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The authors of this letter read the article of Isshiki et al. (2014) on the cost-benefit analysis of HPV vaccination for cervical cancer prevention, and they found it interesting and unique. The article concluded that HPV vaccination at the price of US$500 is not cost-effective, but becomes cost-effective at half that price. This conclusion misevaluates prophylactic cervical cancer programmes by both vaccination and screening in Japan, as the authors found a number of issues in the scenario analysis that Isshiki conducted. Therefore, this article is not suitable for forming political decisions. The authors would like to identify critical issues by discussing Model A, Model B, and the methodology of economic evaluation. The aim of our comment is to help make Isshiki’s analysis more accurate and clear and to provide comprehensive information to support political decision-making by Japanese central and regional authorities. Regarding Model A, it was assumed that screening with cytology was conducted every year from the age of 30 using base-case analysis. Based on current guidance of policy by the Japan regulatory authority, however, women should be screened with cytology every two years (Hamashima et al., 2010). Hence, given that frequency of screening was a factor in the scenario analysis, our concern is that screening costs in ‘Model A’ are overestimated. The article should also have taken into consideration the prophylactic effectiveness of screening for precancerous conditions (it was assumed that women are screened 11 times). Moreover, the authors could not find an appropriate reason why loss of earnings was calculated for only five years in this article, relating to the use of 13.163 of the Leibniz coefficient (at the age of 45, the feasible estimate of working years is 22). With regard to Model B, the authors suggest that the article should incorporate cost of screening weighted by 23.7% (OECD, 2011) because the uptake rate of screening is based on screening not only with but also without vaccinations. It is also unclear why the article did not consider direct costs for mass-screening, treatment, and palliative care (home care may also be relevant), even though it stated that a woman was diagnosed with cervical cancer of stage IIIB at age of 40 and treated with hysterectomy, irradiation, and anticancer drugs in Model B. According to ‘Methods for economic evaluation of health care’ ( Drummond et al., 2005), all the important and relevant costs identified and related to prevention LETTER to the EDITER

Regarding 'HPV Vaccination for Cervical Cancer Prevention is not Cost-effective in Japan'