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Lambach P, Silal S, Sbarra AN, Koh M, Aggarwal R, Farooqui HH, Flasche S, Hogan AB, Kim SY, Leung K, Moss WJ, Munywoki PK, Portnoy A, Sheel M, Wang XY. Report from the World Health Organization's immunization and vaccines-related implementation research advisory committee (IVIR-AC) meeting, virtual gathering, 26 February-1 March 2024. Vaccine 2024; 42:3379-3383. [PMID: 38704250 PMCID: PMC11128797 DOI: 10.1016/j.vaccine.2024.04.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 04/19/2024] [Indexed: 05/06/2024]
Abstract
The Immunization and Vaccine-related Implementation Research Advisory Committee (IVIR-AC) is the World Health Organization's key standing advisory body to conduct an independent review of research, particularly of transmission and economic modeling analyses that estimate the impact and value of vaccines. From 26th February-1st March 2024, at its first of two semi-annual meetings, IVIR-AC provided feedback and recommendations across four sessions; this report summarizes the proceedings and recommendations from that meeting. Session topics included modeling of the impact and cost-effectiveness of the R21/Matrix-M malaria vaccine, meta-analysis of economic evaluations of vaccines, a global analysis estimating the impact of vaccination over the last 50 years, and modeling the impact of different RTS,S malaria vaccine dose schedules in seasonal settings.
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Affiliation(s)
- Philipp Lambach
- Immunizations, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Sheetal Silal
- Modelling and Simulation Hub, Africa, University of Cape Town, Cape Town, South Africa; Centre for Global Health, Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Alyssa N Sbarra
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Mitsuki Koh
- Immunizations, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Rakesh Aggarwal
- Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | | | | | - Alexandra B Hogan
- School of Population Health, University of New South Wales, Sydney, Australia
| | | | - Kathy Leung
- School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region
| | - William J Moss
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Patrick K Munywoki
- Kenya Medical Research Institute, Centre for Global Health Research, Nairobi, Kenya
| | - Allison Portnoy
- Department of Global Health, Boston University School of Public Health, Boston, United States; Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, United States
| | - Meru Sheel
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Xuan-Yi Wang
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
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Manea E, Chitoran E, Rotaru V, Ionescu S, Luca D, Cirimbei C, Alecu M, Capsa C, Gafton B, Prutianu I, Serban D, Simion L. Integration of Ultrasound in Image-Guided Adaptive Brachytherapy in Cancer of the Uterine Cervix. Bioengineering (Basel) 2024; 11:506. [PMID: 38790373 PMCID: PMC11117609 DOI: 10.3390/bioengineering11050506] [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: 04/16/2024] [Revised: 05/09/2024] [Accepted: 05/12/2024] [Indexed: 05/26/2024] Open
Abstract
Cervical cancer continues to be a public health concern, as it remains the second most common cancer despite screening programs. It is the third most common cause of cancer-related death for women, and the majority of cases happen in developing nations. The standard treatment for locally advanced cervical cancer involves the use of external beam radiation therapy, along with concurrent chemotherapy, followed by an image-guided adaptive brachytherapy (IGABT) boost. The five-year relative survival rate for European women diagnosed with cervical cancer was 62% between 2000 and 2007. Updated cervical cancer treatment guidelines based on IGABT have been developed by the Gynecological working group, which is composed of the Group Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology. The therapeutic strategy makes use of three-dimensional imaging, which can be tailored to the target volume and at-risk organs through the use of computed tomography or magnetic resonance imaging. Under anaesthesia, the brachytherapy implantation is carried out. Ultrasonography is utilised to assess the depth of the uterine cavity and to facilitate the dilation of the uterine canal during the application insertion. In this study, we examine data from the international literature regarding the application of ultrasound in cervical cancer brachytherapy.
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Affiliation(s)
- Elena Manea
- Department of Radiotherapy, Regional Institute of Oncology, 700483 Iasi, Romania; (E.M.)
- “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Elena Chitoran
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Vlad Rotaru
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Sinziana Ionescu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Dan Luca
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Ciprian Cirimbei
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Mihnea Alecu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Cristina Capsa
- Radiology and Medical Imaging Department, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Bogdan Gafton
- Department of Radiotherapy, Regional Institute of Oncology, 700483 Iasi, Romania; (E.M.)
- “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Iulian Prutianu
- “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Morpho-Functional Sciences I—Histology, University of Medicine and Pharmacy “Gr. T. Popa”, 700483 Iasi, Romania
| | - Dragos Serban
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- Surgery Department IV, Bucharest Clinical Emergency Hospital, 050098 Bucharest, Romania
| | - Laurentiu Simion
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
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Hagens A, Sloof AC, Janghorban R. Using a Dynamic Model to Estimate the Cost-Effectiveness of HPV Vaccination in Iran. Vaccines (Basel) 2024; 12:438. [PMID: 38675821 PMCID: PMC11054652 DOI: 10.3390/vaccines12040438] [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: 03/04/2024] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
This study aimed to determine the cost-effectiveness of vaccination against HPV. An age-sex structured dynamic disease transmission model was created to estimate the spread of HPV and the HPV-related incidence of cervical cancer (CC) in Iran. Sixteen age groups of men and women were incorporated to reflect the differences in sexual preferences, vaccination uptake, and disease-related outcomes. Three scenarios were evaluated by using an Incremental Cost-Effectiveness Ratio (ICER) with gained quality-adjusted life years (QALYs). ICER values below one gross domestic product (GDP) per capita are evaluated as highly cost-effective. Vaccination reduces the number of infections and CC-related mortality. Over time, the vaccinated group ages and older age groups experience protection. An initial investment is required and savings in treatment spending reduce the impact over time. Vaccinating girls only was found to be cost-effective, with an ICER close to once the GDP per capita. Vaccinating both sexes was shown to be less cost-effective compared to girls only, and vaccinating boys only was not found to be cost-effective, with an ICER between once and three times, and greater than three times the GDP per capita, respectively. The estimates are conservative since societal cost-saving and the impact of other HPV-related illnesses were not considered and would likely reduce the ICERs.
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Affiliation(s)
- Arnold Hagens
- Department of Health Sciences, University Medical Center Groningen, University of Groningen (RUG), 9713 AV Groningen, The Netherlands
- Triangulate Health Ltd., Doncaster DN11 9QU, UK
| | | | - Roksana Janghorban
- Maternal-Fetal Medicine Research Center, Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz 71936-13119, Iran;
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Chairunnisa S, Mustopa AZ, Bela B, Firdaus MER, Irawan S, Arifah RK, Irawan H, Nurfatwa M, Umami RN, Ekawati N, Hertati A, Hasan N. Expression and scale-up production of recombinant human papillomavirus type 52 L1 protein in methylotrophic yeast Hansenula polymorpha. J Genet Eng Biotechnol 2024; 22:100342. [PMID: 38494245 PMCID: PMC10903760 DOI: 10.1016/j.jgeb.2023.100342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
BACKGROUND Human papillomavirus (HPV) vaccination is one of the crucial national vaccination programs aimed at reducing the prevalence of the diseases associated with HPV infections, which continue to pose a global health concern. However, a significant disparity exists in the distribution of HPV vaccine, particularly in low-middle income countries where the cost of HPV vaccine becomes a major obstacle. Thus, it is essential to ensure the availability of an economically feasible HPV vaccine, necessitating immediate efforts to enhance the cost-effectiveness of vaccine production. This study aimed to develop an efficient production system for the recombinant HPV type 52 L1 protein as HPV vaccine material using methylotrophic yeast Hansenula polymorpha expression system. RESULTS This study presents an in-depth examination of the expression and scale-up production of HPV type 52 L1 protein using DASGIP® parallel bioreactor system. The pHIPX4 plasmid, which is regulated by the MOX promoter, generates stable clones that express the target protein. Cultivation employing the synthetic medium SYN6(10) with controlled parameters (e.g. temperature, pH, feeding strategy, and aeration) produces 0.15 µg/mL of HPV type 52 L1 protein, suggesting a possibility for scaling up to a higher production level. CONCLUSION The scale-up production of HPV type 52 L1 protein using Hansenula polymorpha expression system described in this study provides an opportunity for an economical manufacturing platform for the development of the HPV vaccine.
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Affiliation(s)
- Sheila Chairunnisa
- Master's Programme in Biomedical Sciences, Faculty of Medicine Universitas Indonesia, Jakarta 10430, Indonesia; Research Center for Genetic Engineering, National Research and Innovation Agency (BRIN), Bogor 16911, Indonesia
| | - Apon Zaenal Mustopa
- Research Center for Genetic Engineering, National Research and Innovation Agency (BRIN), Bogor 16911, Indonesia.
| | - Budiman Bela
- Department of Microbiology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Moh Egy Rahman Firdaus
- Research Center for Genetic Engineering, National Research and Innovation Agency (BRIN), Bogor 16911, Indonesia
| | - Shasmita Irawan
- Research Center for Genetic Engineering, National Research and Innovation Agency (BRIN), Bogor 16911, Indonesia
| | - Rosyida Khusniatul Arifah
- Research Center for Genetic Engineering, National Research and Innovation Agency (BRIN), Bogor 16911, Indonesia
| | - Herman Irawan
- Research Center for Genetic Engineering, National Research and Innovation Agency (BRIN), Bogor 16911, Indonesia
| | - Maritsa Nurfatwa
- Research Center for Genetic Engineering, National Research and Innovation Agency (BRIN), Bogor 16911, Indonesia
| | - Rifqiyah Nur Umami
- Research Center for Genetic Engineering, National Research and Innovation Agency (BRIN), Bogor 16911, Indonesia
| | - Nurlaili Ekawati
- Research Center for Genetic Engineering, National Research and Innovation Agency (BRIN), Bogor 16911, Indonesia
| | - Ai Hertati
- Research Center for Genetic Engineering, National Research and Innovation Agency (BRIN), Bogor 16911, Indonesia
| | - Nurhasni Hasan
- Faculty of Pharmacy, Universitas Hasanuddin, Jl. Perintis Kemerdekaan Km 10, Makassar 90245, Indonesia.
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Kiendrébéogo JA, Sidibe ARO, Compaoré GB, Nacanabo R, Sory O, Ouédraogo I, Nawaz S, Schuind AE, Clark A. Cost-effectiveness of human papillomavirus (HPV) vaccination in Burkina Faso: a modelling study. BMC Health Serv Res 2023; 23:1338. [PMID: 38041075 PMCID: PMC10693094 DOI: 10.1186/s12913-023-10283-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/06/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Africa has some of the highest cervical cancer incidence and mortality rates globally. Burkina Faso launched a human papillomavirus (HPV) vaccination programme for 9-year-old girls in 2022 with support from Gavi, the Vaccine Alliance (Gavi). An economic evaluation of HPV vaccination is required to help sustain investment and inform decisions about optimal HPV vaccine choices. METHODS We used a proportionate outcomes static cohort model to evaluate the potential impact and cost-effectiveness of HPV vaccination for 9-year-old girls over a ten-year period (2022-2031) in Burkina Faso. The primary outcome measure was the cost (2022 US$) per disability-adjusted life year (DALY) averted from a limited societal perspective (including all vaccine costs borne by the government and Gavi, radiation therapy costs borne by the government, and all other direct medical costs borne by patients and their families). We evaluated four vaccines (CERVARIX®, CECOLIN®, GARDASIL-4®, GARDASIL-9®), comparing each to no vaccination (and no change in existing cervical cancer screening and treatment strategies) and to each other. We combined local estimates of HPV type distribution, healthcare costs, vaccine coverage and costs with GLOBOCAN 2020 disease burden data and clinical trial efficacy data. We ran deterministic and probabilistic uncertainty analyses. RESULTS HPV vaccination could prevent 37-72% of cervical cancer cases and deaths. CECOLIN® had the most favourable cost-effectiveness (cost per DALY averted < 0.27 times the national gross domestic product [GDP] per capita). When cross-protection was included, CECOLIN® remained the most cost-effective (cost per DALY averted < 0.20 times the national GDP per capita), but CERVARIX® provided greater health benefits (66% vs. 48% reduction in cervical cancer cases and deaths) with similar cost-effectiveness (cost per DALY averted < 0.28 times the national GDP per capita, with CECOLIN® as the comparator). We estimated the annual cost of the vaccination programme at US$ 2.9, 4.1, 4.4 and 19.8 million for CECOLIN®, GARDASIL-4®, CERVARIX® and GARDASIL-9®, respectively. A single dose strategy reduced costs and improved cost-effectiveness by more than half. CONCLUSION HPV vaccination is cost-effective in Burkina Faso from a limited societal perspective. A single dose strategy and/or alternative Gavi-supported HPV vaccines could further improve cost-effectiveness.
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Affiliation(s)
- Joël Arthur Kiendrébéogo
- Department of Public Health, University Joseph Ki-Zerbo, Ouagadougou, Burkina Faso.
- Recherche pour la santé et le développement (RESADE), Ouagadougou, Burkina Faso.
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany.
| | - Annick Raissa O Sidibe
- Directorate of Prevention through Immunization, Ministry of Health, Ouagadougou, Burkina Faso
- Jhpiego, Ouagadougou, Burkina Faso
| | | | - Relwendé Nacanabo
- Institute of Health Sciences and Research (IRSS), Ouagadougou, Burkina Faso
| | - Orokia Sory
- Recherche pour la santé et le développement (RESADE), Ouagadougou, Burkina Faso
| | - Issa Ouédraogo
- Directorate of Prevention through Immunization, Ministry of Health, Ouagadougou, Burkina Faso
| | | | | | - Andrew Clark
- London School of Hygiene and Tropical Medicine, Department of Health Services Research and Policy, London, UK
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Mwenda V, Jalang'o R, Miano C, Bor JP, Nyangasi M, Mecca L, Were V, Kariithi E, Pecenka C, Schuind A, Abbas K, Clark A. Impact, cost-effectiveness, and budget implications of HPV vaccination in Kenya: A modelling study. Vaccine 2023:S0264-410X(23)00546-7. [PMID: 37296015 DOI: 10.1016/j.vaccine.2023.05.019] [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: 02/20/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Sub-Saharan Africa has the highest rate of cervical cancer cases and deaths worldwide. Kenya introduced a quadrivalent HPV vaccine (GARDASIL, hereafter referred to as GARDASIL-4) for ten-year-old girls in late 2019 with donor support from Gavi, the Vaccine Alliance. As Kenya may soon graduate from Gavi support, it is important to evaluate the potential cost-effectiveness and budget impact of the current HPV vaccine, and potential alternatives. METHODS We used a proportionate outcomes static cohort model to evaluate the annual budget impact and lifetime cost-effectiveness of vaccinating ten-year-old girls over the period 2020-2029. We included a catch-up campaign for girls aged 11-14 years in 2020. We estimated cervical cancer cases, deaths, disability adjusted life years (DALYs), and healthcare costs (government and societal perspective) expected to occur with and without vaccination over the lifetimes of each cohort of vaccinated girls. For each of the four products available globally (CECOLIN©, CERVARIX©, GARDASIL-4©, and GARDASIL-9 ©), we estimated the cost (2021 US$) per DALY averted compared to no vaccine and to each other. Model inputs were obtained from published sources, as well as local stakeholders. RESULTS We estimated 320,000 cases and 225,000 deaths attributed to cervical cancer over the lifetimes of the 14 evaluated birth cohorts. HPV vaccination could reduce this burden by 42-60 %. Without cross-protection, CECOLIN had the lowest net cost and most attractive cost-effectiveness. With cross-protection, CERVARIX was the most cost-effective. Under either scenario the most cost-effective vaccine had a 100 % probability of being cost-effective at a willingness-to-pay threshold of US$ 100 (5 % of Kenya's national gross domestic product per capita) compared to no vaccination. Should Kenya reach its target of 90 % coverage and graduate from Gavi support, the undiscounted annual vaccine program cost could exceed US$ 10 million per year. For all three vaccines currently supported by Gavi, a single-dose strategy would be cost-saving compared to no vaccination. CONCLUSION HPV vaccination for girls is highly cost-effective in Kenya. Compared to GARDASIL-4, alternative products could provide similar or greater health benefits at lower net costs. Substantial government funding will be required to reach and sustain coverage targets as Kenya graduates from Gavi support. A single dose strategy is likely to have similar benefits for less cost.
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Affiliation(s)
- Valerian Mwenda
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya.
| | - Rose Jalang'o
- National Vaccines and Immunization Program, Ministry of Health, Nairobi, Kenya
| | - Christine Miano
- National Vaccines and Immunization Program, Ministry of Health, Nairobi, Kenya
| | - Joan-Paula Bor
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Mary Nyangasi
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Lucy Mecca
- National Vaccines and Immunization Program, Ministry of Health, Nairobi, Kenya
| | - Vincent Were
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | | | - Kaja Abbas
- London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Clark
- London School of Hygiene and Tropical Medicine, London, UK
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Chughtai N, Perveen K, Gillani SR, Abbas A, Chunara R, Manji AA, Karani S, Noorali AA, Zakaria M, Shamsi U, Chishti U, Khan AA, Soofi S, Pervez S, Samad Z. National cervical cancer burden estimation through systematic review and analysis of publicly available data in Pakistan. BMC Public Health 2023; 23:834. [PMID: 37147640 PMCID: PMC10163779 DOI: 10.1186/s12889-023-15531-z] [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: 05/23/2022] [Accepted: 03/27/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Cervical cancer is a major cause of cancer-related deaths among women worldwide. Paucity of data on cervical cancer burden in countries like Pakistan hamper requisite resource allocation. OBJECTIVE To estimate the burden of cervical cancer in Pakistan using available data sources. METHODS We performed a systematic review to identify relevant data on Pakistan between 1995 to 2022. Study data identified through the systematic review that provided enough information to allow age specific incidence rates and age standardized incidence rates (ASIR) calculations for cervical cancer were merged. Population at risk estimates were derived and adjusted for important variables in the care-seeking pathway. The calculated ASIRs were applied to 2020 population estimates to estimate the number of cervical cancer cases in Pakistan. RESULTS A total of 13 studies reported ASIRs for cervical cancer for Pakistan. Among the studies selected, the Karachi Cancer Registry reported the highest disease burden estimates for all reported time periods: 1995-1997 ASIR = 6.81, 1998-2002 ASIR = 7.47, and 2017-2019 ASIR = 6.02 per 100,000 women. Using data from Karachi, Punjab and Pakistan Atomic Energy Cancer Registries from 2015-2019, we derived an unadjusted ASIR for cervical cancer of 4.16 per 100,000 women (95% UI 3.28, 5.28). Varying model assumptions produced adjusted ASIRs ranging from 5.2 to 8.4 per 100,000 women. We derived an adjusted ASIR of 7.60, (95% UI 5.98, 10.01) and estimated 6166 (95% UI 4833, 8305) new cases of cervical cancer per year. CONCLUSION The estimated cervical cancer burden in Pakistan is higher than the WHO target. Estimates are sensitive to health seeking behavior, and appropriate physician diagnostic intervention, factors that are relevant to the case of cervical cancer, a stigmatized disease in a low-lower middle income country setting. These estimates make the case for approaching cervical cancer elimination through a multi-pronged strategy.
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Affiliation(s)
- Novera Chughtai
- Department of Obstetrics and Gynecology, Aga Khan University, Karachi, Pakistan
| | - Kausar Perveen
- Department of Medicine, CITRIC Health Data Science Center, Aga Khan University, 1st Floor Faculty Office Building, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | | | - Aamir Abbas
- Department of Medicine, CITRIC Health Data Science Center, Aga Khan University, 1st Floor Faculty Office Building, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Rumi Chunara
- Department of Biostatistics, School of Global Public Health, New York University, New York, USA
- Department of Computer Science and Engineering, Tandon School of Engineering, New York University, New York, USA
| | - Afshan Ali Manji
- Department of Medicine, CITRIC Health Data Science Center, Aga Khan University, 1st Floor Faculty Office Building, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Salima Karani
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Maheen Zakaria
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Uzma Shamsi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Uzma Chishti
- Department of Obstetrics and Gynecology, Aga Khan University, Karachi, Pakistan
| | - Adnan A Khan
- Research and Development Solutions, Islamabad, Pakistan
| | - Sajid Soofi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Shahid Pervez
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Zainab Samad
- Department of Medicine, CITRIC Health Data Science Center, Aga Khan University, 1st Floor Faculty Office Building, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.
- Department of Medicine, Aga Khan University, Karachi, Pakistan.
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Petrie K, Wells A, Eckert LO. Human Papillomavirus Vaccine. Obstet Gynecol Clin North Am 2023; 50:339-348. [PMID: 37149314 DOI: 10.1016/j.ogc.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Cervical cancer is the fourth most common cancer in women worldwide with immense associated morbidity and mortality. Although most of the cervical cancer cases are caused by the human papillomavirus (HPV) and can effectively be prevented by HPV vaccination, vaccination unfortunately remains underused on a global scale with vast inequities in distribution. A vaccine as a tool to prevent cancer, cervical and others, is largely unprecedented. Then why do HPV vaccination rates globally remain so low? This article explores the burden of disease, development of the vaccine and its subsequent uptake, cost-effectiveness, and associated equity issues.
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Chaiken SR, Bruegl AS, Caughey AB, Emerson J, Munro EG. Adjuvant Human Papillomavirus Vaccination After Excisional Procedure for Cervical Intraepithelial Neoplasia: A Cost-Effectiveness Analysis. Obstet Gynecol 2023; 141:756-763. [PMID: 36897145 DOI: 10.1097/aog.0000000000005106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/15/2022] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To examine the cost effectiveness of human papillomavirus (HPV) vaccination after excisional procedure compared with no vaccination. METHODS We constructed a decision-analytic model (TreeAge Pro 2021) to compare outcomes between patients who underwent an excisional procedure followed by nonavalent HPV vaccination to those who underwent an excisional procedure without vaccination. Our theoretical cohort contained 250,000 patients, the approximate number undergoing excisional procedures annually in the United States. Our outcomes were costs, quality-adjusted life-years (QALYs), recurrence events, number of surveillance Pap tests with co-testing, number of colposcopies, and second excisional procedures. Probabilities of recurrence were based on a recently published meta-analysis. All values were derived from the literature, and QALYs were discounted at a rate of 3%. Outcomes were applied for 4 years after the initial excisional procedure. Our cost-effectiveness threshold was $100,000 per QALY. Sensitivity analyses were performed to evaluate the robustness of the model. RESULTS In our theoretical cohort of patients who underwent an excisional procedure, the HPV vaccination strategy was associated with 17,281 fewer recurrences of cervical intraepithelial neoplasia (CIN) (8,360 fewer cases of CIN 1 and 8,921 fewer cases of CIN 2 or 3), 26,203 fewer Pap tests (1,025,368 vs 1,051,570), 17,281 fewer colposcopies (20,588 vs 37,869), and 8,921 fewer second excisional procedures (4,779 vs 13,701). The vaccination strategy was associated with a higher cost of $135 million. Vaccination was a cost-effective strategy, with an incremental cost-effectiveness ratio of $29,181 per QALY, compared with no vaccination. In our sensitivity analyses, the HPV vaccination strategy remained cost effective until the cost of the three-dose HPV vaccine series reached $1,899 or the baseline (nonvaccinated) probability of recurrence was less than 4.8%. CONCLUSION In our model, HPV vaccination for patients with a prior excisional procedure led to improved outcomes and was cost effective. Our study suggests that clinicians should consider offering the three-dose HPV vaccine series to patients who have undergone an excisional procedure to decrease the risk of CIN recurrence and its sequelae.
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Affiliation(s)
- Sarina R Chaiken
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon
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Van Lissa CJ, van Erp S, Clapper EB. Selecting relevant moderators with Bayesian regularized meta-regression. Res Synth Methods 2023; 14:301-322. [PMID: 36797984 DOI: 10.1002/jrsm.1628] [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: 04/23/2022] [Revised: 12/07/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
When meta-analyzing heterogeneous bodies of literature, meta-regression can be used to account for potentially relevant between-studies differences. A key challenge is that the number of candidate moderators is often high relative to the number of studies. This introduces risks of overfitting, spurious results, and model non-convergence. To overcome these challenges, we introduce Bayesian Regularized Meta-Analysis (BRMA), which selects relevant moderators from a larger set of candidates by shrinking small regression coefficients towards zero with regularizing (LASSO or horseshoe) priors. This method is suitable when there are many potential moderators, but it is not known beforehand which of them are relevant. A simulation study compared BRMA against state-of-the-art random effects meta-regression using restricted maximum likelihood (RMA). Results indicated that BRMA outperformed RMA on three metrics: BRMA had superior predictive performance, which means that the results generalized better; BRMA was better at rejecting irrelevant moderators, and worse at detecting true effects of relevant moderators, while the overall proportion of Type I and Type II errors was equivalent to RMA. BRMA regression coefficients were slightly biased towards zero (by design), but its residual heterogeneity estimates were less biased than those of RMA. BRMA performed well with as few as 20 studies, suggesting its suitability as a small sample solution. We present free open source software implementations in the R-package pema (for penalized meta-analysis) and in the stand-alone statistical program JASP. An applied example demonstrates the use of the R-package.
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Affiliation(s)
| | - Sara van Erp
- Dept. Methodology & Statistics, Utrecht University, The Netherlands
| | - Eli-Boaz Clapper
- Dept. Methodology & Statistics, Utrecht University, The Netherlands
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Lebanova H, Stoev S, Naseva E, Getova V, Wang W, Sabale U, Petrova E. Economic Burden of Cervical Cancer in Bulgaria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2746. [PMID: 36768109 PMCID: PMC9915037 DOI: 10.3390/ijerph20032746] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
Bulgaria is among the European Union (EU) countries with the highest burden of cervical cancers and life expectancy below the EU average. The majority of cervical cancer cases (more than 95%) are caused by the human papillomavirus (HPV). The aim of this retrospective, cost of illness study is to identify direct healthcare costs of cervical cancer in Bulgaria from the payer perspective and to calculate indirect costs and the associated years of life lost. Costs data were sourced from the National Health Insurance Fund from January 2018 to December 2020. Years of life lost were calculated based on the country and gender-specific life expectancy. Indirect costs due to productivity loss were calculated using the human capital approach. The total treatment costs for 3540 patients with cervical cancer are EUR 5,743,657 (2018), EUR 6,377,508 (2019), and EUR 6,751,182 (2020). The costs associated with drug acquisition and administration accounted for the majority (63%) of total healthcare costs followed by hospital management costs (14%). An estimated total of 20,446 years of life were lost due to cervical cancer for the period 2018-2020. The costs of productivity losses are estimated at EUR 7,578,014. Our study showed that the economic burden of cervical cancer in Bulgaria is substantial. Focus on cervical cancer prevention via vaccination against the human papillomavirus, timely screening, early diagnosis, and higher vaccine coverage rates could reduce its economic burden in Bulgaria.
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Affiliation(s)
- Hristina Lebanova
- Faculty of Pharmacy, Medical University-Pleven, 5800 Pleven, Bulgaria
| | - Svetoslav Stoev
- Faculty of Pharmacy, Medical University-Pleven, 5800 Pleven, Bulgaria
| | - Emilia Naseva
- Faculty of Public Health “Prof. Tsekomir Vodenicharov, MD, DSc”, Medical University of Sofia, 1527 Sofia, Bulgaria
| | - Violeta Getova
- Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria
| | - Wei Wang
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Rahway, NJ 07065, USA
| | - Ugne Sabale
- Center for Observational and Real-World Evidence, Merck Sharp & Dohme, 11330 Stockholm, Sweden
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12
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The cost and cost-effectiveness of novel tuberculosis vaccines in low- and middle-income countries: A modeling study. PLoS Med 2023; 20:e1004155. [PMID: 36693081 PMCID: PMC9873163 DOI: 10.1371/journal.pmed.1004155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 12/09/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) is preventable and curable but eliminating it has proven challenging. Safe and effective TB vaccines that can rapidly reduce disease burden are essential for achieving TB elimination. We assessed future costs, cost-savings, and cost-effectiveness of introducing novel TB vaccines in low- and middle-income countries (LMICs) for a range of product characteristics and delivery strategies. METHODS AND FINDINGS We developed a system of epidemiological and economic models, calibrated to demographic, epidemiological, and health service data in 105 LMICs. For each country, we assessed the likely future course of TB-related outcomes under several vaccine introduction scenarios, compared to a "no-new-vaccine" counterfactual. Vaccine scenarios considered 2 vaccine product profiles (1 targeted at infants, 1 at adolescents/adults), both assumed to prevent progression to active TB. Key economic inputs were derived from the Global Health Cost Consortium, World Health Organization (WHO) patient cost surveys, and the published literature. We estimated the incremental impact of vaccine introduction for a range of health and economic outcomes. In the base-case, we assumed a vaccine price of $4.60 and used a 1× per-capita gross domestic product (GDP) cost-effectiveness threshold (both varied in sensitivity analyses). Vaccine introduction was estimated to require substantial near-term resources, offset by future cost-savings from averted TB burden. From a health system perspective, adolescent/adult vaccination was cost-effective in 64 of 105 LMICs. From a societal perspective (including productivity gains and averted patient costs), adolescent/adult vaccination was projected to be cost-effective in 73 of 105 LMICs and cost-saving in 58 of 105 LMICs, including 96% of countries with higher TB burden. When considering the monetized value of health gains, we estimated that introduction of an adolescent/adult vaccine could produce $283 to 474 billion in economic benefits by 2050. Limited data availability required assumptions and extrapolations that may omit important country-level heterogeneity in epidemiology and costs. CONCLUSIONS TB vaccination would be highly impactful and cost-effective in most LMICs. Further efforts are needed for future development, adoption, and implementation of novel TB vaccines.
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Richardson MT, Attwood K, Smith G, Liang SY, LaVigne Mager K, Tewari KS, Coleman RL, Kapp DS, Chan JK, Monk BJ. Sequential Targeted Therapy for Advanced, Metastatic, and Recurrent Cervical Cancer: A Cost-Effectiveness Analysis of the Patient Journey. Cancer Control 2023; 30:10732748231182795. [PMID: 37646470 PMCID: PMC10469236 DOI: 10.1177/10732748231182795] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVES To evaluate outcomes and cost-effectiveness of targeted therapy sequencing for metastatic and recurrent cervical cancer. METHOD Models were simulated based on phase II and III trials on bevacizumab (bev) from GOG-240, cemiplimab (cemi) from GOG 3016, pembrolizumab (pembro) from KEYNOTE-826, and tisotumab vedotin (tiso) from GOG 3023. Costs were based on IBM Micromedex RED BOOK™ and company listed costs. RESULTS For [chemo + bev → chemo], total cost was $125,918.04, with median overall survival (mOS) of 21.8 months, and cost-effectiveness ratio (CER) of $119,835.79. For [chemo + bev → cemi], total cost was $187,562.99 with mOS of 28.5 months and CER of $162,039.16. For [chemo + bev + pembro → chemo], total cost was $319,963.78 with mOS 32.9 months and CER of $249,930.10. For [chemo + bev + pembro → tiso], total cost was $455,204.45, with mOS 36.5 months and CER of $320,072.99. CONCLUSION The combination of immunotherapies and biologics have significantly increased overall survival, but with associated higher costs, primarily related to drug costs.
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Affiliation(s)
| | | | | | - Su-Ying Liang
- Sutter Health, Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | | | | | | | - Daniel S. Kapp
- Stanford University School of Medicine, Stanford, CA, USA
| | - John K. Chan
- California Pacific Medical Center, Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - Bradley J. Monk
- Honor Health Research Institute, University of Arizona, Creighton University, Phoenix, AZ, USA
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Lu X, Ji M, Wagner AL, Huang W, Shao X, Zhou W, Lu Y. Willingness to pay for HPV vaccine among female health care workers in a Chinese nationwide survey. BMC Health Serv Res 2022; 22:1324. [PMID: 36335333 PMCID: PMC9637298 DOI: 10.1186/s12913-022-08716-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022] Open
Abstract
Background Payment methods for human papillomavirus (HPV) vaccine could substantially influence vaccination behavior. In China, HPV vaccination uptake remains currently low. This study aims to determine willingness to pay (WTP) for HPV vaccines among Chinese female health care workers under different payment scenarios. Methods This is a nationwide online survey recruiting female health care workers aged 18–45 years from 31 provinces throughout China. We collected the respondents’ vaccination status of HPV vaccines and their sociodemographics. Two WTPs were defined and estimated in the study. A general WTP for HPV vaccination was determined using the contingent valuation method with double dichotomous choice bidding. A WTP out-of-pocket was estimated for each HPV vaccine under two scenarios, including partial coverage by governmental subsidy or partial incorporation in basic medical insurance. Accordingly, a multivariable linear regression model was employed to determine the association between sociodemographis and general WTP. Then the maximum WTP out-of-pocket was compared among the respondents’ attitude shift towards HPV vaccination, payment scenarios, and levels of vaccine attributes, using non-parametric Kruskal-Wallis test. Results A total of 15,969 respondents were included in the study. The median general WTP was 2000 CNY (interquartile range, 1000–3200 CNY), positively associated with younger age, unmarried status, higher monthly income, fewer children, more positive vaccination behavior, working in tertiary hospital, higher local GDP and HDI (each P < 0.05). Moreover, the median WTP out-of-pocket was 1250 CNY (540–2000 CNY). It was significantly higher for vaccines partly covered by governmental subsidy (median, 1250 CNY; interquartile range, 560–2000 CNY), imported vaccines (1260 CNY; 630–1960 CNY), and 9-valent vaccines (1400 CNY; 750–2240 CNY) (each P < 0.001). Additionally, majority of respondents did not change their attitude towards HPV vaccination between two payment scenarios; those remaining with more expensive HPV vaccines (51.1%) had higher WTP out-of-pocket (1400 CNY; 560–2250 CNY) than those with cheaper vaccines (39.0%) (1120 CNY; 490–1960 CNY) (P < 0.001). Conclusion Chinese female health care workers have high WTP for HPV vaccines. A direct public funding for HPV vaccination is more preferable. Our findings may facilitate the adjustment of HPV vaccination strategy and payment mechanism in China. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08716-6.
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Soares GH, Sethi S, Hedges J, Jamieson L. Disparities in Human Papillomavirus vaccination coverage among adolescents in Australia: A geospatial analysis. Vaccine 2022; 40:4644-4653. [PMID: 35750540 DOI: 10.1016/j.vaccine.2022.06.030] [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: 03/30/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022]
Abstract
AIM This ecological study aimed to examine the geographic patterns in Human Papillomavirus (HPV) vaccination rates among boys and girls aged 15 years across locations in Australia, in addition to assessing contextual area-level factors that may explain the variations in HPV vaccination coverage. METHODS Aggregate HPV vaccination data for Australian girls and boys aged 15 years from 2015 to 16 was obtained from the Australian Institute of Health and Welfare for each Statistical Area level 4 (SA4). A Gradient Boosting Machine learning model was applied to assess the predictors' importance for the study outcomes. Geographically weighted regression (GWR) models were run to assess whether substantially different relationships between predictors and outcomes occur at different locations in space. RESULTS Completed HPV vaccination across the 88 SA4 regions ranged from 57.6% to 90.6% among girls, and from 53.6% to 85.5% among boys. The 2016 SEIFA Index of Economic Resources was the variable with the highest contribution to the predictions of both girls' and boys' HPV vaccination rates. Selected predictors explained 45% and 72% of the geographic variance in vaccination rates among boys and girls, respectively. Normalised coefficients for both GWR models showed a high variation in the associations between predictors and HPV vaccination rates across regions. CONCLUSION Socioeconomic and education factors were important predictors for HPV vaccination rates among Australian boys and girls aged 15 years, although no variable presented a uniform effect on HPV vaccination across SA4 regions. Important spatial heterogeneity in the effect of predictors was identified across the study area.
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Affiliation(s)
- Gustavo Hermes Soares
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA, Australia.
| | - Sneha Sethi
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA, Australia.
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA, Australia.
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA, Australia.
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Cost-effectiveness of rotavirus vaccination in children under five years of age in 195 countries: A meta-regression analysis. Vaccine 2022; 40:3903-3917. [PMID: 35643565 PMCID: PMC9208428 DOI: 10.1016/j.vaccine.2022.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/14/2022] [Accepted: 05/16/2022] [Indexed: 11/22/2022]
Abstract
Background Rotavirus caused an estimated 151,714 deaths from diarrhea among children under 5 in 2019. To reduce mortality, countries are considering adding rotavirus vaccination to their routine immunization program. Cost-effectiveness analyses (CEAs) to inform these decisions are not available in every setting, and where they are, results are sensitive to modeling assumptions, especially about vaccine efficacy. We used advances in meta-regression methods and estimates of vaccine efficacy by location to estimate incremental cost-effectiveness ratios (ICERs) for rotavirus vaccination in 195 countries. Methods Beginning with Tufts University CEA and Global Health CEA registries we used 515 ICERs from 68 articles published through 2017, extracted 938 additional one-way sensitivity analyses, and excluded 33 ICERs for a sample of 1,418. We used a five-stage, mixed-effects, Bayesian metaregression framework to predict ICERs, and logistic regression model to predict the probability that the vaccine was cost-saving. For both models, covariates were vaccine characteristics including efficacy, study methods, and country-specific rotavirus disability-adjusted life-years (DALYs) and gross domestic product (GDP) per capita. All results are reported in 2017 United States dollars. Results Vaccine efficacy, vaccine cost, GDP per capita and rotavirus DALYs were important drivers of variability in ICERs. Globally, the median ICER was $2,289 (95% uncertainty interval (UI): $147–$38,993) and ranged from $85 per DALY averted (95% UI: $13–$302) in Central African Republic to $70,599 per DALY averted (95% UI: $11,030–$263,858) in the United States. Among countries eligible for support from Gavi, The Vaccine Alliance, the mean ICER was $255 per DALY averted (95% UI: $39–$918), and among countries eligible for the PAHO revolving fund, the mean ICER was $2,464 per DALY averted (95% UI: $382–$3,118). Conclusion Our findings incorporate recent evidence that vaccine efficacy differs across locations, and support expansion of rotavirus vaccination programs, particularly in countries eligible for support from Gavi, The Vaccine Alliance.
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