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Termrungruanglert W, Khemapech N, Vasuratna A, Havanond P, Tantitamit T. Cost-effectiveness analysis of single-dose or 2-dose of bivalent, quadrivalent, or nonavalent HPV vaccine in a low/middle-income country setting. J Gynecol Oncol 2024; 35:35.e85. [PMID: 38670561 DOI: 10.3802/jgo.2024.35.e85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/29/2024] [Accepted: 03/31/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE To compare the health impact and economic benefits among individuals who did not receive the human papillomavirus (HPV) vaccine to those who received a single dose, or 2 doses. The comparison was stratified by 4 types of vaccine in conjunction with primary HPV screening in a low/middle-income country setting. METHODS A Markov model was employed to simulate HPV infection and cervical cancer in a cohort of 100,000 12-year-old girls free of HPV. The study scrutinized 9 strategies: 1 dose and 2 doses of 2vHPV (Cervarix®), 2vHPV (Cecolin®), 4vHPV (Gardasil®), 9vHPV vaccine (Gardasil9®), and no vaccination. The primary outcome measure was the quality-adjusted life year (QALY) of each strategy. Incremental cost-effectiveness ratios were estimated over a lifetime horizon, accompanied by sensitivity analyses conducted. RESULTS All vaccination programs yielded 41,298-71,057 QALYs gained accompanied by cost savings of 14,914,186-19,821,655 USD compared to no vaccination. Administering 2 doses of 9vHPV vaccine emerged as the most cost-effective strategy, boasting 406 USD/QALY, within a lower willingness to pay threshold. Sensitivity analysis demonstrated an 80% probability of the cost-effectiveness of the 2 doses of 9vHPV vaccine regimen. Furthermore, uncertainty around the costs of vaccination and vaccine efficacy exerted the most substantial influence on the cost-effectiveness findings. CONCLUSION Oping for 2 doses of 9vHPV vaccine in conjunction with a primary HPV screening represents the most cost-effective option for implementing a school-based HPV vaccination program targeting 12-year-old girls in Thailand. Such findings provide valuable insights for policymakers in the realm of cervical cancer prevention.
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Affiliation(s)
- Wichai Termrungruanglert
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Nipon Khemapech
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Apichai Vasuratna
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Piyalamporn Havanond
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Tanitra Tantitamit
- Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand.
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Song Y, Choi W, Shim E. Cost-Effectiveness of Human Papillomavirus Vaccination in the UK: Two Versus Single-Dose of Nonavalent HPV Vaccination. Am J Prev Med 2024:S0749-3797(24)00102-8. [PMID: 38508425 DOI: 10.1016/j.amepre.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION The UK implemented a single-dose HPV vaccination policy in September 2023, aiming for sustained protection, better vaccine coverage, and reduced healthcare costs. This research assesses the cost-effectiveness of both one-dose and two-dose schedules from a healthcare perspective. METHODS Using an age-structured dynamic model, the study analyzed long-term health and economic outcomes of these two different vaccination approaches. It focused on the effects of vaccinating 12- to 13-year-olds with the 9-valent HPV vaccine in either single-dose or two-dose regimens from 2023 to 2093. The analysis, conducted in 2023-2024, explored different immunity durations (10, 30 years, or lifetime) and efficacy levels for the single-dose strategy. RESULTS The study indicated that in the UK, vaccinating 12- to 13-year-olds with a two-dose regimen is not considered cost-effective compared to the single-dose option, assumed to be 90% as effective for 10 years. The incremental cost-effectiveness ratios for two doses ranged from £230,903 to £1,082,916 per quality-adjusted life year (QALY), significantly exceeding the UK's £20,000/QALY willingness-to-pay threshold. Over 70 years, a switch from a two-dose to a single-dose vaccination schedule could potentially lead to savings of over £1,073 million in the healthcare system. Furthermore, the single-dose regimen was cost-effective compared to no vaccination, with an incremental cost-effectiveness ratio below £2,040/QALY. CONCLUSIONS The study affirms the cost-effectiveness of the UK's single-dose HPV vaccine, in sync with its September 2023 policy shift. The shift not only provides financial benefits but also simplifies vaccine administration, strategically reducing HPV's epidemiological and economic impacts.
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Affiliation(s)
- Youngji Song
- Department of Mathematics, Soongsil University, Seoul, Republic of Korea
| | - Wongyeong Choi
- Department of Mathematics, Soongsil University, Seoul, Republic of Korea
| | - Eunha Shim
- Department of Mathematics, Soongsil University, Seoul, Republic of Korea.
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Choi W, Shim E. Evaluating the cost-effectiveness of HPV vaccination for adolescent girls in Japan: A comparison of 2-valent, 4-valent, and 9-valent HPV vaccines with consideration of cross-protection. Prev Med 2024; 178:107743. [PMID: 37866695 DOI: 10.1016/j.ypmed.2023.107743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/04/2023] [Accepted: 10/19/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE In April 2023, the Japanese Health Ministry panel approved the inclusion of the 9-valent human papillomavirus (9vHPV) vaccine in the National Immunization Program, alongside the 2-valent (2vHPV) and 4-valent HPV (4vHPV) vaccines. In response to this, we evaluated the cost-effectiveness of these three vaccines for routine immunization of girls aged 12-16 in Japan, considering the cross-protection of 2vHPV and 4vHPV vaccines. METHODS We constructed an age-structured mathematical model for HPV transmission, aiming to quantify the economic and epidemiological effects of various HPV vaccination strategies over a 70-year period in Japan. We determined incremental costs and quality-adjusted life years (QALYs) for each strategy, applying a 3% annual discount. Univariate and probabilistic sensitivity analyses were conducted to assess the uncertainty of our model results, with all evaluations done in 2023. RESULTS Our projections indicate that the HPV vaccination program in Japan will significantly reduce the incidence of HPV-related diseases. All HPV vaccination strategies, using the 2vHPV, 4vHPV, and 9vHPV vaccines, were found to be cost-effective compared to no vaccination, with incremental cost-effectiveness ratios of ¥971,447/QALY, ¥1,237,297/QALY, and ¥742,084/QALY, respectively. Direct comparisons between vaccines demonstrated that the 9vHPV vaccination was more cost-effective than the 2vHPV vaccination, whereas 4vHPV vaccination was dominated by 2vHPV vaccination. CONCLUSIONS Our study validates the cost-effectiveness of implementing the 9vHPV vaccine as the primary option over the 2vHPV or 4vHPV vaccine for girls in Japan. These findings underscore the need to improve the acceptance rate and coverage of HPV vaccinations in the country.
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Affiliation(s)
- Wongyeong Choi
- Department of Mathematics, Soongsil University, 369 Sangdoro, Dongjak-gu, Seoul 06978, Republic of Korea.
| | - Eunha Shim
- Department of Mathematics, Soongsil University, 369 Sangdoro, Dongjak-gu, Seoul 06978, Republic of Korea.
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Prem K, Choi YH, Bénard É, Burger EA, Hadley L, Laprise JF, Regan MC, Drolet M, Sy S, Abbas K, Portnoy A, Kim JJ, Brisson M, Jit M. Global impact and cost-effectiveness of one-dose versus two-dose human papillomavirus vaccination schedules: a comparative modelling analysis. BMC Med 2023; 21:313. [PMID: 37635227 PMCID: PMC10463590 DOI: 10.1186/s12916-023-02988-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 07/20/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND To eliminate cervical cancer as a public health problem, the World Health Organization had recommended routine vaccination of adolescent girls with two doses of the human papillomavirus (HPV) vaccine before sexual initiation. However, many countries have yet to implement HPV vaccination because of financial or logistical barriers to delivering two doses outside the infant immunisation programme. METHODS Using three independent HPV transmission models, we estimated the long-term health benefits and cost-effectiveness of one-dose versus two-dose HPV vaccination, in 188 countries, under scenarios in which one dose of the vaccine gives either a shorter duration of full protection (20 or 30 years) or lifelong protection but lower vaccine efficacy (e.g. 80%) compared to two doses. We simulated routine vaccination with the 9-valent HPV vaccine in 10-year-old girls at 80% coverage for the years 2021-2120, with a 1-year catch-up campaign up to age 14 at 80% coverage in the first year of the programme. RESULTS Over the years 2021-2120, one-dose vaccination at 80% coverage was projected to avert 115.2 million (range of medians: 85.1-130.4) and 146.8 million (114.1-161.6) cervical cancers assuming one dose of the vaccine confers 20 and 30 years of protection, respectively. Should one dose of the vaccine provide lifelong protection at 80% vaccine efficacy, 147.8 million (140.6-169.7) cervical cancer cases could be prevented. If protection wanes after 20 years, 65 to 889 additional girls would need to be vaccinated with the second dose to prevent one cervical cancer, depending on the epidemiological profiles of the country. Across all income groups, the threshold cost for the second dose was low: from 1.59 (0.14-3.82) USD in low-income countries to 44.83 (3.75-85.64) USD in high-income countries, assuming one dose confers 30-year protection. CONCLUSIONS Results were consistent across the three independent models and suggest that one-dose vaccination has similar health benefits to a two-dose programme while simplifying vaccine delivery, reducing costs, and alleviating vaccine supply constraints. The second dose may become cost-effective if there is a shorter duration of protection from one dose, cheaper vaccine and vaccination delivery strategies, and high burden of cervical cancer.
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Affiliation(s)
- Kiesha Prem
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
| | - Yoon Hong Choi
- Modelling and Economics Unit, Data, Analytics and Surveillance, UK Health Security Agency, London, UK
| | - Élodie Bénard
- Centre de recherche du CHU de Québec - Université Laval, Québec, QC, Canada
| | - Emily A Burger
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Liza Hadley
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | | | - Mary Caroline Regan
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mélanie Drolet
- Centre de recherche du CHU de Québec - Université Laval, Québec, QC, Canada
| | - Stephen Sy
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kaja Abbas
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Allison Portnoy
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jane J Kim
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marc Brisson
- Centre de recherche du CHU de Québec - Université Laval, Québec, QC, Canada
- Department of Social and Preventive Medicine, Université Laval, Québec, QC, Canada
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
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Doggen K, van Hoek AJ, Luyten J. Accounting for Adverse Events Following Immunization in Economic Evaluation: Systematic Review of Economic Evaluations of Pediatric Vaccines Against Pneumococcus, Rotavirus, Human Papillomavirus, Meningococcus and Measles-Mumps-Rubella-Varicella. PHARMACOECONOMICS 2023; 41:481-497. [PMID: 36809673 DOI: 10.1007/s40273-023-01252-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES Economic evaluations of vaccines should accurately represent all relevant economic and health consequences of vaccination, including losses due to adverse events following immunization (AEFI). We investigated to what extent economic evaluations of pediatric vaccines account for AEFI, which methods are used to do so and whether inclusion of AEFI is associated with study characteristics and the vaccine's safety profile. METHODS A systematic literature search (MEDLINE, EMBASE, Cochrane Systematic Reviews and Trials, Database of the Centre for Reviews and Dissemination of the University of York, EconPapers, Paediatric Economic Database Evaluation, Tufts New England Cost-Effectiveness Analysis Registry, Tufts New England Global Health CEA, International Network of Agencies for Health Technology Assessment Database) was performed for economic evaluations published between 2014 and 29 April 2021 (date of search) pertaining to the five groups of pediatric vaccines licensed in Europe and the United States since 1998: the human papillomavirus (HPV) vaccines, the meningococcal vaccines (MCV), the measles-mumps-rubella-varicella (MMRV) combination vaccines, the pneumococcal conjugate vaccines (PCV) and the rotavirus vaccines (RV). Rates of accounting for AEFI were calculated, stratified by study characteristics (e.g., region, publication year, journal impact factor, level of industry involvement) and triangulated with the vaccine's safety profile (Advisory Committee on Immunization Practices [ACIP] recommendations and information on safety-related product label changes). The studies accounting for AEFI were analyzed in terms of the methods used to account for both cost and effect implications of AEFI. RESULTS We identified 112 economic evaluations, of which 28 (25%) accounted for AEFI. This proportion was significantly higher for MMRV (80%, four out of five evaluations), MCV (61%, 11 out of 18 evaluations) and RV (60%, nine out of 15 evaluations) compared to HPV (6%, three out of 53 evaluations) and PCV (5%, one out of 21 evaluations). No other study characteristics were associated with a study's likelihood of accounting for AEFI. Vaccines for which AEFI were more frequently accounted for also had a higher frequency of label changes and a higher level of attention to AEFI in ACIP recommendations. Nine studies accounted for both the cost and health implications of AEFI, 18 studies considered only costs and one only health outcomes. While the cost impact was usually estimated based on routine billing data, the adverse health impact of AEFI was usually estimated based on assumptions. DISCUSSION Although (mild) AEFI were demonstrated for all five studied vaccines, only a quarter of reviewed studies accounted for these, mostly in an incomplete and inaccurate manner. We provide guidance on which methods to use to better quantify the impact of AEFI on both costs and health outcomes. Policymakers should be aware that the impact of AEFI on cost-effectiveness is likely to be underestimated in the majority of economic evaluations.
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Affiliation(s)
- Kris Doggen
- Faculty of Medicine, KU Leuven, Leuven, Belgium
- Belgian Intermutualistic Agency, Brussels, Belgium
| | - Albert Jan van Hoek
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Jeroen Luyten
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Kapucijnenvoer 35, 3000, Leuven, Belgium.
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Harper K, Short MB, Bistricky S, Kusters IS. 1-2-3! Catch-Up for HPV: A Theoretically Informed Pilot Intervention to Increase HPV Vaccine Uptake among Young Adults. AMERICAN JOURNAL OF HEALTH EDUCATION 2023. [DOI: 10.1080/19325037.2022.2163005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
| | | | - Steven Bistricky
- University of Houston-Clear Lake
- University of Colorado at Colorado Springs, Colorado Springs
- Lyda Hill Institute for Human Resilience, Colorado Springs
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Cost-Effectiveness of Bivalent, Quadrivalent, and Nonavalent HPV Vaccination in South Africa. Clin Drug Investig 2022; 42:333-343. [PMID: 35294726 PMCID: PMC8989937 DOI: 10.1007/s40261-022-01138-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES In South Africa, the prevalence of human papillomavirus (HPV) and associated diseases, such as cervical cancer and genital warts, is among the highest in the world. This study evaluates the cost-effectiveness of bivalent, quadrivalent, and nonavalent HPV vaccination for 9- to 14-year-old girls from the South African healthcare system perspective. METHODS A Markov model portraying the natural HPV disease progression from high-risk infection to cervical intraepithelial neoplasia (CIN) I, CIN II/III, or cervical cancer and from low-risk infection to genital warts was built. Transition probability, utility, and efficacy data were sourced from peer-reviewed literature. Vaccination costs were calculated based on the World Health Organization (WHO) guidelines. The model was populated with a cohort of 520,000 9-year-old girls to calculate incremental cost-effectiveness ratios (ICER) in South African Rand (R) per quality-adjusted life-years (QALYs) gained for each vaccination strategy. RESULTS All HPV vaccination strategies dominate the no vaccine strategy. Compared with the bivalent vaccine, the nonavalent strategy increases QALYs by 0.14 and costs by R1793 (ICER: R13,013 per QALY) per person, while the quadrivalent vaccination provides -0.02 incremental QALYs and R1748 costs (ICER: -R116,397 per QALY). Consequently, at the South African willingness-to-pay threshold of R23,630 per QALY, nonavalent vaccination is the preferred strategy, with a probability of 90.2%. Scenario analysis demonstrated that results are influenced by vaccine coverage, efficacy, and duration of efficacy. CONCLUSIONS The introduction of nonavalent for bivalent HPV vaccination is a cost-effective intervention in South Africa. HPV vaccination should be part of a multifaceted public health strategy entailing screening, condoms, and education of all stakeholders to reduce the significant burden of sexual transmitted diseases in South Africa. Sex-neutral and catch-up vaccinations are subjects for further research.
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Portnoy A, Pedersen K, Nygård M, Trogstad L, Kim JJ, Burger EA. Identifying a Single Optimal Integrated Cervical Cancer Prevention Policy in Norway: A Cost-Effectiveness Analysis. Med Decis Making 2022; 42:795-807. [PMID: 35255741 DOI: 10.1177/0272989x221082683] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Interventions targeting the same disease but at different points along the disease continuum (e.g., screening and vaccination to prevent cervical cancer [CC]) are often evaluated in isolation, which can affect cost-effectiveness profiles and policy conclusions. We evaluated nonavalent human papillomavirus (HPV) vaccine (9vHPV) compared with bivalent HPV vaccine (2vHPV) alongside deintensified screening intervals for a vaccinated birth cohort to inform a single optimal integrated CC prevention policy. METHODS Using a multimodeling approach, we evaluated the health and economic impacts of alternative CC screening strategies for a Norwegian birth cohort eligible for HPV vaccination in 2021 assuming they received 1) 2vHPV or 2) 9vHPV. We conducted 1) a restricted analysis that evaluated the optimal HPV vaccine under current screening guidelines; and 2) a comprehensive analysis including alternative screening and vaccination strategy combinations. We calculated incremental cost-effectiveness ratios (ICERs) and evaluated them according to different cost-effectiveness thresholds. RESULTS Assuming a cost-effectiveness threshold of $40,000 per quality-adjusted life year (QALY) gained, we found that, while holding screening intensity fixed, switching the routine vaccination program in Norway from 2vHPV to 9vHPV would not be considered cost-effective (ICER of $132,700 per QALY gained). However, when allowing for varying intensities of CC screening, we found that switching to 9vHPV would be cost-effective compared with 2vHPV under an alternative threshold of $55,000 per QALY gained, if coupled with reductions in the number of lifetime screens. CONCLUSIONS Our analysis highlights the importance of evaluating the full potential policy landscape for country-level decision makers considering policy adoption, including nonindependent primary and secondary prevention efforts, to draw appropriate conclusions and avoid sub-optimal outcomes. HIGHLIGHTS Without evaluating the full potential policy landscape, including primary and secondary prevention efforts, country-level decision makers may not be able to draw appropriate policy conclusions, resulting in suboptimal outcomes.An applied example from cervical cancer prevention in Norway compared a restricted analysis of current screening guidelines to a comprehensive analysis including alternative screening and vaccination strategy combinations.We found that a switch from bivalent to nonavalent human papillomavirus vaccine would be considered cost-effective in Norway if coupled with reductions in the number of lifetime screens compared with the current screening strategy.A comprehensive analysis that considers how different types of interventions along the disease continuum affect each other will be critical for decision makers interpreting cost-effectiveness analysis results.
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Affiliation(s)
- Allison Portnoy
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kine Pedersen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Lill Trogstad
- The Norwegian Institute of Public Health, Oslo, Norway
| | - Jane J Kim
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Emily A Burger
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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Abstract
It is estimated that 5% of the global cancer burden, or approximately 690,000 cancer cases annually, is attributable to human papillomavirus (HPV). Primary prevention through prophylactic vaccination is the best option for reducing the burden of HPV-related cancers. Most high-income countries (HICs) have introduced the HPV vaccine and are routinely vaccinating adolescent boys and girls. Unfortunately, although they suffer the greatest morbidity and mortality due to HPV-related cancers, many lower- and middle-income countries (LMICs) have been unable to initiate and sustain vaccination programs. Secondary prevention in the form of screening has led to substantial declines in cervical cancer incidence in areas with established screening programs, but LMICs with absent or inadequate screening programs have high incidence rates. Meanwhile, HICs have seen incidence rates of anal and oropharyngeal cancers rise owing to the limited availability of organized screening for anal cancer and no validated screening options for oropharyngeal cancer. The implementation of screening programs for individuals at high risk of these cancers has the potential to reduce the burden of cervical cancer in LMICs, of anal and oropharyngeal cancers in HICs, and of anal cancer for highly selected HIV+ populations in LMICs. This review will discuss primary prevention of HPV-related cancers through vaccination and secondary prevention through screening of cervical, anal, and oropharyngeal cancers. Areas of concern and highlights of successes already achieved are included.
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Lewis RM, Laprise JF, Gargano JW, Unger ER, Querec TD, Chesson HW, Brisson M, Markowitz LE. Estimated Prevalence and Incidence of Disease-Associated Human Papillomavirus Types Among 15- to 59-Year-Olds in the United States. Sex Transm Dis 2021; 48:273-277. [PMID: 33492097 PMCID: PMC10037549 DOI: 10.1097/olq.0000000000001356] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Human papillomavirus (HPV) can cause anogenital warts and several types of cancer, including cervical cancers and precancers. We estimated the prevalence, incidence, and number of persons with prevalent and incident HPV infections in the United States in 2018. METHODS Prevalence and incidence were estimated for infections with any HPV (any of 37 types detected using Linear Array) and disease-associated HPV, 2 types that cause anogenital warts plus 14 types detected by tests used for cervical cancer screening (HPV 6/11/16/18/31/33/35/39/45/51/52/56/58/59/66/68). We used the 2013-2016 National Health and Nutrition Examination Survey to estimate prevalence among 15- to 59-year-olds, overall and by sex. Incidences in 2018 were estimated per 10,000 persons using an individual-based transmission-dynamic type-specific model calibrated to US data. We estimated number of infected persons by applying prevalences and incidences to 2018 US population estimates. RESULTS Prevalence of infection with any HPV was 40.0% overall, 41.8% in men, and 38.4% in women; prevalence of infection with disease-associated HPV was 24.2% in men and 19.9% in women. An estimated 23.4 and 19.2 million men and women had a disease-associated HPV type infection in 2018. Incidences of any and disease-associated HPV infection were 1222 and 672 per 10,000 persons; incidence of disease-associated HPV infection was 708 per 10,000 men and 636 per 10,000 women. An estimated 6.9 and 6.1 million men and women had an incident infection with a disease-associated HPV type in 2018. CONCLUSIONS We document a high HPV burden of infection in the United States in 2018, with 42 million persons infected with disease-associated HPV and 13 million persons acquiring a new infection. Although most infections clear, some disease-associated HPV type infections progress to disease. The HPV burden highlights the need for continued monitoring of HPV-associated cancers, cervical cancer screening, and HPV vaccination to track and prevent disease.
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Affiliation(s)
| | | | - Julia W Gargano
- From the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Elizabeth R Unger
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Troy D Querec
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Harrell W Chesson
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Marc Brisson
- Centre de Recherche du CHU de Québec, Université Laval, Quebec, Canada
| | - Lauri E Markowitz
- From the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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Phua LC, Choi HCW, Wu J, Jit M, Low J, Ng K, Pearce F, Hall C, Abdul Aziz MI. Cost-effectiveness analysis of the nonavalent human papillomavirus vaccine for the prevention of cervical cancer in Singapore. Vaccine 2021; 39:2255-2263. [PMID: 33744050 DOI: 10.1016/j.vaccine.2021.03.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The nonavalent human papillomavirus (HPV) vaccine has been shown to extend protection against oncogenic HPV types 31/33/45/52/58 (HPV-OV) not covered by the bivalent and quadrivalent HPV vaccines. Besides its clinical benefit, evidence on the economic value of the nonavalent vaccine is required to inform local vaccination strategies and funding decisions. This study evaluated the cost-effectiveness of replacing the bivalent vaccine with the nonavalent vaccine in the national school-based HPV vaccination programme in Singapore. METHODS An existing age-structured dynamic transmission model coupled with stochastic individual-based simulations was adapted to project the health and economic impact of vaccinating 13-year-old girls with two doses of the nonavalent or bivalent HPV vaccines in Singapore. Direct costs (in Singapore dollars, S$) were obtained from public healthcare institutions in Singapore, while health state utilities were sourced from the literature. Incremental cost-effectiveness ratios (ICERs) were estimated over a lifetime horizon, from a healthcare system perspective. Probabilistic sensitivity analysis was performed to obtain the ICERs and corresponding variations across variable uncertainty. Particularly, this study tested the scenarios of lifelong and 20-year vaccine-induced protection, assumed 96.0% and 22.3% cross-protection against HPV-OV by nonavalent and bivalent vaccines respectively, and fixed vaccine prices per dose at S$188 for nonavalent and S$61.50 for bivalent vaccines. RESULTS Compared with the bivalent vaccine, the use of the nonavalent vaccine was associated with an ICER of S$61,629 per quality-adjusted life year gained in the base case. The result was robust across a range of plausible input values, and to assumptions regarding the duration of vaccine protection. CONCLUSION Given the high ICER, the nonavalent vaccine is unlikely to represent a cost-effective option compared with the bivalent vaccine for school-based HPV vaccination of 13-year old female students in Singapore. Substantial price reductions would be required to justify its inclusion in the school-based programme in the future.
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Affiliation(s)
- Lee Cheng Phua
- Agency for Care Effectiveness, Ministry of Health, Singapore
| | - Horace C W Choi
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Joseph Wu
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region; WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
| | - Mark Jit
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jeffrey Low
- Gynaecologic Oncology, National University Cancer Institute, National University Hospital, Singapore
| | - Kwong Ng
- Agency for Care Effectiveness, Ministry of Health, Singapore
| | - Fiona Pearce
- Agency for Care Effectiveness, Ministry of Health, Singapore
| | - Cameron Hall
- Agency for Care Effectiveness, Ministry of Health, Singapore
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Portnoy A, Pedersen K, Trogstad L, Hansen BT, Feiring B, Laake I, Smith MA, Sy S, Nygård M, Kim JJ, Burger EA. Impact and cost-effectiveness of strategies to accelerate cervical cancer elimination: A model-based analysis. Prev Med 2021; 144:106276. [PMID: 33678239 DOI: 10.1016/j.ypmed.2020.106276] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/28/2020] [Accepted: 09/27/2020] [Indexed: 12/12/2022]
Abstract
Following the global call for action by the World Health Organization to eliminate cervical cancer (CC), we evaluated how each CC policy decision in Norway influenced the timing of CC elimination, and whether introducing nonavalent human papillomavirus (HPV) vaccine would accelerate elimination timing and be cost-effective. We used a multi-modeling approach that captured HPV transmission and cervical carcinogenesis to estimate the CC incidence associated with six past and future CC prevention policy decisions compared with a pre-vaccination scenario involving 3-yearly cytology-based screening. Scenarios examined the introduction of routine HPV vaccination of 12-year-old girls with quadrivalent vaccine in 2009, a temporary catch-up program for females aged up to 26 years in 2016-2018 with bivalent vaccine, the universal switch to bivalent vaccine in 2017, expansion to include 12-year-old boys in 2018, the switch from cytology- to HPV-based screening for women aged 34-69 in 2020, and the potential switch to nonavalent vaccine in 2021. Introducing routine female vaccination in 2009 enabled elimination to be achieved by 2056 and prevented 17,300 cases. Cumulatively, subsequent policy decisions accelerated elimination to 2039. According to our modeling assumptions, switching to the nonavalent vaccine would not be considered 'good value for money' at relevant cost-effectiveness thresholds in Norway unless the incremental cost was $19 per dose or less (range: $17-24) compared to the bivalent vaccine. CC control policies implemented over the last decade in Norway may have accelerated the timeframe to elimination by more than 17 years and prevented over 23,800 cases by 2110.
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Affiliation(s)
- Allison Portnoy
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA.
| | - Kine Pedersen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Lill Trogstad
- The Norwegian Institute of Public Health, Oslo, Norway
| | | | - Berit Feiring
- The Norwegian Institute of Public Health, Oslo, Norway
| | - Ida Laake
- The Norwegian Institute of Public Health, Oslo, Norway
| | - Megan A Smith
- Cancer Council New South Wales, Sydney, Australia; Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Stephen Sy
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA
| | | | - Jane J Kim
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA
| | - Emily A Burger
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA; Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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13
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Whitworth HS, Schiller J, Markowitz LE, Jit M, Brisson M, Simpson E, Watson-Jones D. Continued HPV vaccination in the face of unexpected challenges: A commentary on the rationale for an extended interval two-dose schedule. Vaccine 2021; 39:871-875. [PMID: 33451778 DOI: 10.1016/j.vaccine.2020.12.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/30/2020] [Accepted: 12/09/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Hilary S Whitworth
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK.
| | - John Schiller
- National Cancer Institute, National Institutes of Health, Maryland, USA
| | - Lauri E Markowitz
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Marc Brisson
- Centre de recherche du CHU de Québec and Department of Social and Preventive Medicine, Université Laval, Quebec, QC, Canada
| | - Evan Simpson
- Center for Vaccine Innovation and Access, PATH, Seattle, USA
| | - Deborah Watson-Jones
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
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14
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Mahumud RA, Alam K, Keramat SA, Ormsby GM, Dunn J, Gow J. Cost-effectiveness evaluations of the 9-Valent human papillomavirus (HPV) vaccine: Evidence from a systematic review. PLoS One 2020; 15:e0233499. [PMID: 32484811 PMCID: PMC7266321 DOI: 10.1371/journal.pone.0233499] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 05/06/2020] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION The World Health Organization (WHO) recommends that human papillomavirus (HPV) vaccination programs are established to be cost-effective before implementation. WHO recommends HPV vaccination for girls aged 9-13 years to tackle the high burden of cervical cancer. This review examined the existing evidence on the cost-effectiveness of the 9-valent HPV vaccine within a global context. METHODS The literature search covering a period of January 2000 to 31 July 2019 was conducted in PubMed and Scopus bibliographic databases. A combined checklist (i.e., WHO, Drummond and CHEERS) was used to examine the quality of eligible studies. A total of 12 studies were eligible for this review and most of them were conducted in developed countries. RESULTS Despite some heterogeneity in approaches to measure cost-effectiveness, ten studies concluded that 9vHPV vaccination was cost-effective and two did not. The addition of adolescent boys into immunisation programs was cost effective when vaccine price and coverage was comparatively low. When vaccination coverage for females was more than 75%, gender neutral HPV vaccination was less cost-effective than vaccination targeting only girls aged 9-18 years. Multi cohort immunization approach was found cost-effective in the age range of 9-14 years. However, the upper age limit at which vaccination was found not cost-effective requires further evaluation. This review identified duration of vaccine protection, time horizon, vaccine price, coverage, healthcare costs, efficacy and discounting rates as the most dominating parameters in determining cost-effectiveness. CONCLUSIONS These findings have implications in extending HPV immunization programs whether switching to the 9-valent vaccine or the inclusion of adolescent boys' vaccination or extending the age of vaccination. Further, this review also supports extending vaccination programs to low-resource settings where vaccine prices are competitive, donor funding is available, burden of cervical cancer is high and screening options are limited.
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Affiliation(s)
- Rashidul Alam Mahumud
- Health Economics and Policy Research, Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Commerce, University of Southern Queensland, Toowoomba, Queensland, Australia
- Health Systems and Population Studies Division, Health Economics and Financing Research, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- School of Social Sciences, Western Sydney University, Penrith, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Khorshed Alam
- Health Economics and Policy Research, Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Commerce, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Syed Afroz Keramat
- Health Economics and Policy Research, Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Commerce, University of Southern Queensland, Toowoomba, Queensland, Australia
- Economics Discipline, School of Social Science, University of Khulna, Khulna, Bangladesh
| | - Gail M. Ormsby
- School of Health and Wellbeing, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Jeff Dunn
- Health Economics and Policy Research, Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia
- Prostate Cancer Foundation of Australia, St Leonards, NSW, Australia
| | - Jeff Gow
- Health Economics and Policy Research, Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Commerce, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
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Wu CF, Lairson DR, Dahlstrom KR, Fokom Domgue J, Fu S, Sturgis EM, Chan W. Lifetime health care costs of oropharyngeal cancer for commercially insured patients in the United States. Head Neck 2020; 42:2321-2329. [PMID: 32359131 DOI: 10.1002/hed.26201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/09/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Incidence of oropharyngeal cancer (OPC) is expected to increase but its health care cost is unknown. The purpose for this study was to estimate the phase-specific lifetime health care costs of OPC for commercially insured individuals in the United States. METHODS We used the Truven MarketScan Commercial Claims and Encounter Database to identify our patient population. Cox survival analysis was used to estimate patients' monthly survival probabilities. We determined the ratios of the cumulative costs up to a particular survival probability and the costs from that time point to death for all subjects who died before end of the 5-year follow-up period. This relationship was then used to predict phase-specific lifetime health care costs. RESULTS Our study included 2445 patients with OPC. The predicted phase-specific lifetime health care costs attributable to OPC were $88 872, $24 038, and $1537 in the initial, continuous, and terminal phases, respectively, among commercially insured patients.
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Affiliation(s)
- Chi-Fang Wu
- Department of Management, Policy, and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - David R Lairson
- Department of Management, Policy, and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Kristina R Dahlstrom
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Joël Fokom Domgue
- Department of Epidemiology and Gynecologic Oncology and Reproductive Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.,Department of Obstetrics and Gynecology, Faculty of Medicine and Biomedical Sciences, The University of Yaounde, Yaounde, Cameroon
| | - Shuangshuang Fu
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Erich M Sturgis
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Wenyaw Chan
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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Laprise JF, Chesson HW, Markowitz LE, Drolet M, Martin D, Bénard É, Brisson M. Effectiveness and Cost-Effectiveness of Human Papillomavirus Vaccination Through Age 45 Years in the United States. Ann Intern Med 2020; 172:22-29. [PMID: 31816629 PMCID: PMC7217714 DOI: 10.7326/m19-1182] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In the United States, the routine age for human papillomavirus (HPV) vaccination is 11 to 12 years, with catch-up vaccination through age 26 years for women and 21 years for men. U.S. vaccination policy on use of the 9-valent HPV vaccine in adult women and men is being reviewed. OBJECTIVE To evaluate the added population-level effectiveness and cost-effectiveness of extending the current U.S. HPV vaccination program to women aged 27 to 45 years and men aged 22 to 45 years. DESIGN The analysis used HPV-ADVISE (Agent-based Dynamic model for VaccInation and Screening Evaluation), an individual-based transmission dynamic model of HPV infection and associated diseases, calibrated to age-specific U.S. data. DATA SOURCES Published data. TARGET POPULATION Women aged 27 to 45 years and men aged 22 to 45 years in the United States. TIME HORIZON 100 years. PERSPECTIVE Health care sector. INTERVENTION 9-valent HPV vaccination. OUTCOME MEASURES HPV-associated outcomes prevented and cost-effectiveness ratios. RESULTS OF BASE-CASE ANALYSIS The model predicts that the current U.S. HPV vaccination program will reduce the number of diagnoses of anogenital warts and cervical intraepithelial neoplasia of grade 2 or 3 and cases of cervical cancer and noncervical HPV-associated cancer by 82%, 80%, 59%, and 39%, respectively, over 100 years and is cost saving (vs. no vaccination). In contrast, extending vaccination to women and men aged 45 years is predicted to reduce these outcomes by an additional 0.4, 0.4, 0.2, and 0.2 percentage points, respectively. Vaccinating women and men up to age 30, 40, and 45 years is predicted to cost $830 000, $1 843 000, and $1 471 000, respectively, per quality-adjusted life-year gained (vs. current vaccination). RESULTS OF SENSITIVITY ANALYSIS Results were most sensitive to assumptions about natural immunity and progression rates after infection, historical vaccination coverage, and vaccine efficacy. LIMITATION Uncertainty about the proportion of HPV-associated disease due to infections after age 26 years and about the level of herd effects from the current HPV vaccination program. CONCLUSION The current HPV vaccination program is predicted to be cost saving. Extending vaccination to older ages is predicted to produce small additional health benefits and result in substantially higher incremental cost-effectiveness ratios than the current recommendation. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
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Affiliation(s)
- Jean-François Laprise
- Centre de recherche du CHU de Québec-Université Laval, Québec City, Québec, Canada (J.L., M.D., D.M., É.B.)
| | - Harrell W Chesson
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.W.C., L.E.M.)
| | - Lauri E Markowitz
- Centers for Disease Control and Prevention, Atlanta, Georgia (H.W.C., L.E.M.)
| | - Mélanie Drolet
- Centre de recherche du CHU de Québec-Université Laval, Québec City, Québec, Canada (J.L., M.D., D.M., É.B.)
| | - Dave Martin
- Centre de recherche du CHU de Québec-Université Laval, Québec City, Québec, Canada (J.L., M.D., D.M., É.B.)
| | - Élodie Bénard
- Centre de recherche du CHU de Québec-Université Laval, Québec City, Québec, Canada (J.L., M.D., D.M., É.B.)
| | - Marc Brisson
- Centre de recherche du CHU de Québec-Université Laval and Département de médecine sociale et préventive, Université Laval, Québec City, Québec, Canada and Imperial College, London, United Kingdom (M.B.)
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17
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Wilson KJ, Brown HS, Patel U, Tucker D, Becker K. Cost-effectiveness of a comprehensive immunization program serving high-risk, uninsured adults. Prev Med 2020; 130:105860. [PMID: 31678176 DOI: 10.1016/j.ypmed.2019.105860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 10/01/2019] [Accepted: 10/08/2019] [Indexed: 10/25/2022]
Abstract
Despite the numerous social and economic benefits of vaccination, adult immunization rates fall far short of recommended levels costing the United States $9 billion annually in health care expenditures and reduced productivity. While it is well recognized that childhood immunization is highly cost-effective, the economic impact of adult immunization programs varies by disease and is influenced by population demographics. This study aimed to assess the cost-effectiveness of a comprehensive adult immunization program serving high-need populations delivered by a local health department (LHD) in partnership with community organizations. We modeled incremental cost-effectiveness taking the payer perspective of each vaccine separately in simulated cohorts of 100,000 over a 20-year horizon using data provided by the LHD and data from the published literature. We adjusted the results to align with actual program delivery and used them to estimate an incremental cost-effectiveness ratio (ICER) for the entire program. We assessed the effects of varying our base model parameters in univariate sensitivity analyses. We discounted benefits and life years saved (LYS) at 3% and adjusted results to 2016 US$. Four of seven disease models were cost-effective (using a $100,000 CE threshold) with ICERS ranging from $14,260 to $79,022/LYS. Sensitivity analyses did not substantially impact the results. The ICER for program as a whole was $67,940/LYS. A community-delivered comprehensive immunization program serving uninsured, low income, high-risk adults is a cost-effective investment even when most do not receive the full regimen of some vaccines.
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Affiliation(s)
- Kimberly J Wilson
- University of Texas Health Science Center School of Public Health, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, United States of America.
| | - H Shelton Brown
- University of Texas Health Science Center School of Public Health, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, United States of America.
| | - Ujas Patel
- University of Texas Health Science Center School of Public Health, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, United States of America
| | - Debbie Tucker
- Austin Public Health, 15 Waller Street, Austin, TX 78701, United States of America.
| | - Kurt Becker
- Austin Public Health, 15 Waller Street, Austin, TX 78701, United States of America.
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18
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Origoni M, Cristoforoni P, Mariani L, Costa S, Preti M, Sandri MT, Preti EP, Ghelardi A, Perino A. [HPV vaccination: not only female adolescents and not only prophylactic. Review and position paper of the Italian HPV Study Group (IHSG)]. ACTA ACUST UNITED AC 2019; 71:442-459. [PMID: 31741364 DOI: 10.23736/s0026-4784.19.04443-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
HPV vaccination has been introduced in clinical practice in recent years and represents the most effective strategy of primary prevention of cervical carcinoma and of female genital preneoplastic conditions. One of the major issues of the subject is represented by vaccination coverage of the target population. Since its introduction, HPV vaccine efficacy has been progressively demonstrated also towards extragenital HPV-correlated conditions and in males too. Moreover, even subjects of older age groups or subjects who already had HPV infections have been demonstrated to received benefits from vaccination, due to improvements of their immunological response. Recently, vaccine efficacy has also been investigated in terms of adjuvant administration after treatments of preneoplastic or benign conditions of the female lower genital tract caused by HPVs; preliminary results indicate an interesting and promising field of application. On this basis, in this article an analysis of the state of the art has been performed, with specific regard to the Italian scenario and with the focus of future perspectives of implementation of the HPV vaccination policy. From the available evidences, the Italian HPV Study Group recommends the extension of systematic HPV vaccination to males too, to adult subjects and also after conservative treatment of genital HPV correlated conditions.
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Affiliation(s)
- Massimo Origoni
- Dipartimento di Ginecologia e Ostetricia, Università Vita Salute San Raffaele, Milano, Italia -
| | | | | | | | - Mario Preti
- Dipartimento di Ginecologia e Ostetricia, Università di Torino, Torino, Italia
| | | | | | | | - Antonio Perino
- Dipartimento di Ginecologia e Ostetricia, Università di Palermo, Palermo, Italia
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Mahumud RA, Alam K, Dunn J, Gow J. The cost-effectiveness of controlling cervical cancer using a new 9-valent human papillomavirus vaccine among school-aged girls in Australia. PLoS One 2019; 14:e0223658. [PMID: 31596899 PMCID: PMC6785120 DOI: 10.1371/journal.pone.0223658] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 09/24/2019] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Cervical cancer imposes a substantial health burden worldwide including in Australia and is caused by persistent infection with one of 13 sexually transmitted high-risk human papillomavirus (HPV) types. The objective of this study was to assess the cost-effectiveness of adding a nonavalent new Gardasil-9® (9vHPV) vaccine to the national immunisation schedule in Australia across three different delivery strategies. MATERIALS AND METHODS The Papillomavirus Rapid Interface for Modelling and Economics (PRIME) model was used to examine the cost-effectiveness of 9vHPV vaccine introduction to prevent HPV infection. Academic literature and anecdotal evidence were included on the demographic variables, cervical cancer incidence and mortality, treatment costs, and vaccine delivery costs. The incremental cost-effectiveness ratios (ICERs) were measured per disability-adjusted life years (DALYs) averted, using the heuristic cost-effectiveness threshold defined by the World Health Organisation (WHO). Analyses and data from international agencies were used in scenario analysis from the health system and societal perspectives. RESULTS The 9vHPV vaccination was estimated to prevent 113 new cases of cervical cancer (discounted) during a 20-year period. From the health system and societal perspectives, the 9vHPV vaccination was very cost-effective in comparison with the status quo, with an ICER of A$47,008 and A$44,678 per DALY averted, respectively, using the heuristic cost-effectiveness threshold level. Considering delivery strategies, the ICERs per DALY averted were A$47,605, A$46,682, and A$46,738 for school, health facilities, and outreach-based vaccination programs from the health system perspective, wherein, from the societal perspective, the ICERs per DALY averted were A$46,378, A$43,729, A$43,930, respectively. All estimates of ICERs fell below the threshold level (A$73,267). CONCLUSIONS This cost-effectiveness evaluation suggests that the routine two-dose 9vHPV vaccination strategy of preadolescent girls against HPV is very cost-effective in Australia from both the health system and societal perspectives. If equally priced, the 9vHPV option is the most economically viable vaccine. Overall, this analysis seeks to contribute to an evidence-based recommendation about the new 9vHPV vaccination in the national immunisation program in Australia.
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Affiliation(s)
- Rashidul Alam Mahumud
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Commerce, University of Southern Queensland, Toowoomba, QLD Australia
- Health Economics Research, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Health and Epidemiology Research, Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
| | - Khorshed Alam
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Commerce, University of Southern Queensland, Toowoomba, QLD Australia
| | - Jeff Dunn
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia
- Prostate Cancer Foundation of Australia, St Leonards NSW, Australia
| | - Jeff Gow
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Commerce, University of Southern Queensland, Toowoomba, QLD Australia
- School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
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20
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Canfell K, Kim JJ, Kulasingam S, Berkhof J, Barnabas R, Bogaards JA, Campos N, Jennett C, Sharma M, Simms KT, Smith MA, Velentzis LS, Brisson M, Jit M. HPV-FRAME: A consensus statement and quality framework for modelled evaluations of HPV-related cancer control. PAPILLOMAVIRUS RESEARCH 2019; 8:100184. [PMID: 31505258 PMCID: PMC6804684 DOI: 10.1016/j.pvr.2019.100184] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 08/05/2019] [Accepted: 09/04/2019] [Indexed: 11/26/2022]
Abstract
Intense research activity in HPV modelling over this decade has prompted the development of additional guidelines to those for general modelling. A specific framework is required to address different policy questions and unique complexities of HPV modelling. HPV-FRAME is an initiative to develop a consensus statement and quality-based framework for epidemiologic and economic HPV models. Its development involved an established process. Reporting standards have been structured according to seven domains reflecting distinct policy questions in HPV and cancer prevention and categorised by relevance to a population or evaluation. Population-relevant domains are: 1) HPV vaccination in pre-adolescent and young adolescent individuals; 2) HPV vaccination in older individuals; 3) targeted vaccination in men who have sex with men; 4) considerations for individuals living with HIV and 5) considerations for low- and middle-income countries. Additional considerations applicable to specific evaluations are: 6) cervical screening or integrated cervical screening and HPV vaccination approaches and 7) alternative vaccine types and alternative dosing schedules. HPV-FRAME aims to promote the development of models in accordance with an explicit framework, to better enable target audiences to understand a model's strength and weaknesses in relation to a specific policy question and ultimately improve the model's contribution to informed decision-making. General modelling guidelines are insufficient for reporting HPV models. HPV-FRAME is an initiative to develop a quality-based framework for HPV models. The framework has seven domains consisting of distinct reporting standards. HPV-FRAME aims to promote transparency and improve the quality in reporting.
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Affiliation(s)
- Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, 2011, NSW, Australia; School of Public Health, Sydney Medical School, University of Sydney, NSW, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
| | - Jane J Kim
- Department of Health Policy and Management and Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | | | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, Netherlands
| | - Ruanne Barnabas
- Department of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
| | - Johannes A Bogaards
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, Netherlands; Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Nicole Campos
- Department of Health Policy and Management and Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Chloe Jennett
- Cancer Research Division, Cancer Council NSW, Sydney, 2011, NSW, Australia
| | - Monisha Sharma
- Department of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
| | - Kate T Simms
- Cancer Research Division, Cancer Council NSW, Sydney, 2011, NSW, Australia
| | - Megan A Smith
- Cancer Research Division, Cancer Council NSW, Sydney, 2011, NSW, Australia; School of Public Health, Sydney Medical School, University of Sydney, NSW, Australia
| | - Louiza S Velentzis
- Cancer Research Division, Cancer Council NSW, Sydney, 2011, NSW, Australia; School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Marc Brisson
- Centre de Recherche du CHU de Québec, Université Laval, Axe santé des Populations et Pratiques Optimales en santé, Québec, Canada; Imperial College, Department of Infectious Disease Epidemiology, London, UK
| | - Mark Jit
- London School of Hygiene and Tropical Medicine, London, UK; Modelling and Economics Unit, Public Health England, London, UK
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21
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Murillo R, Ordóñez-Reyes C. Human papillomavirus (HPV) vaccination: from clinical studies to immunization programs. Int J Gynecol Cancer 2019; 29:1317-1326. [PMID: 31455660 DOI: 10.1136/ijgc-2019-000582] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/06/2019] [Accepted: 06/10/2019] [Indexed: 12/13/2022] Open
Abstract
Cervical cancer incidence and mortality have decreased in high-income countries, but low- and middle-income countries continue to bear a significant burden from the disease. Human papillomavirus (HPV) vaccines are a promising alternative for disease control; however, their introduction is slow in settings with greater need. We conducted a review of HPV vaccine efficacy and effectiveness reported in clinical trials and population-based studies. Efficacy of HPV vaccines is close to 100% when using a three-dose schedule in HPV-negative young women (<25 years old) for protection against persistent infection and HPV vaccine-type associated pre-cancerous lesions. Furthermore, sustained protection for up to 12 years of follow-up has been demonstrated; cross-protection against non-vaccine types is particularly observed for the bivalent vaccine, and preliminary data regarding impact on invasive cancer have emerged. Given its lower efficacy, catch-up vaccination beyond 19 years of age and proposals for vaccinating adult women deserve careful evaluation in accurately designed studies and economic analyses. Despite positive results regarding immunogenicity and post-hoc analysis for cervical intra-epithelial neoplasia in clinical trials, population-based data for prime and booster two-dose schedules are not available. Evaluation of vaccine safety from surveillance systems in immunization programs that have already distributed more than 270 million doses found no association of HPV vaccination with serious side effects. The introduction of HPV vaccination in national immunization programs remains the main challenge in tackling the burden of cervical cancer (up to 2018, only 89 countries have introduced vaccination worldwide, and most of these are high-income countries). Access models and technical capacity require further development to help low- and middle-income countries to increase the pace of vaccine delivery. Alternative approaches such as one-dose schedules and vaccination at younger ages may help reduce the programmatic and economic challenges to adolescent vaccination.
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Affiliation(s)
- Raúl Murillo
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogota, Colombia .,Facultad de Medicina, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Camila Ordóñez-Reyes
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogota, Colombia
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Direct medical cost of oropharyngeal cancer among patients insured by Medicaid in Texas. Oral Oncol 2019; 96:21-26. [PMID: 31422209 DOI: 10.1016/j.oraloncology.2019.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 05/17/2019] [Accepted: 06/28/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aim of this study was to estimate the direct 2-year mean incremental medical care costs for incident oropharyngeal cancer (OPC) from the perspective of the Texas Medicaid program. METHODS OPC patients treated from 2008 to 2012 were selected in the Texas Medicaid database. Using a two-step 1:1 propensity score matching method, we selected controls to determine the differential cost associated with OPC. Monthly and yearly direct costs were estimated for 2 years after the cancer diagnosis. For patients without 2-year complete follow-up, a generalized linear model with gamma distribution and log link function was applied to predict costs for the censored months. RESULTS A total of 352 patients with OPC and the same number of controls were included in the study. Among OPC patients, 204 (58%) were covered by Medicaid and Medicare, and 148 patients (42%) were insured under Medicaid only. The adjusted first- and second-year mean differential costs were $45,102 and $11,684 for Medicaid-only enrollees and $5734 and $2162 for Medicaid-Medicare dual-eligible enrollees, respectively. Being male, Hispanic, Medicaid-only eligible, living in the Harlingen region, and having more comorbidities were positively associated with monthly cost. Lubbock residents experienced lower costs. CONCLUSIONS The direct incremental medical costs associated with OPCs among patients insured by Texas Medicaid were substantial in the first 2 years after cancer diagnosis and should be considered in assessing the economic consequences of increasing the investment in HPV vaccination in Texas.
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Wong LP, Han L, Li H, Zhao J, Zhao Q, Zimet GD. Current issues facing the introduction of human papillomavirus vaccine in China and future prospects. Hum Vaccin Immunother 2019; 15:1533-1540. [PMID: 31017500 DOI: 10.1080/21645515.2019.1611157] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The introduction of human papillomavirus (HPV) vaccination in China aims to prevent HPV infection in all women. The issues that China might face include high cost of vaccines made in other countries, shortage in HPV vaccine supply, negative events attributed to vaccination (whether justified or not) that jeopardizes the general public's confidence in the HPV vaccine, cultural and literacy barriers, and sensitivity to receiving a vaccine for a sexually transmitted disease. Ensuring the effective delivery of the HPV vaccine in China, a country with vast economic, geographical, and cultural complexities, will require a commitment of significant resources. In light of the high price of imported vaccines, the availability of locally manufactured HPV vaccines would greatly facilitate the national HPV vaccination program. New evidence supporting the efficacy of a two-dose regime in younger adolescents would also be advantageous in terms of affordability and logistical simplicity of vaccine administration. Furthermore, it would potentially enhance the compliance and uptake, especially for hard to reach women in remote regions.
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Affiliation(s)
- Li Ping Wong
- a Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia.,b Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University , Ningbo , Zhejiang , PR China
| | - Liyuan Han
- b Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University , Ningbo , Zhejiang , PR China
| | - Hui Li
- c Non-infectious Disease Prevention and Control Institute, Ningbo Municipal Center for Disease Control and Prevention , Ningbo , PR China
| | - Jinshun Zhao
- b Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University , Ningbo , Zhejiang , PR China
| | - Qinjian Zhao
- d State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University , Xiamen , Fujian PR China
| | - Gregory D Zimet
- e Department of Pediatrics, School of Medicine, Indiana University , Indianapolis , IN , USA
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Tam S, Wu CF, Peng HL, Dahlstrom KR, Sturgis EM, Lairson DR. Cost of treating recurrent respiratory papillomavirus in commercially insured and medicaid patients. Laryngoscope 2019; 130:1186-1194. [PMID: 31194270 DOI: 10.1002/lary.28139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/09/2019] [Accepted: 05/28/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The study objective was to estimate the first 2 years' direct costs of treating new cases of juvenile-onset and adult-onset recurrent respiratory papillomatosis (RRP) and determine the predictors of treatment costs. METHODS Cases were patients diagnosed with RRP in commercial insurance claims in 2011-2014 and Texas Medicaid in 2008-2012 for treatment of RRP. Controls were patients without a diagnosis of HPV-related cancer or RRP, matched with cases by age, sex, geographic area, date of diagnosis of RRP, and propensity score. Total health care costs in the first 2 years after diagnosis were obtained from cases and matched controls. A generalized linear model was created to identify predictors of monthly costs. RESULTS In commercially insured patients, a total of 122 cases of juvenile-onset (<18 years old) and 1824 cases of adult-onset (≥18 years old) RRP were identified. The mean first 2 years' cost difference between cases and controls was $58,733 for juvenile-onset disease and $11,185 for adult-onset disease after model adjustments. In the Texas Medicaid population, 73 cases of juvenile-onset and 96 cases of adult-onset RRP were identified. The mean first 2 years' cost difference between cases and controls was $76,115 for juvenile-onset disease and $4,633 for adult-onset disease after model adjustments. CONCLUSION The first 2 years' medical costs difference of juvenile-onset and adult-onset RRP among commercially insured and Medicaid population were approximately $60,000 to $70,000 and $5,000 to $11,000, respectively, and should be considered in HPV vaccination promotion investment decisions. LEVEL OF EVIDENCE N/A Laryngoscope, 130:1186-1194, 2020.
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Affiliation(s)
- Samantha Tam
- Department of Head and Neck Surgery, the University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chi-Fang Wu
- Department of Management, Policy, and Community Health the University of Texas Health Science Center, Houston, TX
| | - Ho-Lan Peng
- Department of Management, Policy, and Community Health the University of Texas Health Science Center, Houston, TX
| | - Kristina R Dahlstrom
- Department of Head and Neck Surgery, the University of Texas MD Anderson Cancer Center, Houston, TX
| | - Erich M Sturgis
- Department of Head and Neck Surgery, the University of Texas MD Anderson Cancer Center, Houston, TX.,Department of Epidemiology, the University of Texas MD Anderson Cancer Center, Houston, TX, U.S.A
| | - David R Lairson
- Department of Management, Policy, and Community Health the University of Texas Health Science Center, Houston, TX
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Chesson HW, Meites E, Ekwueme DU, Saraiya M, Markowitz LE. Updated medical care cost estimates for HPV-associated cancers: implications for cost-effectiveness analyses of HPV vaccination in the United States. Hum Vaccin Immunother 2019; 15:1942-1948. [PMID: 31107640 DOI: 10.1080/21645515.2019.1603562] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Estimates of medical care costs for cervical and other cancers associated with human papillomavirus (HPV) are higher in studies published in recent years than in studies published before 2012. The purpose of this report is (1) to review and summarize the recent cancer cost estimates and (2) to illustrate how the estimated cost-effectiveness of HPV vaccination might change when these recent cost estimates are applied. Our literature search yielded 6 studies that provided updated medical care cost estimates for 5 HPV-associated cancers. We found that applying the current cancer cost estimates had a notable impact on the estimated medical costs averted by HPV vaccination over an extended time frame (100 years), and a moderate impact on the estimated cost per quality-adjusted life year (QALY) gained by HPV vaccination. For example, for catch-up vaccination of teenagers and young adults, applying the more recent cancer costs reduced the estimated cost per QALY gained by about $12,400. The cost studies we identified in our literature review are up-to-date and based on reliable data sources from United States settings, and can inform future studies of HPV vaccination cost-effectiveness in the United States. However, careful consideration is warranted to determine the most appropriate cost values to apply.
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Affiliation(s)
- Harrell W Chesson
- a Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Elissa Meites
- b Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Donatus U Ekwueme
- c Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Mona Saraiya
- c Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Lauri E Markowitz
- b Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta , GA , USA
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Donmez HG, Tanacan A, Unal C, Fadiloglu E, Onder SC, Portakal O, Beksac MS. Human papillomavirus infection and autoimmune disorders: a tertiary center experience. Pathog Dis 2019; 77:5481523. [DOI: 10.1093/femspd/ftz028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/27/2019] [Indexed: 02/07/2023] Open
Abstract
ABSTRACT
This study aimed to investigate the relationship between HPV and autoimmune disorders. We retrospectively evaluated 62 women who had HPV-DNA positivity in terms of autoimmune disorders (autoimmune antibody positivity, chronic inflammatory diseases and autoimmune diseases). The patients were divided into two groups according to autoimmune disorder positivity (autoimmune positive (n = 30), autoimmune negative (n = 32)) and compared with each other in terms of single and multiple HPV-DNA types, high and low-risk HPV-DNA types, and Pap smear findings. We determined that 48.4% of the HPV-DNA positive patients had autoimmune disorders. We found that 15 of 62 (24.2%) women had more than one type of HPV and HPV type 16 was the dominant type in this study (58.2%). A total of 27.4% of HPV-DNA positive patients had abnormal cytological findings. There was no statistically significant difference between autoimmune groups in terms of the presence of high-risk HPV types, multiple HPV types and abnormal cytological findings (P = 0.531, P = 0.558 and P = 0.234, respectively). The prevalence of autoimmune disorders was high among HPV-DNA positive women. On the other hand, the rate of high-risk HPV type positivity, multiple HPV infections and cytopathological findings were similar between the autoimmune positive and negative groups.
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Affiliation(s)
- Hanife Guler Donmez
- Department of Biology, Faculty of Science, Hacettepe University, 06800 Beytepe, Ankara, Turkey
| | - Atakan Tanacan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, 06100 Sihhiye, Ankara, Turkey
| | - Canan Unal
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, 06100 Sihhiye, Ankara, Turkey
| | - Erdem Fadiloglu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, 06100 Sihhiye, Ankara, Turkey
| | - Sevgen Celik Onder
- Department of Pathology, Faculty of Medicine, Hacettepe University, 06100 Sihhiye, Ankara, Turkey
| | - Oytun Portakal
- Department of Medical Biochemistry, Faculty of Medicine, Hacettepe University, 06100 Sihhiye, Ankara, Turkey
| | - M Sinan Beksac
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, 06100 Sihhiye, Ankara, Turkey
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Tay SK, Hsu TY, Pavelyev A, Walia A, Kulkarni AS. Clinical and economic impact of school-based nonavalent human papillomavirus vaccine on women in Singapore: a transmission dynamic mathematical model analysis. BJOG 2019; 125:478-486. [PMID: 29266694 DOI: 10.1111/1471-0528.15106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the epidemiological and economic impact of a nine-valent (nonavalent) human papillomavirus (HPV) 6/11/16/18/31/33/45/52/58 vaccine programme for young teenagers in Singapore. DESIGN Mathematical modelling. SETTING Pharmaco-economic simulation projection. POPULATION Singapore demography. METHODS Clinical, epidemiological and financial data from Singapore were used in a validated HPV transmission dynamic mathematical model to analyse the impact of nonavalent HPV vaccination over quadrivalent and bivalent vaccines in a school-based 2-dose vaccination for 11- to 12-year-old girls in the country. The model assumed routine cytology screening in the current rate (50%) and vaccine coverage rate of 80%. MAIN OUTCOME MEASURES Changes over a 100-year time period in the incidence and mortality rates of cervical cancer, case load of genital warts, and incremental cost-effectiveness ratio (ICER). RESULTS Compared with bivalent and quadrivalent HPV vaccination programmes, nonavalent HPV universal vaccination resulted in an additional reduction of HPV31/33/45/52/58 related CIN1 of 40.5%, CIN 2/3 of 35.4%, cervical cancer of 23.5%, and cervical cancer mortality of 20.2%. Compared with bivalent HPV vaccination, there was an additional reduction in HPV-6/11 related CIN1 of 75.7%, and genital warts of 78.9% in women and 73.4% in men. Over the 100 years, after applying a discount of 3%, disease management cost will be reduced by 32.5% (versus bivalent) and 7.5% (versus quadrivalent). The incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year gained was SGD 929 compared with bivalent vaccination and SGD 9864 compared with quadrivalent vaccination. CONCLUSION Universal two-dose nonavalent HPV vaccination for 11- to 12-year-old adolescent women is very cost-effective in Singapore. TWEETABLE ABSTRACT Nonavalent HPV vaccination of 11- to 12-year-old girls is cost-effective in Singapore.
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Affiliation(s)
- S K Tay
- Department of Obstetrics & Gynaecology, Singapore General Hospital, Singapore
| | - T-Y Hsu
- Medical Affairs, MSD Pharma (Singapore) Pte. Ltd., Singapore
| | | | - A Walia
- Department of Medical Affairs, MSD International GmbH (Singapore Branch), Singapore
| | - A S Kulkarni
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
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De La Fuente J, Hernandez Aguado JJ, San Martín M, Ramirez Boix P, Cedillo Gómez S, López N. Estimating the epidemiological impact and cost-effectiveness profile of a nonavalent HPV vaccine in Spain. Hum Vaccin Immunother 2019; 15:1949-1961. [PMID: 30698488 PMCID: PMC6746536 DOI: 10.1080/21645515.2018.1560770] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Human papillomavirus (HPV) is one of the main causes of infection-related cancer. The bivalent vaccine (2vHPV) (16/18) and quadrivalent (6/11/16/18) HPV vaccine (4vHPV) have been included in the Spanish vaccination calendar since 2007. The new nonavalent HPV vaccine (9vHPV), approved in Europe in 2015, includes nine HPV types 6/11/16/18/31/33/45/52/58 and has been available in Spain since May 2017. Our study aims to estimate the epidemiological impact and the cost-effectiveness of a girls-only and a gender-neutral vaccination program with 9vHPV compared to the current vaccination program in Spain. A dynamic transmission model simulating the natural history of HPV infections was calibrated to the Spanish setting and applied to estimate costs and quality-adjusted life years (QALYs) associated with vaccination strategies using a payer perspective and a 100-year time horizon. A girls-only vaccination strategy at age 12 years with 9vHPV was found to be a cost-effective strategy compared with 4vHPV (incremental cost-effectiveness ratio (ICER) of €7,718 per QALY). Compared with girls-only vaccination with 4vHPV, gender-neutral vaccination with 9vHPV was associated with further reductions of up to 28.5% in the incidence of cervical intraepithelial neoplasia (CIN) 2/3 and 17.1% in the incidence of cervical cancer, as well as with a 14.0% reduction in cervical cancer mortality. Furthermore, a gender-neutral vaccination program with 9vHPV could potentially be cost-effective considering some parameters as head and neck protection or discount rates, leading to a reduction in the burden of HPV-related diseases in both sexes in the Spanish population.
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Affiliation(s)
- Jesús De La Fuente
- a Unit of Lower Genital Tract Pathology, Department of Obstetrics and Gynecology, Hospital Universitario Infanta Leonor , Madrid , Spain
| | - Juan José Hernandez Aguado
- a Unit of Lower Genital Tract Pathology, Department of Obstetrics and Gynecology, Hospital Universitario Infanta Leonor , Madrid , Spain
| | | | | | | | - Noelia López
- b Medical Department, MSD Spain , Madrid , Spain
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Spinner C, Ding L, Bernstein DI, Brown DR, Franco EL, Covert C, Kahn JA. Human Papillomavirus Vaccine Effectiveness and Herd Protection in Young Women. Pediatrics 2019; 143:peds.2018-1902. [PMID: 30670582 PMCID: PMC6361347 DOI: 10.1542/peds.2018-1902] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Clinical trials of the 4-valent human papillomavirus (HPV) vaccine demonstrate high efficacy, but surveillance studies are essential to examine the long-term impact of vaccine introduction on HPV prevalence in community settings. The aims of this study were to determine during the 11 years after vaccine introduction the prevalence of (1) vaccine-type HPV in adolescent and young adult women who were vaccinated (to assess vaccine effectiveness) and (2) vaccine-type HPV in women who were unvaccinated (to assess herd protection). METHODS Young women 13 to 26 years of age were recruited from hospital-based and community health clinics for 4 surveillance studies from 2006 to 2017. We determined the proportion of vaccinated and unvaccinated women who were positive for vaccine-type HPV across the studies, and the odds of positivity for vaccine-type HPV using logistic regression; all analyses were propensity score-adjusted to control for between-wave differences in participant characteristics. RESULTS Vaccination rates increased from 0% to 84.3% (97% of study participants received the 4-valent vaccine). Among women who were vaccinated, 4-valent vaccine-type HPV detection decreased from 35% to 6.7% (80.9% decline; odds ratio 0.13, 95% confidence interval 0.08 to 0.22). Among women who were unvaccinated, 4-valent vaccine-type HPV detection decreased from 32.4% to 19.4% (40% decline; odds ratio 0.50, 95% confidence interval 0.26 to 0.97). Estimated vaccine effectiveness was 90.6% in wave 3 and 80.1% in wave 4. CONCLUSIONS In this study in which trends in HPV in a US community >10 years after 4-valent HPV vaccine introduction and after 9-valent vaccine introduction were examined, we found evidence of vaccine effectiveness and herd protection. Further research is needed to examine trends in 9-valent vaccine-type HPV after higher rates of vaccination are achieved.
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Affiliation(s)
| | - Lili Ding
- College of Medicine, Cincinnati, Ohio;,Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - David I. Bernstein
- College of Medicine, Cincinnati, Ohio;,Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | | | - Courtney Covert
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jessica A. Kahn
- College of Medicine, Cincinnati, Ohio;,Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Review of the economic evidence presented to the United States Advisory Committee on Immunization Practices, 2012-2016. Vaccine 2018; 37:7-10. [PMID: 30473183 DOI: 10.1016/j.vaccine.2018.11.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/16/2018] [Accepted: 11/19/2018] [Indexed: 01/17/2023]
Abstract
We identified 16 Advisory Committee on Immunization Practices (ACIP) presentations from 2012 to 2016 that indicated 'cost' or 'economic' content. Characteristics were reviewed, abstracted, and tabulated to quantify and assess the transparency and consistency of economic evidence presented to ACIP. To assess transparency, we documented if each study identified author affiliation, conflicts of interest, study limitations, a clearly described model structure and other model attributes. To assess consistency, we identified the frequency of specific modeling choices, including the perspective, types of health outcomes considered, inclusion of specific types of costs, discount rate, and use of sensitivity analyses. Our results indicate that the content in these presentations appear to be transparent overall and consistent in several important areas, such as study perspective and health outcomes. However, we find the inclusion of particular types of direct costs, indirect costs, program costs, and sensitivity analyses are areas that could improve consistency.
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Dahlstrom KR, Fu S, Chan W, Shelal Z, Ramondetta LM, Lairson DR. Medical Care Costs Associated with Genital Warts for Commercially Insured US Patients. PHARMACOECONOMICS 2018; 36:1355-1365. [PMID: 30019118 DOI: 10.1007/s40273-018-0691-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Genital warts are caused by infection with human papillomavirus (HPV) and are associated with significant morbidity. Primary prevention of genital warts is possible through HPV vaccination, but vaccination rates remain low in the USA. When deciding to implement HPV vaccination programs, public health officials and policy makers rely on cost-effectiveness studies that accurately reflect costs associated with morbidity and mortality. However, previous information on the cost of treating genital warts was outdated. OBJECTIVES We estimated the mean direct medical care costs associated with genital warts in the USA. METHODS This was a retrospective case-control study of patients diagnosed with genital warts and matched controls. We used commercial healthcare claims data from 2011 through 2014 to estimate total 1- and 2-year costs from date of diagnosis. We used a generalized linear model to identify factors associated with monthly costs. RESULTS We identified 34,686 eligible cases of genital warts during the period 2011-2014. The first 2-year mean direct medical cost differences between cases and controls were US$6737 for the USA. Costs were significantly higher in the first 3 months following diagnosis and were higher among older individuals, women, those with co-morbidities or psychiatric illnesses, and those located in the south and southwest USA. CONCLUSIONS The mean direct cost of treating genital warts is approximately US$6700 in the first 2 years after diagnosis in the USA. These data can assist policy makers in decisions with respect to allocation of resources to implement HPV vaccine programs.
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Affiliation(s)
- Kristina R Dahlstrom
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Shuangshuang Fu
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
- Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St., Houston, TX, 77030, USA
| | - Wenyaw Chan
- Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St., Houston, TX, 77030, USA
| | - Zeena Shelal
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Lois M Ramondetta
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - David R Lairson
- Department of Management, Policy, and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St., Houston, TX, 77030, USA.
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Diaz M, de Sanjosé S, Bosch FX, Bruni L. Present challenges in cervical cancer prevention: Answers from cost-effectiveness analyses. Rep Pract Oncol Radiother 2018; 23:484-494. [PMID: 30534011 PMCID: PMC6277268 DOI: 10.1016/j.rpor.2018.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 04/08/2018] [Indexed: 12/20/2022] Open
Abstract
Simulation models are commonly used to address important health policy issues that cannot be explored through experimental studies. These models are especially useful to determine a set of strategies that result in a good value for money (cost-effectiveness). Several mathematical models simulating the natural history of HPV and related diseases, especially cervical cancer, have been developed to calculate a relative effectiveness and cost-effectiveness of HPV vaccination and cervical cancer screening interventions. Virtually all cost-effectiveness analyses identify HPV vaccination programmes for preadolescent girls to be cost-effective, even for relatively low vaccination coverage rates. Routine vaccination of preadolescent girls is the primary target population for HPV vaccination as it shows to provide the greatest health impact. Cost-effectiveness analyses assessing other vaccine target groups are less conclusive. Adding additional age-cohorts would accelerate health benefits in some years, although cost-effectiveness becomes less favourable as age at vaccination increases. Including men in HPV vaccination programmes may be a less efficient strategy if done at the expense of female vaccination coverage for reducing the burden of HPV in the population. However, as the HPV vaccine price decreases, the cost-effectiveness of universal vaccination improves, becoming equally as efficient as female-only vaccination. Vaccine price is a decisive factor in the cost-effectiveness analyses. The lower the price, the greater the likelihood that vaccination groups other than the primary target would be considered cost-effective.
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Affiliation(s)
- Mireia Diaz
- Unit of Infections and Cancer (UNIC-I&I), Cancer Epidemiology Research Programme (CERP), Institut Català d’Oncologia (ICO) – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- CIBERONC, Barcelona, Spain
| | - Silvia de Sanjosé
- Cancer Epidemiology Research Programme (CERP), Institut Català d’Oncologia (ICO) – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- CIBERESP, Barcelona, Spain
- Path, Reproductive Health Programme, Geneva, Switzerland
| | - F. Xavier Bosch
- CIBERONC, Barcelona, Spain
- Cancer Epidemiology Research Programme (CERP), Institut Català d’Oncologia (ICO) – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Laia Bruni
- Unit of Infections and Cancer (UNIC-I&I), Cancer Epidemiology Research Programme (CERP), Institut Català d’Oncologia (ICO) – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- CIBERONC, Barcelona, Spain
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Wu CF, Xu L, Fu S, Peng HL, Messick CA, Lairson DR. Health Care Costs of Anal Cancer in a Commercially Insured Population in the United States. J Manag Care Spec Pharm 2018; 24:1156-1164. [PMID: 30362917 PMCID: PMC10397580 DOI: 10.18553/jmcp.2018.24.11.1156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The incidence and death rate of anal cancer in the United States has been increasing on average 2%-3% per year over the past 10 years. Human papillomavirus (HPV) vaccination is a potentially viable prevention strategy, since about 80% of anal cancers are attributable to HPV. To understand the effect of HPV vaccination, it is important to estimate the treatment costs for the HPV-related disease. OBJECTIVE To estimate the 2-year per patient mean direct health care costs associated with anal cancer in a commercially insured population in the United States. METHODS All newly diagnosed anal cancer patients were identified from a 2011-2014 Truven MarketScan database. Matched population controls were selected from the database with a 2-step matching method using demographic, comorbidity, and health care cost variables. Costs for the first 2 years were measured for cancer patients and controls. The difference in costs between the groups was calculated to estimate the costs associated with anal cancer treatment. A generalized linear model with gamma distribution and log link function was applied to estimate the costs for censored months for the patients who did not have at least 2 years of follow-up. RESULTS 1,976 patients with anal cancer and 1,976 controls were included in the study. The first 2-year per patient adjusted mean cost associated with anal cancer treatment was $127,531 (SD = $189,064). Male sex, cancer diagnosis, higher Charlson Comorbidity Index score, and higher prediagnosis costs were significantly associated with higher monthly costs. Higher psychiatric diagnostic group scores were associated with lower monthly costs. Anal cancer treatment costs were highest in the first 6 months after diagnosis (per patient per month [PPPM] mean = $12,846), leveling off at a much lower monthly cost during the subsequent 18 months of the 2-year period (PPPM mean = $3,717). CONCLUSIONS The first 2-year costs associated with anal cancer treatment were substantial. Given that approximately 80% of anal cancers are attributable to HPV infection, this study provides important parameters for estimating the potential economic benefit of HPV vaccination. DISCLOSURES This research was accomplished within the Oropharynx Program at The University of Texas MD Anderson Cancer Center and was funded in part through the Stiefel Oropharyngeal Research Fund. The authors report funding contributions from the Christopher and Susan Damico Chair in Viral Associated Malignancies (The University of Texas MD Anderson). This work was supported by generous philanthropic contributions, including a contribution from the Lyda Hill Foundation, to The University of Texas MD Anderson HPV-Related Cancers Moon Shot Program. The authors have nothing to disclose.
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Affiliation(s)
- Chi-Fang Wu
- Department of Management, Policy, and Community Health, School of Public Health, The University of Texas Health Science Center at Houston
| | - Li Xu
- Department of Head and Neck Surgery, Division of Surgery
| | - Shuangshuang Fu
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health
| | - Ho-Lan Peng
- Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston
| | - Craig A. Messick
- Department of Surgical Oncology, Section of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - David R. Lairson
- Department of Management, Policy, and Community Health, School of Public Health, The University of Texas Health Science Center at Houston
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Chesson HW, Meites E, Ekwueme DU, Saraiya M, Markowitz LE. Cost-effectiveness of nonavalent HPV vaccination among males aged 22 through 26 years in the United States. Vaccine 2018; 36:4362-4368. [PMID: 29887325 DOI: 10.1016/j.vaccine.2018.04.071] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/02/2018] [Accepted: 04/23/2018] [Indexed: 01/06/2023]
Abstract
INTRODUCTION In the United States, routine human papillomavirus (HPV) vaccination is recommended for females and males at age 11 or 12 years; the series can be started at age 9 years. Vaccination is also recommended for females through age 26 years and males through age 21 years. The objective of this study was to assess the health impact and cost-effectiveness of harmonizing female and male vaccination recommendations by increasing the upper recommended catch-up age of HPV vaccination for males from age 21 to age 26 years. METHODS We updated a published model of the health impact and cost-effectiveness of 9-valent human papillomavirus vaccine (9vHPV). We examined the cost-effectiveness of (1) 9vHPV for females aged 12 through 26 years and males aged 12 through 21 years, and (2) an expanded program including males through age 26 years. RESULTS Compared to no vaccination, providing 9vHPV for females aged 12 through 26 years and males aged 12 through 21 years cost an estimated $16,600 (in 2016 U.S. dollars) per quality-adjusted life year (QALY) gained. The estimated cost per QALY gained by expanding male vaccination through age 26 years was $228,800 and ranged from $137,900 to $367,300 in multi-way sensitivity analyses. CONCLUSIONS The cost-effectiveness ratios we estimated are not so favorable as to make a strong economic case for recommending expanding male vaccination, yet are not so unfavorable as to preclude consideration of expanding male vaccination. The wide range of plausible results we obtained may underestimate the true degree of uncertainty, due to model limitations. For example, the cost per QALY might be less than our lower bound estimate of $137,900 had our model allowed for vaccine protection against re-infection. Models that specifically incorporate men who have sex with men (MSM) are needed to provide a more comprehensive assessment of male HPV vaccination strategies.
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Affiliation(s)
- Harrell W Chesson
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Elissa Meites
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Donatus U Ekwueme
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mona Saraiya
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lauri E Markowitz
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Choi HCW, Jit M, Leung GM, Tsui KL, Wu JT. Simultaneously characterizing the comparative economics of routine female adolescent nonavalent human papillomavirus (HPV) vaccination and assortativity of sexual mixing in Hong Kong Chinese: a modeling analysis. BMC Med 2018; 16:127. [PMID: 30115065 PMCID: PMC6097427 DOI: 10.1186/s12916-018-1118-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/04/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Although routine vaccination of females before sexual debut against human papillomavirus (HPV) has been found to be cost-effective around the world, its cost-benefit has rarely been examined. We evaluate both the cost-effectiveness and cost-benefit of routine female adolescent nonavalent HPV vaccination in Hong Kong to guide its policy, and by extension that of mainland China, on HPV vaccination. One major obstacle is the lack of data on assortativity of sexual mixing. Such difficulty could be overcome by inferring sexual mixing parameters from HPV epidemiologic data. METHODS We use an age-structured transmission model coupled with stochastic individual-based simulations to estimate the health and economic impact of routine nonavalent HPV vaccination for girls at age 12 on cervical cancer burden and consider vaccine uptake at 25%, 50%, and 75% with at least 20 years of vaccine protection. Bayesian inference was employed to parameterize the model using local data on HPV prevalence and cervical cancer incidence. We use the human capital approach in the cost-benefit analysis (CBA) and GDP per capita as the indicative willingness-to-pay threshold in the cost-effectiveness analysis (CEA). Finally, we estimate the threshold vaccine cost (TVC), which is the maximum cost for fully vaccinating one girl at which routine female adolescent nonavalent HPV vaccination is cost-beneficial or cost-effective. RESULTS As vaccine uptake increased, TVC decreased (i.e., economically more stringent) in the CBA but increased in the CEA. When vaccine uptake was 75% and the vaccine provided only 20 years of protection, the TVC was US$444 ($373-506) and $689 ($646-734) in the CBA and CEA, respectively, increasing by approximately 2-4% if vaccine protection was assumed lifelong. TVC is likely to be far higher when non-cervical diseases are included. The inferred sexual mixing parameters suggest that sexual mixing in Hong Kong is highly assortative by both age and sexual activity level. CONCLUSIONS Routine HPV vaccination of 12-year-old females is highly likely to be cost-beneficial and cost-effective in Hong Kong. Inference of sexual mixing parameters from epidemiologic data of prevalent sexually transmitted diseases (i.e., HPV, chlamydia, etc.) is a potentially fruitful but largely untapped methodology for understanding sexual behaviors in the population.
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Affiliation(s)
- Horace C W Choi
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F North Wing, Patrick Manson Building, 7 Sassoon Road, Pok Fu Lam, Hong Kong.,Department of Systems Engineering and Engineering Management, City University of Hong Kong, Kowloon Tong, Hong Kong.,Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Mark Jit
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F North Wing, Patrick Manson Building, 7 Sassoon Road, Pok Fu Lam, Hong Kong.,Modelling and Economics Unit, Public Health England, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Gabriel M Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F North Wing, Patrick Manson Building, 7 Sassoon Road, Pok Fu Lam, Hong Kong
| | - Kwok-Leung Tsui
- Department of Systems Engineering and Engineering Management, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Joseph T Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F North Wing, Patrick Manson Building, 7 Sassoon Road, Pok Fu Lam, Hong Kong.
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Wolff E, Elfström KM, Haugen Cange H, Larsson S, Englund H, Sparén P, Roth A. Cost-effectiveness of sex-neutral HPV-vaccination in Sweden, accounting for herd-immunity and sexual behaviour. Vaccine 2018; 36:5160-5165. [PMID: 30017146 DOI: 10.1016/j.vaccine.2018.07.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 07/06/2018] [Accepted: 07/10/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The aim was to assess cost-effectiveness of expanding the Swedish HPV-vaccination program to include preadolescent boys, by comparing health-effects and costs of HPV-related disease, with a sex-neutral vaccination program versus only vaccinating girls. METHODS We used a dynamic compartmental model to simulate the burden of HPV16/18-related disease in Sweden, accounting for indirect effects of vaccination through herd-immunity. The model accounted for sexual behaviour, such as age preferences and men who have sex with men. The main outcome was number of individuals with HPV-related cancers (cervical, genital, anal and oropharyngeal cancer) and cervical intraepithelial neoplasia (CIN). Costs included in the analysis were those incurred when treating HPV-related cancer and CIN, production losses during sick-leave, and acquisition and administration of vaccine. Health effects were measured as quality-adjusted life years (QALY). The time horizon was set to 100 years, and both effects and costs were discounted by 3% annually. Health effects and costs were accumulated over the time horizon and used to create an incremental cost-effectiveness ratio. RESULTS A sex-neutral vaccination program would reduce HPV-related cancer and CIN, both due to direct effects among vaccinated as well as through herd-immunity, further decreasing HPV-related cancer burden annually by around 60 cases among men and women respectively in steady-state. The cost per gained QALY was estimated to 40,000 euro. Applying the procurement price of 2017, sex-neutral vaccination was dominant. CONCLUSION Introducing a sex-neutral HPV-vaccination program would be good value for money also in Sweden where there this 80% coverage in the current HPV-vaccination program for preadolescent girls. The cost-effectiveness of a sex-neutral program is highly dependent on the price of the vaccine, the lower the price the more favourable it is to also vaccinate boys.
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Affiliation(s)
- Ellen Wolff
- Public Health Agency of Sweden, Nobels väg 18, 171 82 Solna, Sweden; Gothenburg University, Institute of Medicine, Medicinaregatan 3, 405 30 Gothenburg, Sweden.
| | - K Miriam Elfström
- Karolinska Institutet, Stockholm Nobels väg 6, 171 77 Stockholm, Sweden; Regional Cancer Centre of Stockholm-Gotland, Västgötagatan 2, Sweden
| | - Hedda Haugen Cange
- Institute of Clinical Sciences, Sahlgrenska University Hospital, Dept. of Obstetrics and Gynecology, Sahlgrenska University Hospital, Östra, SE 416 85 Gothenburg, Sweden
| | - Sofie Larsson
- Public Health Agency of Sweden, Nobels väg 18, 171 82 Solna, Sweden; Gothenburg University, Institute of Medicine, Medicinaregatan 3, 405 30 Gothenburg, Sweden
| | - Helene Englund
- Public Health Agency of Sweden, Nobels väg 18, 171 82 Solna, Sweden
| | - Pär Sparén
- Karolinska Institutet, Stockholm Nobels väg 6, 171 77 Stockholm, Sweden
| | - Adam Roth
- Public Health Agency of Sweden, Nobels väg 18, 171 82 Solna, Sweden; Institution for Translational Medicine, Lund University, J Waldenströms g 35, CRC, hus 92, plan 11, Malmö, Sweden
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Bogani G, Taverna F, Lombardo C, Signorelli M, Chiappa V, Casarin J, Scaffa C, Leone Roberti Maggiore U, Recalcati D, Ditto A, Martinelli F, Borghi C, Perotto S, Ferrero S, Lorusso D, Raspagliesi F. Potential impact of introducing a nonavalent HPV vaccination. Int J Gynaecol Obstet 2018; 142:338-342. [DOI: 10.1002/ijgo.12546] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 05/11/2018] [Accepted: 06/01/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Giorgio Bogani
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
| | - Francesca Taverna
- Immunohematology and Transfusion Medicine; IRCCS National Cancer Institute; Milan Italy
| | - Claudia Lombardo
- Immunohematology and Transfusion Medicine; IRCCS National Cancer Institute; Milan Italy
| | - Mauro Signorelli
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
| | | | - Jvan Casarin
- Gynecologic Surgery; Mayo Clinic; Rochester MN USA
| | - Cono Scaffa
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
| | | | - Dario Recalcati
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
| | - Antonino Ditto
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
| | - Fabio Martinelli
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
| | - Chiara Borghi
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
| | - Stefania Perotto
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
| | - Simone Ferrero
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI); University of Genoa; Genoa Italy
| | - Domenica Lorusso
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
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Zhang Z, Zhang J, Xia N, Zhao Q. Expanded strain coverage for a highly successful public health tool: Prophylactic 9-valent human papillomavirus vaccine. Hum Vaccin Immunother 2018; 13:2280-2291. [PMID: 28699820 DOI: 10.1080/21645515.2017.1346755] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Human papillomavirus is considered the causative factor for cervical cancer, which accounts for approximately 5% of the global cancer burden and more than 600,000 new cases annually that are attributable to HPV infection worldwide. The first-generation prophylactic HPV vaccines, Gardasil® and Cervarix®, were licensed approximately a decade ago. Both vaccines contain the most prevalent high-risk types, HPV16 and 18, which are associated with 70% of cervical cancer. To further increase the type coverage, 5 additional oncogenic HPV types (31, 33, 45, 52 and 58) were added to the existing Gardasil-4 to develop a 9-valent HPV vaccine (9vHPV), Gardasil 9®, increasing the potential level of protection from ∼70% to ∼90%. The efficacy of the vaccine lies primarily in its ability to elicit type-specific and neutralizing antibodies to fend off the viral infection. Therefore, type-specific and neutralizing murine monoclonal antibodies (mAbs) were used to quantitate the antigenicity of the individual vaccine antigens and to measure the antibody levels in the serum samples from vaccinees in a type- and epitope-specific manner in a competitive immunoassay. Assays for 9vHPV are extended from the proven platform used for 4vHPV by developing and adding new mAbs against the additional types. In Phase III clinical trials, comparable safety profile and immunogenicity against the original 4 types were demonstrated for the 9vHPV vaccine, and these were comparable to the 4vHPV vaccine. The efficacy of the 9vHPV vaccine was established in trials with young women. Immunobridging for younger boys and girls was performed, and the results showed higher immunogenicity in the younger age group. In a subsequent clinical trial, the 2-dose regimen of the 9vHPV vaccine used among girls and boys aged 9-14 y showed non-inferior immunogenicity to the regular 3-dose regimen for young women (aged 16-26 years). Overall, the clinical data and cost-effectiveness analysis for the 9vHPV vaccine support its widespread use to maximize the impact of this important, life-saving vaccine.
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Affiliation(s)
- Zhigang Zhang
- a State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics , National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University , Xiamen , Fujian , PR China
| | - Jun Zhang
- a State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics , National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University , Xiamen , Fujian , PR China
| | - Ningshao Xia
- a State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics , National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University , Xiamen , Fujian , PR China.,b School of Life Science , Xiamen University , Xiamen , Fujian , PR China
| | - Qinjian Zhao
- a State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics , National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University , Xiamen , Fujian , PR China
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Tam S, Fu S, Xu L, Krause KJ, Lairson DR, Miao H, Sturgis EM, Dahlstrom KR. The epidemiology of oral human papillomavirus infection in healthy populations: A systematic review and meta-analysis. Oral Oncol 2018; 82:91-99. [PMID: 29909908 DOI: 10.1016/j.oraloncology.2018.04.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 04/02/2018] [Accepted: 04/07/2018] [Indexed: 10/16/2022]
Abstract
Human papillomavirus (HPV) is a potentially oncogenic sexually transmitted infection. As the incidence of oropharyngeal cancer (OPC) caused by oral HPV infections is rising, further investigation into the natural history of such infections is needed. This systematic review and meta-analysis aimed to synthesize data on the prevalence, incidence, clearance, and persistence of oral HPV infections in healthy individuals. A systematic review of literature published between January 1995 and August 2017 was conducted using Ovid MEDLINE, PubMed, Embase, and the Cochrane Library. Meta-analysis of prevalence and incidence data was conducted. Clearance and persistence data were extracted. Sixty-six studies met the inclusion criteria. Meta-analysis demonstrated an overall prevalence of 7.7% for all types of HPV and 1.4% for high-risk HPV16. The overall incidence was 4.38 cases per 1000 person-months for all HPV types and 0.92 cases per 1000 person-months for HPV16. This systematic review and meta-analysis demonstrated that oral HPV infection has a lower prevalence and incidence than cervicogenital HPV infection in healthy individuals. Nonetheless, oral HPV is still an important concern, given its oncogenicity and the rising incidence of oropharyngeal cancer. Consistency of methodology will allow for better future comparisons, particularly of infection clearance and persistence.
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Affiliation(s)
- Samantha Tam
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1445, Houston, TX 77030, USA.
| | - Shuangshuang Fu
- Department of Epidemiology, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St, Houston, TX 77030, USA.
| | - Li Xu
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1445, Houston, TX 77030, USA.
| | - Kate J Krause
- Research Medical Library, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1445, Houston, TX 77030, USA.
| | - David R Lairson
- Department of Management, Policy, and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St, Houston, TX 77030, USA.
| | - Hongyu Miao
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St, Houston, TX 77030, USA.
| | - Erich M Sturgis
- Department of Head and Neck Surgery, Division of Surgery, and Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1445, Houston, TX 77030, USA.
| | - Kristina R Dahlstrom
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1445, Houston, TX 77030, USA.
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Ng SS, Hutubessy R, Chaiyakunapruk N. Systematic review of cost-effectiveness studies of human papillomavirus (HPV) vaccination: 9-Valent vaccine, gender-neutral and multiple age cohort vaccination. Vaccine 2018; 36:2529-2544. [PMID: 29625764 DOI: 10.1016/j.vaccine.2018.03.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/25/2018] [Accepted: 03/07/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The success of human papillomavirus (HPV) national immunization program depends on effective strategies in optimizing the uptake of HPV vaccine. Given the increasing number of economic evaluations, this review was conducted to update the economic evidence on HPV vaccination, by focusing on: (i) 9-valent vaccine compared to bi- or quadrivalent vaccine; (ii) gender-neutral vaccination compared to female only vaccination; and (iii) multiple age cohort immunization compared to single age cohort immunization. METHODS Searches were performed until June 2016 using 4 databases: PubMed; Embase; Cochrane Library; and LILACS. The combined WHO, Drummond and CHEERS checklist were used to evaluate the quality of included studies. RESULTS Thirty-four studies were included in the review and most of them were conducted in high-income countries. The inclusion of adolescent boys in vaccination program was found to be cost-effective if vaccine price and coverage was low. When coverage for female was above 75%, gender-neutral vaccination was less cost-effective than when targeting only girls aged 9-18 years. Current evidence does not show conclusive proof of greater cost-effectiveness of 9-valent vaccine compared to the older HPV vaccines as the price for 9-valent vaccine was still uncertain. Multicohort immunization strategy was cost-effective in the age range 9-14 years but the upper age limit at which vaccination was no longer cost-effective needs to be further investigated. Key influential parameters identified were duration of vaccine protection, vaccine price, coverage, and discounting rates. CONCLUSIONS These findings are expected to support policy-makers in making recommendations for HPV immunization programs on either switching to the 9-valent vaccine or inclusion of adolescent boys' vaccination or extending the age of vaccination.
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Affiliation(s)
- Siok Shen Ng
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia; Department of Pharmacy, Hospital Melaka, Melaka, Malaysia
| | - Raymond Hutubessy
- World Health Organization, Initiative for Vaccine Research, Geneva, Switzerland
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia; Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Center of Pharmaceutical Outcomes Research (CPOR), Naresuan University, Phitsanulok, Thailand; School of Pharmacy, University of Wisconsin, Madison, USA; Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.
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Milwid RM, Frascoli F, Steben M, Heffernan JM. HPV Screening and Vaccination Strategies in an Unscreened Population: A Mathematical Modeling Study. Bull Math Biol 2018; 81:4313-4342. [DOI: 10.1007/s11538-018-0425-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/28/2018] [Indexed: 11/28/2022]
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Affiliation(s)
- K. Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
- Sydney Medical School, School of Public Health, University of Sydney, Sydney, Australia
- Prince of Wales Clinical School, UNSW Australia, Sydney, Australia
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Markowitz LE, Gee J, Chesson H, Stokley S. Ten Years of Human Papillomavirus Vaccination in the United States. Acad Pediatr 2018; 18:S3-S10. [PMID: 29502635 DOI: 10.1016/j.acap.2017.09.014] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 09/06/2017] [Accepted: 09/15/2017] [Indexed: 01/19/2023]
Abstract
Since human papillomavirus (HPV) vaccine was first introduced for females in the United States in 2006, vaccination policy has evolved as additional HPV vaccines were licensed and new data became available. The United States adopted a gender neutral routine HPV immunization policy in 2011, the first country to do so. Vaccination coverage is increasing, although it remains lower than for other vaccines recommended for adolescents. There are various reasons for low coverage, and efforts are ongoing to increase vaccine uptake. The safety profile of HPV vaccine has been well established from 10 years of postlicensure monitoring. Despite low coverage, the early effects of the HPV vaccination program have exceeded expectations.
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Affiliation(s)
- Lauri E Markowitz
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga.
| | - Julianne Gee
- Immunization Safety Office, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Harrell Chesson
- National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Shannon Stokley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga
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Regan DG, Donovan B. Balancing the cost-benefit equation for cervical cancer prevention: a moving target. Lancet Public Health 2017; 1:e42-e43. [PMID: 29253416 DOI: 10.1016/s2468-2667(16)30024-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/07/2016] [Indexed: 11/30/2022]
Affiliation(s)
- David G Regan
- The Kirby Institute, UNSW Australia, Sydney, NSW 2052, Australia.
| | - Basil Donovan
- The Kirby Institute, UNSW Australia, Sydney, NSW 2052, Australia
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Denny L. Nine-valent human papillomavirus vaccine: great science, but will it save lives? Lancet 2017; 390:2123-2124. [PMID: 28886906 DOI: 10.1016/s0140-6736(17)32144-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 07/18/2017] [Indexed: 11/23/2022]
Affiliation(s)
- Lynette Denny
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, South African Medical Research Council, Gynaecological Cancer Research Centre, Cape Town 7925, South Africa.
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Tartaglia E, Falasca K, Vecchiet J, Sabusco GP, Picciano G, Di Marco R, Ucciferri C. Prevalence of HPV infection among HIV-positive and HIV-negative women in Central/Eastern Italy: Strategies of prevention. Oncol Lett 2017; 14:7629-7635. [PMID: 29344211 DOI: 10.3892/ol.2017.7140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 08/08/2017] [Indexed: 11/06/2022] Open
Abstract
The present cross-sectional-study aimed to determine the prevalence of human papillomavirus (HPV)-genotypes among human immunodeficiency virus (HIV)-positive and -negative women in Central/Eastern Italy, and to identify the optimal strategies for effective HPV-prevention in each group. A representative sample of HIV-negative (150/200) and -positive (50/200) women, who underwent cervico-vaginal-swabbing. Swabs were analysed for a cytological screening and for a HPV-DNA-genotyping-test. A total of 66/200 swabs resulted HPV-positive. The overall HPV-prevalence was 33% with a higher prevalence in the HIV-positive-group (48%) compared with the HIV-negative-group (28%). The most frequent genotypes were: 16, 31, 52, 58, 66, 73 and 89. Furthermore, the prevalence of specific genotypes was different in each group. The results of the present study indicate that HIV infection appears to be an independent risk factor for HPV-infection. In addition, HPV-infection is more common and more likely to persist in HIV-positive compared with in HIV-negative women. The optimal way to counteract HPV infection is through primary prevention. The stage of immunity (cluster of differentiation 4-level) at the time of the HPV-screening is one of the most important parameters for detection of susceptibility to HPV-infection and to evaluate the response to the HPV-vaccine in HIV-positive women. It may be used to determine the sub-group of HIV-positive women that are more prone to HPV-infections or that exhibit a partial response to the HPV-vaccine. At present, a novel type of vaccine with 9-genotypes is available and in the near future, it may serve an essential role in the prevention of HPV infections.
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Affiliation(s)
- Edoardo Tartaglia
- Department of Medicine and Health Sciences 'Vincenzo Tiberio', University of Molise, I-86100 Campobasso, Italy
| | - Katia Falasca
- Department of Medicine and Science of Aging-Clinic of Infectious Diseases, University 'G.' d'Annunzio Chieti-Pescara, I-66100 Chieti, Italy
| | - Jacopo Vecchiet
- Department of Medicine and Science of Aging-Clinic of Infectious Diseases, University 'G.' d'Annunzio Chieti-Pescara, I-66100 Chieti, Italy
| | - Giovanna Paola Sabusco
- Department of Medicine and Health Sciences 'Vincenzo Tiberio', University of Molise, I-86100 Campobasso, Italy
| | - Giovanna Picciano
- Department of Gynecology and Obstetrics, Cardarelli Hospital, I-86100 Campobasso, Italy
| | - Roberto Di Marco
- Department of Medicine and Health Sciences 'Vincenzo Tiberio', University of Molise, I-86100 Campobasso, Italy
| | - Claudio Ucciferri
- Department of Medicine and Health Sciences 'Vincenzo Tiberio', University of Molise, I-86100 Campobasso, Italy
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Brotherton JML, Bloem PN. Population-based HPV vaccination programmes are safe and effective: 2017 update and the impetus for achieving better global coverage. Best Pract Res Clin Obstet Gynaecol 2017; 47:42-58. [PMID: 28986092 DOI: 10.1016/j.bpobgyn.2017.08.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 08/27/2017] [Indexed: 01/11/2023]
Abstract
Persistent oncogenic human papillomavirus (HPV) is the cause of cervical cancer, as well as cancers of the anus, penis, vulva, vagina and oropharynx. There is good evidence that prophylactic HPV vaccines are immunogenic and effective against targeted-type HPV infections and type-specific genital lesions, including high-grade cervical intraepithelial neoplasia (CIN), when administered prior to HPV infection. There is good evidence that HPV vaccines are safe in population usage, with the most frequent adverse event being injection-site reactions. There is evidence to support some cross-protection against non-targeted types occurring following the administration of HPV vaccines. There is limited evidence suggesting that HPV vaccines may be beneficial in preventing future disease in women treated for high-grade CIN. This chapter focuses on the accumulated evidence regarding the global use of the three licensed HPV vaccines including safety, immunogenicity, duration of protection, effectiveness, coverage to date and barriers to higher coverage.
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Affiliation(s)
- Julia M L Brotherton
- National HPV Vaccination Program Register, VCS, East Melbourne, Victoria, Australia; School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia.
| | - Paul N Bloem
- Expanded Programme of Immunization, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland.
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48
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Lairson DR, Wu CF, Chan W, Dahlstrom KR, Tam S, Sturgis EM. Medical Care Cost of Oropharyngeal Cancer among Texas Patients. Cancer Epidemiol Biomarkers Prev 2017; 26:1443-1449. [PMID: 28838945 DOI: 10.1158/1055-9965.epi-17-0220] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/17/2017] [Accepted: 06/09/2017] [Indexed: 12/20/2022] Open
Abstract
Background: The incidence of oropharyngeal cancer is rising rapidly, with the majority of cases being attributable to human papillomavirus (HPV). Despite the availability of a vaccine, rates of HPV vaccination among Texas youth are low. The healthcare cost of oropharyngeal cancer in Texas is unknown. The aims of this study were to estimate the first 2-year cost of treating new cases of oropharyngeal cancer and determine the predictors of oropharyngeal cancer treatment cost in Texas.Methods: This study included a retrospective cohort of 467 Texas patients with commercial insurance claims data with oropharyngeal cancer diagnosed from 2011 to 2014 and a control group of 467 noncancer patients obtained with propensity score matching. Total healthcare cost during the first 2 years after the index date was measured. A generalized linear model was used to identify predictors of monthly cost during the 2 years after the index date.Results: The mean differential adjusted healthcare cost for oropharyngeal cancer cases was $139,749 in the first 2 years. The mean adjusted monthly cost in the first 2 years was $6,693 for cases and $870 for controls. Age, comorbidity, mental health, prediagnostic healthcare cost, and time index were significant predictors of monthly cost.Conclusions: Medical care cost was about $140,000 in the first 2 years after diagnosis of oropharyngeal cancer among commercially insured patients in Texas.Impact: The cost estimates provide important parameters for development of decision-analytic models to inform decision makers about the potential value of initiatives for increasing the HPV immunization rate in the state. Cancer Epidemiol Biomarkers Prev; 26(9); 1443-9. ©2017 AACR.
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Affiliation(s)
- David R Lairson
- Department of Management, Policy, and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas.
| | - Chi-Fang Wu
- Department of Management, Policy, and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Wenyaw Chan
- Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Kristina R Dahlstrom
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Samantha Tam
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Erich M Sturgis
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Division of Cancer Prevention and Population Sciences, Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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49
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Mo X, Gai Tobe R, Wang L, Liu X, Wu B, Luo H, Nagata C, Mori R, Nakayama T. Cost-effectiveness analysis of different types of human papillomavirus vaccination combined with a cervical cancer screening program in mainland China. BMC Infect Dis 2017; 17:502. [PMID: 28720082 PMCID: PMC5516327 DOI: 10.1186/s12879-017-2592-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 07/04/2017] [Indexed: 01/30/2023] Open
Affiliation(s)
- Xiuting Mo
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan.,Department of Health Policy, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Ruoyan Gai Tobe
- Department of Health Policy, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Lijie Wang
- Department of Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Xianchen Liu
- College of Pharmacy, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Bin Wu
- Medical Decision and Economic Group, Department of Pharmacy, Ren Ji Hospital affiliated with Medical School of Shanghai Jiao tong University, Shanghai, China
| | - Huiwen Luo
- Nanjing Drum Tower Hospital affiliated Medical School of Nanjing University, Nanjing, China
| | - Chie Nagata
- Department of Education for Clinical Research, National Centre for Child Health and Development, Tokyo, Japan
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
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50
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Mennini FS, Bonanni P, Bianic F, de Waure C, Baio G, Plazzotta G, Uhart M, Rinaldi A, Largeron N. Cost-effectiveness analysis of the nine-valent HPV vaccine in Italy. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2017; 15:11. [PMID: 28701899 PMCID: PMC5504713 DOI: 10.1186/s12962-017-0073-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 06/29/2017] [Indexed: 12/04/2022] Open
Abstract
Background In Italy HPV vaccination with the quadrivalent vaccine (Gardasil®) is offered actively and free of charge to girls aged 12 since 2007. A nine-valent vaccine (Gardasil 9®) received the European market authorization in 2015 to protect, with only 2 doses, against around 90% of all HPV positive cancers, over 80% of high-grade precancerous lesions and 90% of genital warts caused by HPV types 6/11. Methods A dynamic transmission model simulating the natural history of HPV-infections was calibrated to the Italian setting and used to estimate costs and QALYs associated with vaccination strategies. The analyses compared two strategies with the nine-valent vaccine (cervical cancer screening and vaccination in girls only or vaccination in boys and girls) to four alternative strategies (cervical cancer screening and vaccination with quadrialent vaccine in girls only, in both boys and girls, with bivalent vaccine in girls and screening strategy only). The National Health Service perspective was considered. Conclusion The switch to the nine-valent vaccine in Italy can further reduce the burden associated to cervical cancer and HPV-related diseases and is highly cost-effective. Results Compared to the current vaccination program with quadrivalent vaccine, the nine-valent vaccine in a programme including girls and boys shows further reductions of 17% in the incidence of cervical cancer, 35 and 14% in anal cancer for males and females, as well as over a million cases of genital warts avoided after 100 years. The new technology is associated with an ICER of 10,463€ per QALY gained in universal vaccination, decreasing to 4483€ when considering the vaccine switch for girls-only. Electronic supplementary material The online version of this article (doi:10.1186/s12962-017-0073-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Francesco Saverio Mennini
- Faculty of Economics, Centre for Economic and International Studies (CEIS)-Economic Evaluation and HTA (EEHTA), University of Rome, Rome, Italy.,Institute for Leadership and Management in Health, Kingston University, London, UK
| | - Paolo Bonanni
- Dept. of Health Sciences, University of Florence, Florence, Italy
| | | | - Chiara de Waure
- Institute of Public Health, Section of Hygiene, Catholic University of the Sacred Heart, Rome, Italy
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