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BJOG. 2012 Jan;119(2):177-86. doi: 10.1111/j.1471-0528.2011.03036.x. Epub 2011 Jul 28.

Introducing HPV vaccine and scaling up screening procedures to prevent deaths from cervical cancer in Japan: a cost-effectiveness analysis.

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Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Japan.



To assess the cost-effectiveness of universal vaccination of 11-year-old girls against human papillomavirus (HPV) infection and increased screening coverage to prevent cervical cancer in Japan where the coverage of Papanicolaou smears is very low.


A cost-utility analysis from a societal perspective.


Japan, 2010.


The female Japanese population aged 11 years or older.


A Markov model of the natural history of cervical cancer was constructed to compare six strategies: i.e. a screening coverage rate of 20, 50 and 80% with and without routine vaccination at age 11.


Cervical cancer incidence, quality-adjusted life years (QALYs), costs and incremental cost-effectiveness ratios.


Expanding the coverage of Papanicolaou smears from the current level of 20-50 and 80% yields a 45.5 and 63.1% reduction in cervical cancer incidence, respectively. Impact of combined strategies increases with coverage. Coverages of 20, 50 and 80% showed a 66.1, 80.9 and 86.8% reduction in disease, respectively. The costs of strategies with vaccination are four times higher than the cost of strategies without vaccination. Vaccinating all 11-year-old girls with bivalent vaccines with a Papanicolaou smear coverage rate of 50% is likely to be the most cost-effective option among the six strategies.


The introduction of HPV vaccination in Japan is cost-effective as in other countries. It is more cost-effective to increase the coverage of the Papanicolaou smear along with the universal administration of HPV vaccine.

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