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Qendri V, Bogaards JA, Baussano I, Lazzarato F, Vänskä S, Berkhof J. The cost-effectiveness profile of sex-neutral HPV immunisation in European tender-based settings: a model-based assessment. Lancet Public Health 2020; 5:e592-e603. [PMID: 33120045 DOI: 10.1016/s2468-2667(20)30209-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/27/2020] [Accepted: 09/10/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND In many European countries, human papillomavirus (HPV) vaccine uptake among girls has remained below target levels, supporting the scope for vaccination of boys. We aimed to investigate if sex-neutral HPV vaccination can be considered cost-effective compared with girls-only vaccination at uptake levels equal to those among girls and under tender-based vaccination costs achieved throughout Europe. METHODS We investigated the cost-effectiveness of sex-neutral HPV vaccination in European tender-based settings. We applied a Bayesian synthesis framework for health economic evaluation to 11 countries (Austria, Belgium, Croatia, Estonia, Italy, Latvia, the Netherlands, Poland, Slovenia, Spain, and Sweden), accommodating country-specific information on key epidemiological and economic parameters, and on current HPV vaccination programmes. We used projections from three independently developed HPV transmission models to tailor region-specific herd effects. The main outcome measures in the comparison of sex-neutral with girls-only vaccination were cancer cases prevented and incremental cost-effectiveness ratios (ICERs), defined as the cost in international dollars (I$) per life-year gained. FINDINGS The total number of cancer cases to be prevented by vaccinating girls at currently realised vaccine uptake varied from 318 (95% CI 197-405) per cohort of 200 000 preadolescents (100 000 girls plus 100 000 boys) in Croatia (under 20% uptake of the 9-valent vaccine) to 1904 (1741-2101) in Estonia (under 70% uptake of the 9-valent vaccine). Vaccinating boys at equal coverage increased these respective numbers by 168 (95% CI 121-213) in Croatia and 467 (391-587) in Estonia. Sex-neutral vaccination was likely to be cost-effective, with ICERs of sex-neutral compared with girls-only vaccination varying from I$4300 per life-year gained in Latvia (95% credibility interval 3450-5160; 40% uptake) to I$25 720 per life-year gained in Spain (21 380-30 330; 80% uptake). At uniform 80% uptake, a favourable cost-effectiveness profile was retained for most of the countries investigated (Austria, Belgium, Italy, Latvia, the Netherlands, Slovenia, Spain, and Sweden). INTERPRETATION Sex-neutral HPV vaccination is economically attractive in European tender-based settings. However, tendering mechanisms need to ensure that vaccination of boys will remain cost-effective at high vaccine uptake rates. FUNDING European Commission 7th Framework Programme and WHO.
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Affiliation(s)
- Venetia Qendri
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, Netherlands.
| | - Johannes A Bogaards
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, Netherlands; Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | | | - Fulvio Lazzarato
- Unit of Cancer Epidemiology, AOU Cittá della Salute e della Scienza, Hospital of Turin, Turin, Italy
| | - Simopekka Vänskä
- Infectious Disease Control and Vaccination Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Johannes Berkhof
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, Netherlands
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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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Qendri V, Bogaards JA, Berkhof J. Pricing of HPV vaccines in European tender-based settings. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:271-280. [PMID: 30051152 PMCID: PMC6439217 DOI: 10.1007/s10198-018-0996-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/18/2018] [Indexed: 05/07/2023]
Abstract
BACKGROUND Vaccine price is one of the most influential parameters in economic evaluations of HPV vaccination programmes. Vaccine tendering is a cost-containment method widely used by national or regional health authorities, but information on tender-based HPV vaccine prices is scarce. METHODS Procurement notices and awards for the HPV vaccines, published from January 2007 until January 2018, were systematically retrieved from the online platform for public procurement in Europe. Information was collected from national or regional tenders organized for publicly funded preadolescent vaccination programmes against HPV. The influence of variables on the vaccine price was estimated by means of a mixed-effects model. FINDINGS Prices were collected from 178 procurements announced in 15 European countries. The average price per dose for the first-generation HPV vaccines decreased from €101.8 (95% CI 91.3-114) in 2007 to €28.4 (22.6-33.5) in 2017, whereas the average dose price of the 9-valent vaccine in 2016-2017 was €49.1 (38.0-66.8). Unit prices were, respectively, €7.5 (4.4-10.6) and €34.4 (27.4-41.4) higher for the 4-valent and 9-valent vaccines than for the 2-valent vaccine. Contract volume and duration, level of procurement (region or country), per capita GDP and number of offers received had a significant effect on vaccine price. INTERPRETATION HPV vaccine procurement is widely used across Europe. The fourfold decrease in the average tender-based prices compared to list prices confirms the potential of tendering as an efficient cost-containment strategy, thereby expanding the indications for cost-effective HPV vaccination to previously ineligible target groups.
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Affiliation(s)
- Venetia Qendri
- Department of Epidemiology and Biostatistics, VU University Medical Center, PO Box 7057, MF F-wing ST, 1007 MB, Amsterdam, The Netherlands.
| | - Johannes A Bogaards
- Department of Epidemiology and Biostatistics, VU University Medical Center, PO Box 7057, MF F-wing ST, 1007 MB, Amsterdam, The Netherlands
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, VU University Medical Center, PO Box 7057, MF F-wing ST, 1007 MB, Amsterdam, The Netherlands
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Shapiro GK, Perez S, Naz A, Tatar O, Guichon JR, Amsel R, Zimet GD, Rosberger Z. Investigating Canadian parents' HPV vaccine knowledge, attitudes and behaviour: a study protocol for a longitudinal national online survey. BMJ Open 2017; 7:e017814. [PMID: 29025844 PMCID: PMC5652458 DOI: 10.1136/bmjopen-2017-017814] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/27/2017] [Accepted: 08/01/2017] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Human papillomavirus (HPV), a sexually transmitted infection, can cause anogenital warts and a number of cancers. To prevent morbidity and mortality, three vaccines have been licensed and are recommended by Canada's National Advisory Committee on Immunisation (for girls since 2007 and boys since 2012). Nevertheless, HPV vaccine coverage in Canada remains suboptimal in many regions. This study will be the first to concurrently examine the correlates of HPV vaccine decision-making in parents of school-aged girls and boys and evaluate changes in parental knowledge, attitudes and behaviours over time. METHODS AND ANALYSIS Using a national, online survey utilising theoretically driven constructs and validated measures, this study will identify HPV vaccine coverage rates and correlates of vaccine decision-making in Canada at two time points (August-September 2016 and June-July 2017). 4606 participants will be recruited to participate in an online survey through a market research and polling firm using email invitations. Data cleaning methods will identify inattentive or unmotivated participants. ETHICS AND DISSEMINATION The study received research ethics board approval from the Research Review Office, Integrated Health and Social Services University Network for West-Central Montreal (CODIM-FLP-16-219). The study will adopt a multimodal approach to disseminate the study's findings to researchers, clinicians, cancer and immunisation organisations and the public in Canada and internationally.
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Affiliation(s)
- Gilla K Shapiro
- Department of Psychology, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Samara Perez
- Department of Psychology, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Anila Naz
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Ovidiu Tatar
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Juliet R Guichon
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rhonda Amsel
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Gregory D Zimet
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Zeev Rosberger
- Department of Psychology, McGill University, Montreal, Quebec, Canada
- Department of Oncology, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Louise Granofsky Psychosocial Oncology Program, Segal Cancer Center, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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Qendri V, Bogaards JA, Berkhof J. Health and Economic Impact of a Tender-Based, Sex-Neutral Human Papillomavirus 16/18 Vaccination Program in the Netherlands. J Infect Dis 2017; 216:210-219. [PMID: 28586466 DOI: 10.1093/infdis/jix272] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/02/2017] [Indexed: 12/27/2022] Open
Abstract
Background Uptake of human papillomavirus (HPV) vaccine among girls in the Dutch immunization program has plateaued at around 60%. Vaccinating boys may be an appealing complementary strategy for the prevention of HPV-related diseases, especially since tender negotiations and reduced dosing schemes have driven down the cost of vaccination. Methods We expanded a previously published Bayesian synthesis framework to account for all vaccine type-related cancers and herd immunity effects from vaccinating girls and boys. We evaluated the efficiency of vaccinating boys relative to increasing vaccine uptake among girls and assessed the cost-effectiveness of a sex-neutral program. Results Vaccinating 40% of boys along with 60% of girls yielded the same gain in life-years (LYs) as increasing the uptake in girls from 60% to 80%. The incremental cost-effectiveness ratio (ICER) of vaccinating boys was €9134/LY (95% credible interval [CrI], €7323/LY-€11231/LY) under 3% discounting. The ceiling vaccination costs at which the ICER remained below the per capita gross domestic product threshold was €240 (95% CrI, €200-€280) per vaccinated boy. If girls' uptake increased to 90%, the ceiling costs decreased to €70 (95% CrI, €40-€100) per vaccinated boy. Conclusions Vaccinating boys along with girls is only modestly less efficient than increasing uptake among girls and highly likely to be cost-effective under current vaccine costs and uptake in the Netherlands.
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Affiliation(s)
- Venetia Qendri
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam
| | - Johannes A Bogaards
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam.,Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam
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Favato G, Easton T, Vecchiato R, Noikokyris E. Ecological validity of cost-effectiveness models of universal HPV vaccination: A systematic literature review. Vaccine 2017; 35:2622-2632. [PMID: 28408119 DOI: 10.1016/j.vaccine.2017.03.093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 03/13/2017] [Accepted: 03/31/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The protective (herd) effect of the selective vaccination of pubertal girls against human papillomavirus (HPV) implies a high probability that one of the two partners involved in intercourse is immunised, hence preventing the other from this sexually transmitted infection. The dynamic transmission models used to inform immunisation policy should include consideration of sexual behaviours and population mixing in order to demonstrate an ecological validity, whereby the scenarios modelled remain faithful to the real-life social and cultural context. The primary aim of this review is to test the ecological validity of the universal HPV vaccination cost-effectiveness modelling available in the published literature. METHODS The research protocol related to this systematic review has been registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42016034145). Eight published economic evaluations were reviewed. RESULTS None of the studies showed due consideration of the complexities of human sexual behaviour and the impact this may have on the transmission of HPV. DISCUSSION Our findings indicate that all the included models might be affected by a different degree of ecological bias, which implies an inability to reflect the natural demographic and behavioural trends in their outcomes and, consequently, to accurately inform public healthcare policy. In particular, ecological bias have the effect to over-estimate the preference-based outcomes of selective immunisation. A relatively small (15-20%) over-estimation of quality-adjusted life years (QALYs) gained with selective immunisation programmes could induce a significant error in the estimate of cost-effectiveness of universal immunisation, by inflating its incremental cost effectiveness ratio (ICER) beyond the acceptability threshold. The results modelled here demonstrate the limitations of the cost-effectiveness studies for HPV vaccination, and highlight the concern that public healthcare policy might have been built upon incomplete studies.
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Affiliation(s)
- Giampiero Favato
- Institute for Leadership and Management of Health (ILMH), Kingston Business School, Kingston University, Kingston Hill, Kingston-upon-Thames KT2 7LB, UK; Kingston Business School, Kingston University, Kingston Hill, Kingston-upon-Thames KT2 7LB, UK.
| | - Tania Easton
- Kingston Business School, Kingston University, Kingston Hill, Kingston-upon-Thames KT2 7LB, UK
| | - Riccardo Vecchiato
- Institute for Leadership and Management of Health (ILMH), Kingston Business School, Kingston University, Kingston Hill, Kingston-upon-Thames KT2 7LB, UK; Kingston Business School, Kingston University, Kingston Hill, Kingston-upon-Thames KT2 7LB, UK
| | - Emmanouil Noikokyris
- Kingston Business School, Kingston University, Kingston Hill, Kingston-upon-Thames KT2 7LB, UK
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Favato G, Noikokyris E, Vecchiato R. Ecological validity of cost-effectiveness models of universal HPV vaccination: a protocol for a systematic review. Syst Rev 2017; 6:17. [PMID: 28118846 PMCID: PMC5264325 DOI: 10.1186/s13643-017-0409-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 01/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexually transmitted infection with high-risk, oncogenic strains of human papillomavirus (HPV) still induces a relevant burden of diseases on both men and women. Although vaccines appear to be highly efficacious in preventing the infection of the most common high-risk strains (HPV 6, 11, 16, 18), important questions regarding the appropriate target population for prophylactic vaccination are still debated. Models in the extant literature seem to converge on the cost-effectiveness of high coverage (>80%) of a single cohort of 12-year-old girls. This vaccination strategy should provide an adequate level of indirect protection (herd immunity) to the unvaccinated boys. This argument presupposes the ecological validity of the cost-effectiveness models; the implicit condition that the characteristics of the individuals and the sexual behaviours observed in the models is generalisable to the natural behaviours of the population. The primary aim of this review is to test the ecological validity of the cost-effectiveness models of universal HPV vaccination available in the literature. The ecological validity of each model will be defined by the number of representative characteristics and behaviours taken into consideration. METHODS Nine bibliographic databases will be searched: MEDLINE (via PubMed); Scopus; Science Direct; EMBASE via OVID SP, Web of Science, DARE, NHIR EED and HTA (via NHIR CRD); and CINHAL Plus. An additional search for grey literature will be conducted on Google Scholar and Open Grey. A search strategy will be developed for each of the databases. Data will be extracted following a pre-determined spreadsheet and then clustered and prioritised: the main outcomes will report the inputs to the demographic and epidemiological model, while additional outcomes will refer to basic inputs to the cost-effectiveness valuation. Each study included in the review will be scored by the number of representative characteristics and behaviours taken into consideration (yes or no) on both dimensions. Individual study's scores will be plotted in a 2 by 2 matrix: studies included in the upper right quadrant will be defined as ecologically valid, since which both individuals' characteristics and their sexual behaviours are representative. DISCUSSION The proposed systematic review will be the first to assess the ecological validity of cost-effectiveness studies. In the context of sexually transmitted diseases, when this condition is violated, an error in predicting the protective impact of herd immunity would occur. Hence, a vaccination policy informed on ecologically invalid models would potentially expose boys to a residual risk of contracting HPV-induced malignancies. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016034145.
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Affiliation(s)
- Giampiero Favato
- Institute of Leadership and Management in Health, Kingston University London, London, UK
- Kingston Business School, Kingston University London, Kingston Hill, Kingston-upon-Thames, KT2 7LB London, UK
| | - Emmanouil Noikokyris
- Kingston Business School, Kingston University London, Kingston Hill, Kingston-upon-Thames, KT2 7LB London, UK
| | - Riccardo Vecchiato
- Kingston Business School, Kingston University London, Kingston Hill, Kingston-upon-Thames, KT2 7LB London, UK
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Suijkerbuijk AWM, Donken R, Lugnér AK, de Wit GA, Meijer CJLM, de Melker HE, Bogaards JA. The whole story: a systematic review of economic evaluations of HPV vaccination including non-cervical HPV-associated diseases. Expert Rev Vaccines 2016; 16:361-375. [PMID: 27807989 DOI: 10.1080/14760584.2017.1256778] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Many economic evaluations of HPV vaccination have been published, but most have focused on the prevention of cervical disease as a primary health outcome. The cost-effectiveness of vaccination is likely to be underestimated if not all HPV-associated diseases are taken into account. In this review, we assess the influence of non-cervical HPV-associated diseases on the incremental cost-effectiveness ratio (ICER) of preadolescent HPV vaccination. Areas covered: We systematically searched the literature and identified 18 studies that included non-cervical diseases in the estimates of cost-effectiveness of HPV-vaccination. When taking other HPV-related diseases into account compared to not including such other diseases, the mean ICERs were 2.85 times more favorable for girls only vaccination and 3.89 times for gender neutral vaccination. Expert commentary: Including non-cervical diseases in economic evaluations of HPV vaccination programs makes it more likely that the ICER falls beneath accepted cost-effectiveness thresholds and therefore increases the scope for gender neutral vaccination.
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Affiliation(s)
- Anita W M Suijkerbuijk
- a Center for Nutrition, Prevention and Health Services , National Institute for Public Health and the Environment (RIVM) , Bilthoven , The Netherlands
| | - Robine Donken
- b Center for Epidemiology and Surveillance , National Institute for Public Health and the Environment (RIVM) , Bilthoven , The Netherlands.,c Department of Pathology , VU University Medical Centre (VUmc) , Amsterdam , The Netherlands
| | - Anna K Lugnér
- b Center for Epidemiology and Surveillance , National Institute for Public Health and the Environment (RIVM) , Bilthoven , The Netherlands
| | - G Ardine de Wit
- a Center for Nutrition, Prevention and Health Services , National Institute for Public Health and the Environment (RIVM) , Bilthoven , The Netherlands.,d Julius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Chris J L M Meijer
- c Department of Pathology , VU University Medical Centre (VUmc) , Amsterdam , The Netherlands
| | - Hester E de Melker
- b Center for Epidemiology and Surveillance , National Institute for Public Health and the Environment (RIVM) , Bilthoven , The Netherlands
| | - Johannes A Bogaards
- b Center for Epidemiology and Surveillance , National Institute for Public Health and the Environment (RIVM) , Bilthoven , The Netherlands
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Bucchi D, Stracci F, Buonora N, Masanotti G. Human papillomavirus and gastrointestinal cancer: A review. World J Gastroenterol 2016; 22:7415-7430. [PMID: 27672265 PMCID: PMC5011658 DOI: 10.3748/wjg.v22.i33.7415] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/29/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
Human papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide. Exposure to HPV is very common, and an estimated 65%-100% of sexually active adults are exposed to HPV in their lifetime. The majority of HPV infections are asymptomatic, but there is a 10% chance that individuals will develop a persistent infection and have an increased risk of developing a carcinoma. The International Agency for Research on Cancer has found that the following cancer sites have a strong causal relationship with HPV: cervix uteri, penis, vulva, vagina, anus and oropharynx, including the base of the tongue and the tonsils. However, studies of the aetiological role of HPV in colorectal and esophageal malignancies have conflicting results. The aim of this review was to organize recent evidence and issues about the association between HPV infection and gastrointestinal tumours with a focus on esophageal, colorectal and anal cancers. The ultimate goal was to highlight possible implications for prognosis and prevention.
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Pink J, Parker B, Petrou S. Cost Effectiveness of HPV Vaccination: A Systematic Review of Modelling Approaches. PHARMACOECONOMICS 2016; 34:847-861. [PMID: 27178048 DOI: 10.1007/s40273-016-0407-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND A large number of economic evaluations have been published that assess alternative possible human papillomavirus (HPV) vaccination strategies. Understanding differences in the modelling methodologies used in these studies is important to assess the accuracy, comparability and generalisability of their results. OBJECTIVES The aim of this review was to identify published economic models of HPV vaccination programmes and understand how characteristics of these studies vary by geographical area, date of publication and the policy question being addressed. METHODS We performed literature searches in MEDLINE, Embase, Econlit, The Health Economic Evaluations Database (HEED) and The National Health Service Economic Evaluation Database (NHS EED). From the 1189 unique studies retrieved, 65 studies were included for data extraction based on a priori eligibility criteria. Two authors independently reviewed these articles to determine eligibility for the final review. Data were extracted from the selected studies, focussing on six key structural or methodological themes covering different aspects of the model(s) used that may influence cost-effectiveness results. RESULTS More recently published studies tend to model a larger number of HPV strains, and include a larger number of HPV-associated diseases. Studies published in Europe and North America also tend to include a larger number of diseases and are more likely to incorporate the impact of herd immunity and to use more realistic assumptions around vaccine efficacy and coverage. Studies based on previous models often do not include sufficiently robust justifications as to the applicability of the adapted model to the new context. CONCLUSIONS The considerable between-study heterogeneity in economic evaluations of HPV vaccination programmes makes comparisons between studies difficult, as observed differences in cost effectiveness may be driven by differences in methodology as well as by variations in funding and delivery models and estimates of model parameters. Studies should consistently report not only all simplifying assumptions made but also the estimated impact of these assumptions on the cost-effectiveness results.
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Affiliation(s)
- Joshua Pink
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | - Ben Parker
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Stavros Petrou
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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11
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Law VG, Gustafson DL. Challenging ‘girls only’ publicly funded human papillomavirus vaccination programmes. Nurs Inq 2016; 24. [DOI: 10.1111/nin.12140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 11/29/2022]
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Haeussler K, Marcellusi A, Mennini FS, Favato G, Picardo M, Garganese G, Bononi M, Costa S, Scambia G, Zweifel P, Capone A, Baio G. Cost-Effectiveness Analysis of Universal Human Papillomavirus Vaccination Using a Dynamic Bayesian Methodology: The BEST II Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:956-68. [PMID: 26686779 DOI: 10.1016/j.jval.2015.08.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 08/05/2015] [Accepted: 08/08/2015] [Indexed: 05/23/2023]
Abstract
BACKGROUND Human papillomavirus (HPV) plays a role in the development of benign and malign neoplasms in both sexes. The Italian recommendations for HPV vaccines consider only females. The BEST II study (Bayesian modelling to assess the Effectiveness of a vaccination Strategy to prevent HPV-related diseases) evaluates 1) the cost-effectiveness of immunization strategies targeting universal vaccination compared with cervical cancer screening and female-only vaccination and 2) the economic impact of immunization on various HPV-induced diseases. OBJECTIVE The objective of this study was to evaluate whether female-only vaccination or universal vaccination is the most cost-effective intervention against HPV. METHODS We present a dynamic Bayesian Markov model to investigate transmission dynamics in cohorts of females and males in a follow-up period of 55 years. We assumed that quadrivalent vaccination (against HPV 16, 18, 6, and 11) is available for 12-year-old individuals. The model accounts for the progression of subjects across HPV-induced health states (cervical, vaginal, vulvar, anal, penile, and head/neck cancer as well as anogenital warts). The sexual mixing is modeled on the basis of age-, sex-, and sexual behavioral-specific matrices to obtain the dynamic force of infection. RESULTS In comparison to cervical cancer screening, universal vaccination results in an incremental cost-effectiveness ratio of €1,500. When universal immunization is compared with female-only vaccination, it is cost-effective with an incremental cost-effectiveness ratio of €11,600. Probabilistic sensitivity analysis shows a relatively large amount of parameter uncertainty, which interestingly has, however, no substantial impact on the decision-making process. The intervention being assessed seems to be associated with an attractive cost-effectiveness profile. CONCLUSIONS Universal HPV vaccination is found to be a cost-effective choice when compared with either cervical cancer screening or female-only vaccination within the Italian context.
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Affiliation(s)
- Katrin Haeussler
- Department of Statistical Science, University College London, London, UK.
| | - Andrea Marcellusi
- Economic Evaluation and HTA, Faculty of Economics, University of Rome "Tor Vergata," Rome, Italy; Department of Demography, University of Rome "La Sapienza," Rome, Italy
| | - Francesco Saverio Mennini
- Economic Evaluation and HTA, Faculty of Economics, University of Rome "Tor Vergata," Rome, Italy; Institute of Leadership and Management in Health, Kingston University London, London, UK
| | - Giampiero Favato
- Institute of Leadership and Management in Health, Kingston University London, London, UK
| | - Mauro Picardo
- Laboratory of Cutaneous Pathophysiology, San Gallicano Dermatological Institute (IRCCS), Rome, Italy
| | - Giorgia Garganese
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Marco Bononi
- Department of Surgery Pietro Valdoni, University of Rome "La Sapienza," Rome, Italy
| | - Silvano Costa
- Department of Gynecology and Obstetrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Peter Zweifel
- Socioeconomic Institute, University of Zurich, Zurich, Switzerland
| | - Alessandro Capone
- Institute of Leadership and Management in Health, Kingston University London, London, UK
| | - Gianluca Baio
- Department of Statistical Science, University College London, London, UK
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13
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Audisio RA, Icardi G, Isidori AM, Liverani CA, Lombardi A, Mariani L, Mennini FS, Mitchell DA, Peracino A, Pecorelli S, Rezza G, Signorelli C, Rosati GV, Zuccotti GV. Public health value of universal HPV vaccination. Crit Rev Oncol Hematol 2015; 97:157-67. [PMID: 26346895 DOI: 10.1016/j.critrevonc.2015.07.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 07/28/2015] [Accepted: 07/29/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The story of Human Papillomavirus vaccination demands reflection not only for its public health impact on the prophylactic management of HPV disease, but also for its relevant economic and social outcomes. Greater than ever data confirm the efficacy and support the urge for effective vaccination plans for both genders before sexual debut. METHODS A review of previous experience in gender-restricted vaccination programs has demonstrated a lower effectiveness. Limiting vaccination to women might increase the psychological burden on women by confirming a perceived inequality between genders; and even if all women were immunized, the HPV chain of transmission would still be maintained through men. RESULTS The cost-effectiveness of including boys into HPV vaccination programs should be re-assessed in view of the progressive drop of the economic burden of HPV-related diseases in men and women due to universal vaccination. The cost of the remarkable increase in anal and oropharyngeal HPV driven cancers in both sexes has been grossly underestimated or ignored. CONCLUSIONS Steps must be taken by relevant bodies to achieve the target of universal vaccination. The analysis of HPV vaccination's clinical effectiveness vs. economic efficacy are supportive of the economic sustainability of vaccination programs both in women and men. In Europe, these achievements demand urgent attention to the social equity for both genders in healthcare. There is sufficient ethical, scientific, strategic and economic evidence to urge the European Community to develop and implement a coordinated and comprehensive strategy aimed at both genders and geographically balanced, to eradicate cervical cancer and other diseases caused by HPV in Europe. Policymakers must take into consideration effective vaccination programs in the prevention of cancers.
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Affiliation(s)
| | - Giancarlo Icardi
- Department of Health Sciences, Hygiene Unit, IRCCS AOU San Martino, IST University of Genoa, Genoa, Italy.
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
| | - Carlo A Liverani
- Department of Mother and Infant Sciences, Gynecologic Oncology Unit, University of Milan, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Alberto Lombardi
- Scientific and Medical Consultant, Fondazione Giovanni Lorenzini, Milan, Italy and Houston, TX, USA.
| | - Luciano Mariani
- Department of Gynecologic Oncology, HPV Unit, "Regina Elena" National Cancer Institute, Rome, Italy.
| | - Francesco Saverio Mennini
- Faculty of Economics, University of Rome Tor Vergata, Faculty of Statistics, University of Rome La Sapienza, Kingston University, London, UK.
| | - David A Mitchell
- Bradford Teaching Hospitals NHS Foundation Trust, St. Lukes Hospital, Bradford, UK.
| | - Andrea Peracino
- Fondazione Giovanni Lorenzini Medical Science Foundation, Milan, Italy and Houston, TX, USA.
| | | | - Giovanni Rezza
- Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
| | - Carlo Signorelli
- Department S.Bi.Bi.T., Unit of Public Health, University of Parma, Parma, Italy.
| | | | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Biomedical and Clinical Science Department, University of Milan, Milan, Italy.
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14
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Xu QX, Zhang ZY. High-risk Human Papillomavirus Genotypes in Cervical Lesions and Vaccination Challenges in China. Asian Pac J Cancer Prev 2015; 16:2193-7. [DOI: 10.7314/apjcp.2015.16.6.2193] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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