: The natural history of human papillomavirus infection as measured by repeated DNA testing in adolescent and young women. J Pediatr. 1998, 132 (2): 277-284. 10.1016/S0022-3476(98)70445-7.CrossRefPubMed
36.
Zurück zum Zitat Ho GY, Bierman R, Beardsley L, Chang CJ, Burk RD: Natural history of cervicovaginal papillomavirus infection in young women. N Engl J Med. 1998, 338 (7): 423-428. 10.1056/NEJM199802123380703.CrossRefPubMed Ho GY, Bierman R, Beardsley L, Chang CJ, Burk RD: Natural history of cervicovaginal papillomavirus infection in young women. N Engl J Med. 1998, 338 (7): 423-428. 10.1056/NEJM199802123380703.CrossRefPubMed
37.
Zurück zum Zitat Hildesheim A, Schiffman MH, Gravitt PE, Glass AG, Greer CE, Zhang T, Scott DR, Rush BB, Lawler P, Sherman ME, et al: Persistence of type-specific human papillomavirus infection among cytologically normal women. J Infect Dis. 1994, 169 (2): 235-240.CrossRefPubMed Hildesheim A, Schiffman MH, Gravitt PE, Glass AG, Greer CE, Zhang T, Scott DR, Rush BB, Lawler P, Sherman ME, et al: Persistence of type-specific human papillomavirus infection among cytologically normal women. J Infect Dis. 1994, 169 (2): 235-240.CrossRefPubMed
38.
Zurück zum Zitat Franco EL, Villa LL, Sobrinho JP, Prado JM, Rousseau MC, Desy M, Rohan TE: Epidemiology of acquisition and clearance of cervical human papillomavirus infection in women from a high-risk area for cervical cancer. J Infect Dis. 1999, 180 (5): 1415-1423. 10.1086/315086.CrossRefPubMed Franco EL, Villa LL, Sobrinho JP, Prado JM, Rousseau MC, Desy M, Rohan TE: Epidemiology of acquisition and clearance of cervical human papillomavirus infection in women from a high-risk area for cervical cancer. J Infect Dis. 1999, 180 (5): 1415-1423. 10.1086/315086.CrossRefPubMed
39.
Zurück zum Zitat Koong SL, Yen AM, Chen TH: Efficacy and cost-effectiveness of nationwide cervical cancer screening in Taiwan. J Med Screen. 2006, 13 (Suppl 1): S44-47.PubMed Koong SL, Yen AM, Chen TH: Efficacy and cost-effectiveness of nationwide cervical cancer screening in Taiwan. J Med Screen. 2006, 13 (Suppl 1): S44-47.PubMed
40.
Zurück zum Zitat Stratton KR, Durch JS, Lawrence RS, Eds: Vaccines for the 21st Century: A Tool for Decisionmaking. 2000, Washington: National Academy Press Stratton KR, Durch JS, Lawrence RS, Eds: Vaccines for the 21st Century: A Tool for Decisionmaking. 2000, Washington: National Academy Press
41.
Zurück zum Zitat Tang CH, Pwu RF, Tsai IC, Wang HI, You SL, Chen CA, Scuffham PA, Hsieh CY, Chou CY, Lin SR, et al: Costs of cervical cancer and precancerous lesions treatment in a publicly financed health care system. Arch Gynecol Obstet. Tang CH, Pwu RF, Tsai IC, Wang HI, You SL, Chen CA, Scuffham PA, Hsieh CY, Chou CY, Lin SR, et al: Costs of cervical cancer and precancerous lesions treatment in a publicly financed health care system. Arch Gynecol Obstet.
42.
Zurück zum Zitat Liaw KL, Hsing AW, Schiffman MH, You SL, Zhang T, Burk R, Chen CJ: Human papillomavirus types 52 and 58 are prevalent in cervical cancer from Chinese women. Int J Cancer. 1997, 73 (5): 775-776. 10.1002/(SICI)1097-0215(19971127)73:5<775::AID-IJC27>3.0.CO;2-3.CrossRefPubMed Liaw KL, Hsing AW, Schiffman MH, You SL, Zhang T, Burk R, Chen CJ: Human papillomavirus types 52 and 58 are prevalent in cervical cancer from Chinese women. Int J Cancer. 1997, 73 (5): 775-776. 10.1002/(SICI)1097-0215(19971127)73:5<775::AID-IJC27>3.0.CO;2-3.CrossRefPubMed
43.
Zurück zum Zitat Making choices in health: WHO guide to cost-effectiveness analysis. 2003, Geneva: World Health Organisation Making choices in health: WHO guide to cost-effectiveness analysis. 2003, Geneva: World Health Organisation
44.
Zurück zum Zitat Newall AT, Beutels P, Wood JG, Edmunds WJ, MacIntyre CR: Cost-effectiveness analyses of human papillomavirus vaccination. Lancet Infect Dis. 2007, 7 (4): 289-296. 10.1016/S1473-3099(07)70083-X.CrossRefPubMed Newall AT, Beutels P, Wood JG, Edmunds WJ, MacIntyre CR: Cost-effectiveness analyses of human papillomavirus vaccination. Lancet Infect Dis. 2007, 7 (4): 289-296. 10.1016/S1473-3099(07)70083-X.CrossRefPubMed
45.
Zurück zum Zitat Brisson M, Edmunds WJ: Economic evaluation of vaccination programs: the impact of herd-immunity. Med Decis Making. 2003, 23 (1): 76-82. 10.1177/0272989X02239651.CrossRefPubMed Brisson M, Edmunds WJ: Economic evaluation of vaccination programs: the impact of herd-immunity. Med Decis Making. 2003, 23 (1): 76-82. 10.1177/0272989X02239651.CrossRefPubMed
46.
Zurück zum Zitat Harper DM, Franco EL, Wheeler CM, Moscicki AB, Romanowski B, Roteli-Martins CM, Jenkins D, Schuind A, Costa Clemens SA, Dubin G: Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised control trial. Lancet. 2006, 367 (9518): 1247-1255. 10.1016/S0140-6736(06)68439-0.CrossRefPubMed Harper DM, Franco EL, Wheeler CM, Moscicki AB, Romanowski B, Roteli-Martins CM, Jenkins D, Schuind A, Costa Clemens SA, Dubin G: Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised control trial. Lancet. 2006, 367 (9518): 1247-1255. 10.1016/S0140-6736(06)68439-0.CrossRefPubMed
47.
Zurück zum Zitat Villa LL, Costa RL, Petta CA, Andrade RP, Paavonen J, Iversen OE, Olsson SE, Hoye J, Steinwall M, Riis-Johannessen G, et al: High sustained efficacy of a prophylactic quadrivalent human papillomavirus types 6/11/16/18 L1 virus-like particle vaccine through 5 years of follow-up. Br J Cancer. 2006, 95 (11): 1459-1466. 10.1038/sj.bjc.6603469.CrossRefPubMedPubMedCentral Villa LL, Costa RL, Petta CA, Andrade RP, Paavonen J, Iversen OE, Olsson SE, Hoye J, Steinwall M, Riis-Johannessen G, et al: High sustained efficacy of a prophylactic quadrivalent human papillomavirus types 6/11/16/18 L1 virus-like particle vaccine through 5 years of follow-up. Br J Cancer. 2006, 95 (11): 1459-1466. 10.1038/sj.bjc.6603469.CrossRefPubMedPubMedCentral
48.
Zurück zum Zitat Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. 2007, 356 (19): 1915-1927. 10.1056/NEJMoa061741. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. 2007, 356 (19): 1915-1927. 10.1056/NEJMoa061741.
49.
Zurück zum Zitat Markowitz LE, Dunne EF, Saraiya M, Lawson HW, Chesson H, Unger ER: Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2007, 56 (RR-2): 1-24.PubMed Markowitz LE, Dunne EF, Saraiya M, Lawson HW, Chesson H, Unger ER: Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2007, 56 (RR-2): 1-24.PubMed
50.
Zurück zum Zitat Liaw KL, Hsing AW, Chen CJ, Schiffman MH, Zhang TY, Hsieh CY, Greer CE, You SL, Huang TW, Wu TC, et al: Human papillomavirus and cervical neoplasia: a case-control study in Taiwan. Int J Cancer. 1995, 62 (5): 565-571. 10.1002/ijc.2910620513.CrossRefPubMed Liaw KL, Hsing AW, Chen CJ, Schiffman MH, Zhang TY, Hsieh CY, Greer CE, You SL, Huang TW, Wu TC, et al: Human papillomavirus and cervical neoplasia: a case-control study in Taiwan. Int J Cancer. 1995, 62 (5): 565-571. 10.1002/ijc.2910620513.CrossRefPubMed
51.
Zurück zum Zitat Liaw KL, Glass AG, Manos MM, Greer CE, Scott DR, Sherman M, Burk RD, Kurman RJ, Wacholder S, Rush BB, et al: Detection of human papillomavirus DNA in cytologically normal women and subsequent cervical squamous intraepithelial lesions. J Natl Cancer Inst. 1999, 91 (11): 954-960. 10.1093/jnci/91.11.954.CrossRefPubMed Liaw KL, Glass AG, Manos MM, Greer CE, Scott DR, Sherman M, Burk RD, Kurman RJ, Wacholder S, Rush BB, et al: Detection of human papillomavirus DNA in cytologically normal women and subsequent cervical squamous intraepithelial lesions. J Natl Cancer Inst. 1999, 91 (11): 954-960. 10.1093/jnci/91.11.954.CrossRefPubMed
52.
Zurück zum Zitat Chen CA, Liu CY, Chou HH, Chou CY, Ho CM, Twu NF, Kan YY, Chuang MH, Chu TY, Hsieh CY: The distribution and differential risks of human papillomavirus genotypes in cervical preinvasive lesions: A Taiwan Cooperative Oncologic Group Study. Int J Gynecol Cancer. 2006, 16 (5): 1801-1808. 10.1111/j.1525-1438.2006.00655.x.CrossRefPubMed Chen CA, Liu CY, Chou HH, Chou CY, Ho CM, Twu NF, Kan YY, Chuang MH, Chu TY, Hsieh CY: The distribution and differential risks of human papillomavirus genotypes in cervical preinvasive lesions: A Taiwan Cooperative Oncologic Group Study. Int J Gynecol Cancer. 2006, 16 (5): 1801-1808. 10.1111/j.1525-1438.2006.00655.x.CrossRefPubMed
53.
Zurück zum Zitat Herrero R, Castle PE, Schiffman M, Bratti MC, Hildesheim A, Morales J, Alfaro M, Sherman ME, Wacholder S, Chen S, et al: Epidemiologic profile of type-specific human papillomavirus infection and cervical neoplasia in Guanacaste, Costa Rica. J Infect Dis. 2005, 191 (11): 1796-1807. 10.1086/428850.CrossRefPubMed Herrero R, Castle PE, Schiffman M, Bratti MC, Hildesheim A, Morales J, Alfaro M, Sherman ME, Wacholder S, Chen S, et al: Epidemiologic profile of type-specific human papillomavirus infection and cervical neoplasia in Guanacaste, Costa Rica. J Infect Dis. 2005, 191 (11): 1796-1807. 10.1086/428850.CrossRefPubMed
54.
Zurück zum Zitat Myers ER, McCrory DC, Nanda K, Bastian L, Matchar DB: Mathematical model for the natural history of human papillomavirus infection and cervical carcinogenesis. Am J Epidemiol. 2000, 151 (12): 1158-1171.CrossRefPubMed Myers ER, McCrory DC, Nanda K, Bastian L, Matchar DB: Mathematical model for the natural history of human papillomavirus infection and cervical carcinogenesis. Am J Epidemiol. 2000, 151 (12): 1158-1171.CrossRefPubMed
55.
Zurück zum Zitat Ostor AG: Natural history of cervical intraepithelial neoplasia: a critical review. Int J Gynecol Pathol. 1993, 12 (2): 186-192. 10.1097/00004347-199304000-00018.CrossRefPubMed Ostor AG: Natural history of cervical intraepithelial neoplasia: a critical review. Int J Gynecol Pathol. 1993, 12 (2): 186-192. 10.1097/00004347-199304000-00018.CrossRefPubMed
56.
Zurück zum Zitat Melnikow J, Nuovo J, Willan AR, Chan BK, Howell LP: Natural history of cervical squamous intraepithelial lesions: a meta-analysis. Obstet Gynecol. 1998, 92 (4 Pt 2): 727-735. 10.1016/S0029-7844(98)00245-2.PubMed Melnikow J, Nuovo J, Willan AR, Chan BK, Howell LP: Natural history of cervical squamous intraepithelial lesions: a meta-analysis. Obstet Gynecol. 1998, 92 (4 Pt 2): 727-735. 10.1016/S0029-7844(98)00245-2.PubMed
57.
Zurück zum Zitat Holowaty P, Miller AB, Rohan T, To T: Natural history of dysplasia of the uterine cervix. J Natl Cancer Inst. 1999, 91 (3): 252-258. 10.1093/jnci/91.3.252.CrossRefPubMed Holowaty P, Miller AB, Rohan T, To T: Natural history of dysplasia of the uterine cervix. J Natl Cancer Inst. 1999, 91 (3): 252-258. 10.1093/jnci/91.3.252.CrossRefPubMed
58.
Zurück zum Zitat Schlecht NF, Platt RW, Duarte-Franco E, Costa MC, Sobrinho JP, Prado JC, Ferenczy A, Rohan TE, Villa LL, Franco EL: Human papillomavirus infection and time to progression and regression of cervical intraepithelial neoplasia. J Natl Cancer Inst. 2003, 95 (17): 1336-1343.CrossRefPubMed Schlecht NF, Platt RW, Duarte-Franco E, Costa MC, Sobrinho JP, Prado JC, Ferenczy A, Rohan TE, Villa LL, Franco EL: Human papillomavirus infection and time to progression and regression of cervical intraepithelial neoplasia. J Natl Cancer Inst. 2003, 95 (17): 1336-1343.CrossRefPubMed
59.
Zurück zum Zitat Moscicki AB, Hills N, Shiboski S, Powell K, Jay N, Hanson E, Miller S, Clayton L, Farhat S, Broering J, et al: Risks for incident human papillomavirus infection and low-grade squamous intraepithelial lesion development in young females. JAMA. 2001, 285 (23): 2995-3002. 10.1001/jama.285.23.2995.CrossRefPubMed Moscicki AB, Hills N, Shiboski S, Powell K, Jay N, Hanson E, Miller S, Clayton L, Farhat S, Broering J, et al: Risks for incident human papillomavirus infection and low-grade squamous intraepithelial lesion development in young females. JAMA. 2001, 285 (23): 2995-3002. 10.1001/jama.285.23.2995.CrossRefPubMed
60.
Zurück zum Zitat Nobbenhuis MA, Helmerhorst TJ, Brule van den AJ, Rozendaal L, Voorhorst FJ, Bezemer PD, Verheijen RH, Meijer CJ: Cytological regression and clearance of high-risk human papillomavirus in women with an abnormal cervical smear. Lancet. 2001, 358 (9295): 1782-1783. 10.1016/S0140-6736(01)06809-X.CrossRefPubMed Nobbenhuis MA, Helmerhorst TJ, Brule van den AJ, Rozendaal L, Voorhorst FJ, Bezemer PD, Verheijen RH, Meijer CJ: Cytological regression and clearance of high-risk human papillomavirus in women with an abnormal cervical smear. Lancet. 2001, 358 (9295): 1782-1783. 10.1016/S0140-6736(01)06809-X.CrossRefPubMed
61.
Zurück zum Zitat Janerich DT, Hadjimichael O, Schwartz PE, Lowell DM, Meigs JW, Merino MJ, Flannery JT, Polednak AP: The screening histories of women with invasive cervical cancer, Connecticut. Am J Public Health. 1995, 85 (6): 791-794. 10.2105/AJPH.85.6.791.CrossRefPubMedPubMedCentral Janerich DT, Hadjimichael O, Schwartz PE, Lowell DM, Meigs JW, Merino MJ, Flannery JT, Polednak AP: The screening histories of women with invasive cervical cancer, Connecticut. Am J Public Health. 1995, 85 (6): 791-794. 10.2105/AJPH.85.6.791.CrossRefPubMedPubMedCentral
62.
Zurück zum Zitat Schwartz PE, Hadjimichael O, Lowell DM, Merino MJ, Janerich D: Rapidly progressive cervical cancer: the Connecticut experience. Am J Obstet Gynecol. 1996, 175 (4 Pt 2): 1105-1109. 10.1016/S0002-9378(96)70012-1.CrossRefPubMed Schwartz PE, Hadjimichael O, Lowell DM, Merino MJ, Janerich D: Rapidly progressive cervical cancer: the Connecticut experience. Am J Obstet Gynecol. 1996, 175 (4 Pt 2): 1105-1109. 10.1016/S0002-9378(96)70012-1.CrossRefPubMed
63.
Zurück zum Zitat Oyesanya OA, Amerasinghe CN, Manning EA: Outpatient excisional management of cervical intraepithelial neoplasia. A prospective, randomized comparison between loop diathermy excision and laser excisional conization. Am J Obstet Gynecol. 1993, 168 (2): 485-488.CrossRefPubMed Oyesanya OA, Amerasinghe CN, Manning EA: Outpatient excisional management of cervical intraepithelial neoplasia. A prospective, randomized comparison between loop diathermy excision and laser excisional conization. Am J Obstet Gynecol. 1993, 168 (2): 485-488.CrossRefPubMed
64.
Zurück zum Zitat Wright TC, Koulos J, Schnoll F, Swanbeck J, Ellerbrock TV, Chiasson MA, Richart RM: Cervical intraepithelial neoplasia in women infected with the human immunodeficiency virus: outcome after loop electrosurgical excision. Gynecol Oncol. 1994, 55 (2): 253-258. 10.1006/gyno.1994.1286.CrossRefPubMed Wright TC, Koulos J, Schnoll F, Swanbeck J, Ellerbrock TV, Chiasson MA, Richart RM: Cervical intraepithelial neoplasia in women infected with the human immunodeficiency virus: outcome after loop electrosurgical excision. Gynecol Oncol. 1994, 55 (2): 253-258. 10.1006/gyno.1994.1286.CrossRefPubMed
Metadaten
Titel
Cost-effectiveness of human papillomavirus vaccination for prevention of cervical cancer in Taiwan
verfasst von
Pang-Hsiang Liu
Fu-Chang Hu
Ping-Ing Lee
Song-Nan Chow
Chao-Wan Huang
Jung-Der Wang
Publikationsdatum
01.12.2010
Verlag
BioMed Central
Erschienen in
BMC Health Services Research / Ausgabe 1/2010
Elektronische ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-10-11

Weitere Artikel der Ausgabe 1/2010

BMC Health Services Research 1/2010 Zur Ausgabe