Cost-Effectiveness of Cervical Cancer Screening and HPV Vaccination: A Markov Model from the Healthcare Payer Perspective

LIU Weixia¹Huan Hongxin¹Huang Xiaojun¹Xuan Yan²Jiang KuanLie¹Jing Li^3*Wei Lu^1,2*

• ¹Hainan Medical University, Haikou, Hainan Province, China
• ²Hainan Women and Children's Medical Center, Haikou, Hainan Province, China
• ³Haina, haiko, Afghanistan

Background: Substantial progress has been made in cervical cancer screening and HPV vaccination in China. However, evidence on the cost-effectiveness of these interventions remains scarce, particularly for combined vaccination and screening strategies at the provincial level. To address this gap, we evaluated the cost-effectiveness of alternative cervical cancer prevention strategies in a southern province of China from the healthcare payer perspective. Methods: A Markov model was constructed to simulate a cohort of 100,000 females beginning at age 9 and followed until death (up to 100 years). The model compared the outcomes of bivalent, quadrivalent, and 9-valent HPV vaccines combined with two screening methods: TCT and HPV testing. Analyses were conducted from the healthcare payer perspective, considering only direct medical costs. The primary outcome was quality-adjusted life years (QALYs), discounted at 3% annually. Herd immunity effects were not incorporated. Model calibration relied on data from the China Health Statistics Yearbook, and sensitivity analyses assessed parameter uncertainty. Reporting followed the CHEERS 2024 guidelines. Results: Thirteen strategies were evaluated, including no intervention, screening alone, and combinations of screening with the three HPV vaccines. The combination of HPV testing and the 9-valent vaccine was the most cost-effective, with an incremental cost-effectiveness ratio (ICER) of ¥139.58 per QALY, well below the willingness-to-pay threshold. By contrast, TCT combined with the 9-valent vaccine yielded the highest ICER at ¥193,240.60 per QALY, exceeding the threshold. Sensitivity analyses showed ICER estimates were most influenced by screening coverage, vaccination uptake, test sensitivity, and the discount rate. Conclusions: Within the current resource and policy context, combining HPV testing with the 9-valent vaccine provides the highest economic value. This strategy offers evidence to guide future cervical cancer prevention policies in southern China.