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Title:	Economic evaluation of vaccination against human papilloma virus (HPV) infections in the prevention of cervical cancer
Authors:	Sharifa Ezat Wan Puteh (P38685)
Supervisor:	Dato' Prof Syed Mohamed Al Junid
Keywords:	Cervical cancer Human Papillomavirus (HPV) Vaccination. Dissertations, Academic -- Malaysia
Issue Date:	27-Jun-2011
Description:	Cervical cancer is the second commonest cancer among Malaysian women. The high costs of chronic management have a great impact on the natio ' s health budget and patient' s quality of life. This can be avoided by better screeni g and Human Papillomavirus (HPV) vaccination. This was a cross sectional study done from 2006-2009 and respondents from six public Gynecology-Oncology hospitals were interviewed. Methods included experts' panel discussions to estimate treatment costs by sever ty and direct interviews with respondents using costing and SF-36 quality of life (QOL) questionnaires. Three program options were compared i.e. screening via Pap smear; qu drivalent HPV vaccination and combined strategy (screening plus vaccination). Scenario based sensitivity analysis using screening population coverage (40-80%) and costs of vaccine (RM 300-400/dose) were calculated. Five hundred and two pre invasive and invasive cervical cancer patients participated in the study. The mean age was 53.3 ± 11.21 years; majority received secondary level education (39.4%); were of Malay ethni (44.2%) and were married for 27.73 ± 12.12 years. Life expectancy gained from vaccination was 13.04 years and average Quality Adjusted Life Years saved (QALYs) was 24.40 in vaccinated vs 6.29 in unvaccinated women. Cost/QALYs for Pap smear at base c was RM 1,214.96/QALYs and RM 1,100.01/QALYs at increased screening coverage. In HPV vaccination, the base case scenario was at RM 35,346.79/QALYs and RM 46,530.08/QALYs when vaccination price was increased. In combined strategy, cost/QALYs base case was RM 11,289.58/QALYs; RM 7,712.74/QALYs at best case and RM 14,590.37/QALYs at worst case scenario. Incremental cost-effectiveness ratio (ICER) showed that screening at 70 coverage or higher was highly cost effective at RM 946.74 per QALYs saved and this was followed by combined strategy at RM 35,346.67 per QALYs saved. Budget impact analysis indicated that it cost the government RM 180.4 million per year and 2.5% of the national health budget. Vaccination increases life expectancy with better QOL women when cancer is avoided. Cost effective strategies will include increasing the Pap smear coverage to 70% or higher. Since feasibility and long rm screening adherence are doubtful among Malaysian women; vaccination of young women is a more cost effective strategy against cervical cancers. Key words: HPV quadrivalent vaccines, cervical cancer, quality adjusted life years, cost effectiveness, Pap s ar, quality of life.,Kanser pangkal rahim merupakan kanser wanita kedua tertinggi di Malaysia. Kos pengurusan penyakit kronik ini memberi impak yang ting kepada negara dan kualiti hidup pesakit yang boleh dielakkan melalui saringan calitan Pap yang baik dan vaksinasi virus papilloma manusia (HPV). Kajian merupakan kajian hirisan lintang dari 2006-2009 dan responden dipilih dan ditemubual dari enam hospital awam dengan kemudahan Onkologi dan Ginekologi. Metod meliputi panel perbincangan bersama kar untuk menilai kos berdasarkan tahap keterukan penyakit dan temubual langsung dengan responden menggunakan borang pengkosan dan borang kualiti hidup F-36. Tiga program pilihan telah dibandingkan iaitu saringan calitan Pap, vaksinasi HPV kuadrivalen an strategi kombinasi (saringan bersama vaksinasi). Analisa sensit berdasarkan senario menurut liputan populasi wanita disaring (40-80%) dan kos vaksin (RM 300-400/dos) dinilai. Seramai 502 pesakit tahap pra kanser dan kanser invasif terlibat di dalam kajian ini. Purata umur wanita ialah 53.3 ± 11.21 tahun, berpendidikan sehingga tahap sekun er (39.4%), berbangsa Melayu (41.2%) dan telah berkahwin selama 27.73 ± 12.12 tahun. Jangka hayat purata yang ditambah melalui vaksinasi ialah 13.04 tahun dan purat tahun kualiti hidup terselaras yang diselamatkan (QALYs) ialah 24.40 bagi a divaksinasi dan 6.29 di kalangan wanita tidak divaksinasi. Kos/QALYs untuk saringan calitan Pap, kes asas ialah RM 1,214.96/QALYs dan RM 1,100.01/QALYs jika liputan saringan Pap bertambah. Untuk program vaksinasi HPV, kes asas ialah RM 35,346. LYs dan RM 46,530.08/QALYs jika harga vaksinasi bertambah. Di dalam strategi kombinasi, kes asas ialah 11,289.58/QALYs; RM 7,712.74/QALYs di kes paling baik dan RM 14,590.37/QALYs di kes senario paling buruk. Nisbah kos keberkesanan tertingkat (ICER) menunjukkan bahawa saringan Pap pada liputan 70% dan lebih, adalah sangat kos efektif pada RM 946.74 untuk setiap tahun kualiti yang dapat diselamatkan, dan diikuti dengan strategi kombinasi pada RM 35,346.67 untuk setiap tahun kualiti diselamatkan. Impak analisis kewangan menunjukkan bahawa ia membebankan ke ajaan sebanyak RM 180.4 juta setahun dan 2.5% dari peruntukan kewangan kesihatan negara. Vaksinasi meningkatkan jangka hayat wanita dan juga kualiti hidup apabila barah dielakkan. Strategi kos yang lebih berkesan melibatkan penambahan liputan aringan calitan Pap sehingga 70% dan lebih. Memandangkan kejayaan perlaksanaan dan eraguan dalam mematuhi jadual saringan calitan Pap di kalangan wanita Malaysi ; vaksinasi di kalangan wanita muda merupakan strategi lebih kos berkesan menentang k r pangkal rahim. Kata kekunci: Vaksin kuadrivalen HPV, kanser pangkal rahim, tahun kualiti hidup terselaras yang diselamatkan, keberkesanan kos, calitan Pap, kualiti hidup,Ph.D
Pages:	292
Call Number:	WP20.S531e 2011 9HUKM
Publisher:	UKM, Kuala Lumpur
Appears in Collections:	Faculty of Medicine / Fakulti Perubatan

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