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Diakite I, Martins B, Owusu-Edusei K, Palmer C, Patterson-Lomba O, Gomez-Lievano A, Zion A, Simpson R, Daniels V, Elbasha E. Structured Literature Review to Identify Human Papillomavirus's Natural History Parameters for Dynamic Population Models of Vaccine Impacts. Infect Dis Ther 2024; 13:965-990. [PMID: 38589763 PMCID: PMC11098984 DOI: 10.1007/s40121-024-00952-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: 11/10/2023] [Accepted: 02/23/2024] [Indexed: 04/10/2024] Open
Abstract
Human papillomavirus (HPV) is a common sexually transmitted virus that can cause cervical cancer and other diseases. Dynamic transmission models (DTMs) have been developed to evaluate the health and economic impacts of HPV vaccination. These models typically include many parameters, such as natural history of the disease, transmission, demographic, behavioral, and screening. To ensure the accuracy of DTM projections, it is important to parameterize them with the best available evidence. This study aimed to identify and synthesize data needed to parametrize DTMs on the natural history of HPV infection and related diseases. Parameters describing data of interest were grouped by their anatomical location (genital warts, recurrent respiratory papillomatosis, and cervical, anal, vaginal, vulvar, head and neck, and penile cancers), and natural history (progression, regression, death, cure, recurrence, detection), and were identified through a systematic literature review (SLR) and complementary targeted literature reviews (TLRs). The extracted data were then synthesized by pooling parameter values across publications, and summarized using the range of values across studies reporting each parameter and the median value from the most relevant study. Data were extracted and synthesized from 223 studies identified in the SLR and TLRs. Parameters frequently reported pertained to cervical cancer outcomes, while data for other anatomical locations were less available. The synthesis of the data provides a large volume of parameter values to inform HPV DTMs, such as annual progression rates from cervical intraepithelial neoplasia (CIN) 1 to CIN 2+ (median of highest quality estimate 0.0836), CIN 2 to CIN 3+ (0.0418), carcinoma in situ (CIS) 2 to local cancer+ (0.0396), and regional to distant cancer (0.0474). Our findings suggest that while there is a large body of evidence on cervical cancer, parameter values featured substantial heterogeneity across studies, and further studies are needed to better parametrize the non-cervical components of HPV DTMs.
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Affiliation(s)
- Ibrahim Diakite
- Health Economic and Decision Sciences, Merck & Co., Inc., Rahway, NJ, 07065, USA.
- Merck & Co., Inc. Biostatistics and Research Decision Sciences (BARDS), Health Economic and Decision Sciences (HEDS), Vaccines, WP 37A-150 770 Sumneytown Pike, 1st Floor, West Point, PA, 19486, USA.
| | - Bruno Martins
- Analysis Group, Inc, 111 Huntington Avenue, 14th Floor, Boston, MA, 02199, USA
| | - Kwame Owusu-Edusei
- Health Economic and Decision Sciences, Merck & Co., Inc., Rahway, NJ, 07065, USA
| | - Cody Palmer
- Health Economic and Decision Sciences, Merck & Co., Inc., Rahway, NJ, 07065, USA
| | | | | | - Abigail Zion
- Analysis Group, Inc, 111 Huntington Avenue, 14th Floor, Boston, MA, 02199, USA
| | - Ryan Simpson
- Analysis Group, Inc, 111 Huntington Avenue, 14th Floor, Boston, MA, 02199, USA
| | - Vincent Daniels
- Health Economic and Decision Sciences, Merck & Co., Inc., Rahway, NJ, 07065, USA
| | - Elamin Elbasha
- Health Economic and Decision Sciences, Merck & Co., Inc., Rahway, NJ, 07065, USA
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Gamachu M, Mussa I, Deressa A, Tolera M, Birhanu A, Getachew T, Negash A, Jibro U, Abdurahman D, Motuma A, Mohammed F, Balis B, Demissie Regassa L. Patterns of basic pneumococcal conjugated vaccine coverage in Ethiopia from 2015 to 2018; further analysis of Ethiopian DHS (2016-2019). Vaccine X 2024; 17:100428. [PMID: 38299201 PMCID: PMC10825603 DOI: 10.1016/j.jvacx.2024.100428] [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: 08/31/2023] [Revised: 12/26/2023] [Accepted: 01/01/2024] [Indexed: 02/02/2024] Open
Abstract
Background Geographic variation is crucial in spotting performance gaps in immunization programs, including the Pneumococcal Conjugated Vaccine (PCV). This will help speed up targeted vaccination and disease elimination programs in resource-limited countries. Thus, this study aimed to investigate the geographic variation and determinants of PCV vaccination coverage among children aged under five years old in Ethiopia. Methods This analysis was carried out based on the 2016 and 2019 nationally representative Ethiopia Demographic and Health Survey (EDHS). We included two surveys of 10,640 children aged 12-23 months. The spatial analysis also covered 645 and 305 clusters with geographical information for both 2016 and 2019, respectively. We explored the spatial distribution, global spatial autocorrelation, spatial interpolation, and Stats Can windows of children with PCV-3 vaccination. P-values were generated using 999 Monte Carlo simulations to identify statistically significant clusters. To understand the coverage of PCV-3 in all areas of the country, we employed the ordinary Kriging interpolation method to estimate the coverage in unsampled areas. We also used hierarchical multivariate logistic regression to identify the factors associated with the utilization of the PCV vaccine (full vaccination). Results Except for Addis Ababa, children in all regions have lower odds of receiving all three PCV vaccines compared to the Tigray region. Residence, sex of a child, mother's literacy status, household wealth index, and place of delivery were significant factors associated with receiving the third dose of PCV. Spatial analysis also showed the Somali and Afar regions had the lowest coverage, while the Addis Ababa and Tigray regions had higher coverage in both surveys. Conclusion Even though the coverage of the full PCV vaccine improved from 2016 to 2019, variation was observed among regions and between rural and urban areas. The wealth index and educational status of mothers were the most important determinants of PCV vaccine utilization. Hence, the mass campaign might boost coverage in nomadic and semi-nomadic regions and rural areas. Similarly, programs that narrow the gap due to low socioeconomic differences should be formulated and implemented to increase uptake and general coverage.
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Affiliation(s)
- Mulugeta Gamachu
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Ibsa Mussa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Alemayehu Deressa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Moti Tolera
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abdi Birhanu
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tamirat Getachew
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abraham Negash
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Usmael Jibro
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dureti Abdurahman
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Aboma Motuma
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fethia Mohammed
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bikila Balis
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lemma Demissie Regassa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Windon MJ, D'Souza G, Fakhry C. The evolving landscape of oropharyngeal cancer: a window of opportunity for primary prevention. J Natl Cancer Inst 2023; 115:1454-1456. [PMID: 37794753 DOI: 10.1093/jnci/djad171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 07/30/2023] [Indexed: 10/06/2023] Open
Affiliation(s)
- Melina J Windon
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, KY, USA
| | - Gypsyamber D'Souza
- Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carole Fakhry
- Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University, Baltimore, MD, USA
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Sy F, Berner-Rodoreda A, Asnake T, Getnet M, Amogne W, Bussmann H, Abera H, Bärnighausen T, Deckert A. Exploring computer-aided health decision-making on cervical cancer interventions through deliberative interviews in Ethiopia. NPJ Digit Med 2023; 6:68. [PMID: 37069432 PMCID: PMC10106317 DOI: 10.1038/s41746-023-00808-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 03/30/2023] [Indexed: 04/19/2023] Open
Abstract
Cervical cancer is a significant disease burden in Ethiopia. Mathematical models and computer simulations on disease dynamics can support effective resource allocation. The objectives of this work are (i) to explore the perspectives of health decision-makers on computer-aided predictions supporting cervical cancer interventions, (ii) to identify their information needs from these predictions, and (iii) their willingness to apply the results in their work. We conducted deliberative interviews with 15 health decision-makers and advisors in Ethiopia in autumn 2019. We analyze the data using a five steps framework approach drawing on thematic analysis and find that Ethiopian health decision-makers are willing to use computer-aided predictions in their decisions. Data on HPV prevalence and the cervical cancer burden are scarce but valued highly and decision-makers are particularly interested in the identification of local HPV hotspots. Data-driven mathematical models and computer simulations may increasingly influence health decision-making in Ethiopia.
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Affiliation(s)
- Frithjof Sy
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.
| | | | | | - Misrak Getnet
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Wondwossen Amogne
- Infectious Disease Department (TASH) Addis Ababa University, Addis Ababa, Ethiopia
| | - Hermann Bussmann
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Helen Abera
- Infectious Disease Department (TASH) Addis Ababa University, Addis Ababa, Ethiopia
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Harvard Center for Population & Development Studies, Harvard University, Cambridge, MA, USA
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Andreas Deckert
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.
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Segal HA, Rashid N. A targeted literature review of health economic analyses of human papillomavirus vaccination from various countries. Int J STD AIDS 2023:9564624231165547. [DOI: 10.1177/09564624231165547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Background Understanding the cost-effectiveness of the HPV vaccine from a global perspective is important to assess from a policy perspective and to support current and future HPV vaccination programs. Objectives The aim of this analysis was to conduct a targeted literature review of published pharmacoeconomic literature on the cost-effectiveness of the HPV vaccine to treat patients in various countries, with a focus on cost-savings and their impact on vaccine recommendations. Methods We searched cost-effectiveness studies in HPV published in peer-reviewed literature from 2012 to 2020 using MEDLINE via the PubMed database and Google Scholar. Results HPV vaccine cost-effectiveness was found to be greatest in low-income countries where screen programs were not yet in place, additionally, in adolescent males and females. The majority of the economic evaluations viewed the implementation of the HPV vaccine as cost-effective and recommended national HPV vaccination. Conclusion The majority of economic studies favored national HPV vaccination for adolescent males and females in various countries. Feasibility of this strategy and implementation remains an open question, in addition to screening coverage rate in countries with no vaccine programs or countries yet to introduce national HPV vaccination.
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Choi HCW, Leung K, Chan KKL, Bai Y, Jit M, Wu JT. Maximizing the cost-effectiveness of cervical screening in the context of routine HPV vaccination by optimizing screening strategies with respect to vaccine uptake: a modeling analysis. BMC Med 2023; 21:48. [PMID: 36765349 PMCID: PMC9921628 DOI: 10.1186/s12916-023-02748-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/23/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Regarding primary and secondary cervical cancer prevention, the World Health Organization proposed the cervical cancer elimination strategy that requires countries to achieve 90% uptake of human papillomavirus (HPV) vaccines and 70% screening uptake. The optimal cervical screening strategy is likely different for unvaccinated and vaccinated cohorts upon national HPV immunization. However, health authorities typically only provide a one-size-fits-all recommendation for the general population. We aimed to evaluate the cost-effectiveness for determining the optimal screening strategies for vaccinated and unvaccinated cohorts. METHODS We considered the women population in Hong Kong which has a unique HPV infection and cervical cancer epidemiology compared to other regions in China and Asia. We used mathematical models which comprise a deterministic age-structured compartmental dynamic component and a stochastic individual-based cohort component to evaluate the cost-effectiveness of screening strategies for cervical screening. Following the recommendations in local guidelines in Hong Kong, we considered strategies that involved cytology, HPV testing, or co-testing as primary cervical screening. We also explored the impacts of adopting alternative de-intensified strategies for vaccinated cohorts. The 3-year cytology screening was used as the base comparator while no screening was also considered for vaccinated cohorts. Women's lifetime life years, quality-adjusted life years, and costs of screening and treatment were estimated from the societal perspective based on the year 2022 and were discounted by 3% annually. Incremental cost-effectiveness ratios (ICERs) were compared to a willingness to pay (WTP) threshold of one gross domestic product per capita (US $47,792). Probabilistic and one-way sensitivity analyses were conducted. RESULTS Among unvaccinated cohorts, the strategy that adds reflex HPV to triage mild cytology abnormality generated more life years saved than cytology-only screening and could be a cost-effective alternative. Among vaccinated cohorts, when vaccine uptake was 85% (based on the uptake in 2022), all guideline-based strategies (including the cytology-only screening) had ICERs above the WTP threshold when compared with no screening if the vaccine-induced protection duration was 20 years or longer. Under the same conditions, HPV testing with genotyping triage had ICERs (compared with no screening) below the WTP threshold if the routine screening interval was lengthened to 10 and 15 years or screening was initiated at ages 30 and 35 years. CONCLUSIONS HPV testing is a cost-effective alternative to cytology for vaccinated cohorts, and the associated optimal screening frequency depends on vaccine uptake. Health authorities should optimize screening recommendations by accounting for population vaccine uptake.
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Affiliation(s)
- Horace C W Choi
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Patrick Manson Building (North Wing), 7 Sassoon Road, Hong Kong Special Administrative Region, China. .,Laboratory of Data Discovery for Health Limited, Hong Kong Science Park, Hong Kong Special Administrative Region, China.
| | - Kathy Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Patrick Manson Building (North Wing), 7 Sassoon Road, Hong Kong Special Administrative Region, China.,Laboratory of Data Discovery for Health Limited, Hong Kong Science Park, Hong Kong Special Administrative Region, China
| | - Karen K L Chan
- Department of Obstetrics and Gynaecology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yuan Bai
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Patrick Manson Building (North Wing), 7 Sassoon Road, Hong Kong Special Administrative Region, China.,Laboratory of Data Discovery for Health Limited, Hong Kong Science Park, Hong Kong Special Administrative Region, China
| | - Mark Jit
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Patrick Manson Building (North Wing), 7 Sassoon Road, Hong Kong Special Administrative Region, China.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Modelling and Economics Unit, Public Health England, London, UK
| | - Joseph T Wu
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Patrick Manson Building (North Wing), 7 Sassoon Road, Hong Kong Special Administrative Region, China.,Laboratory of Data Discovery for Health Limited, Hong Kong Science Park, Hong Kong Special Administrative Region, China
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7
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Drevinskaite M, Patasius A, Kincius M, Jonušas J, Ladukas A, Jievaltas M, Kairevice L, Smailyte G. Incidence, mortality and survival trends of penile cancer in Lithuania 1998-2017. Front Oncol 2023; 13:1124101. [PMID: 37213282 PMCID: PMC10196467 DOI: 10.3389/fonc.2023.1124101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/24/2023] [Indexed: 05/23/2023] Open
Abstract
Background and objectives The aim of this study was to analyse trends in penile cancer incidence, mortality, and relative survival in Lithuania during the period of 1998-2017. Materials and methods The study was based on all cases of penile cancer reported to the Lithuanian Cancer Registry between 1998 and 2017. Age-specific rates standardized rates were calculated, using the direct method (World standard population). The Joinpoint regression model was used to provide estimated average annual percentage change (AAPC). One-year and five-year relative survival estimates were calculated using period analysis. Relative survival was calculated as the ratio of the observed survival of cancer patients and the expected survival of the underlying general population. Results During the study period, the age-standardized incidence rate of penile cancer varied between 0.72 and 1.64 per 100 000, with AAPC 0.9% (95% CI -0.8-2.7). The mortality rate of penile cancer in Lithuania during this period varied from 0.18 to 0.69 per 100 000, with AAPC of -2.6% (95% CI -5.3-0.3). Relative one-year survival of patients, diagnosed with penile cancer improved over the time from 75.84% in period 1998-2001 to 89.33% in period 2014-2017. Relative five-year survival rate of patients, diagnosed with penile cancer changed from 55.44% in period 1998-2001 to 72.90% in period 2014-2017. Conclusions The incidence rates of penile cancer showed an increasing trend, while mortality rates were decreasing in Lithuania during 1998-2017. One-year and five-year relative survival increased, however, it does not reach the highest scores of Northern European countries.
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Affiliation(s)
- Mingaile Drevinskaite
- Laboratory of Cancer Epidemiology, National Cancer Institute, Vilnius, Lithuania
- *Correspondence: Mingaile Drevinskaite,
| | - Ausvydas Patasius
- Laboratory of Cancer Epidemiology, National Cancer Institute, Vilnius, Lithuania
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Marius Kincius
- Laboratory of Clinical Oncology, National Cancer Institute, Vilnius, Lithuania
| | - Justinas Jonušas
- Laboratory of Cancer Epidemiology, National Cancer Institute, Vilnius, Lithuania
- The Clinic of Internal Diseases, Family Medicine and Oncology, Faculty of Medicine, Vilnius Universitys, Vilnius, Lithuania
| | - Adomas Ladukas
- Laboratory of Cancer Epidemiology, National Cancer Institute, Vilnius, Lithuania
| | - Mindaugas Jievaltas
- Urology Department, Lithuanian University of Health Sciences, Medicine Academy, Kaunas, Lithuania
| | - Laura Kairevice
- Department of Oncology and Hematology, Institute of Oncology, Medical Faculty, Lithuanian University of Health Science, Kaunas, Lithuania
| | - Giedre Smailyte
- Laboratory of Cancer Epidemiology, National Cancer Institute, Vilnius, Lithuania
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Palmer C, Tobe K, Negishi Y, You X, Chen YT, Abe M. Health impact and cost effectiveness of implementing gender-neutral HPV vaccination in Japan. J Med Econ 2023; 26:1546-1554. [PMID: 37962015 DOI: 10.1080/13696998.2023.2282912] [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: 10/03/2023] [Accepted: 11/09/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE To assess the public health impact and cost effectiveness of gender-neutral vaccination (GNV) versus female-only vaccination (FOV) with human papillomavirus (HPV) vaccination in Japan. METHODS We modeled the public health impact and cost effectiveness of GNV versus FOV to prevent HPV-associated diseases in Japan over the next 100 years. We used one-way sensitivity analyses to examine the impact of varying key model input parameters and conducted scenario analyses to explore the effects of varying the vaccination coverage rate (VCR) of each cohort. RESULTS In the base-case analysis, GNV averted additional cancer cases (17,228 female/6,033 male) and deaths (1,892 female/1,849 male) compared to FOV. When all HPV-associated diseases were considered, GNV had an incremental cost-effectiveness ratio of ¥4,732,320 (US$35,987)/quality-adjusted life year gained compared to FOV. The model was most sensitive to the discount rate and the disutility associated with HPV-related diseases. GNV had greater relative public health benefits when the female VCR was lower and was cost effective at a female VCR of 30%. CONCLUSIONS Immediate implementation of GNV would reduce the disease burden and mortality associated with HPV in Japan, and would be cost effective compared to FOV if the female VCR remains low (30%).
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Affiliation(s)
- Cody Palmer
- Biostatistics & Research Decision Sciences, Merck & Co., Inc, Rahway, NJ, USA
| | | | | | - Xuedan You
- Center for Observational & Real-world Evidence (CORE), Merck & Co., Inc, Rahway, NJ, USA
| | - Ya-Ting Chen
- Center for Observational & Real-world Evidence (CORE), Merck & Co., Inc, Rahway, NJ, USA
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Dykens JA, Peterson CE, Holt HK, Harper DM. Gender neutral HPV vaccination programs: Reconsidering policies to expand cancer prevention globally. Front Public Health 2023; 11:1067299. [PMID: 36895694 PMCID: PMC9989021 DOI: 10.3389/fpubh.2023.1067299] [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: 10/11/2022] [Accepted: 01/23/2023] [Indexed: 02/23/2023] Open
Abstract
Human papillomavirus (HPV) infection is responsible for many cancers in both women and men. Cervical cancer, caused by HPV, is the fourth most common cancer among women worldwide, even though it is one of the most preventable cancers. Prevention efforts include HPV vaccination, however these programs remain nascent in many countries. In 2020 the World Health Assembly adopted the Global Strategy for cervical cancer elimination including a goal to fully vaccinate 90% of girls with the HPV vaccine by the age of 15. However, very few countries have reached even 70% coverage. Increased vaccine availability in the future may allow the opportunity to vaccinate more people. This could add to the feasibility of introducing gender-neutral HPV vaccination programs. Adopting a gender-neutral HPV vaccine approach will reduce HPV infections transmitted among the population, combat misinformation, minimize vaccine-related stigma, and promote gender equity. We propose approaching programmatic research through a gender-neutral lens to reduce HPV infections and cancers and promote gender equality. In order to design more effective policies and programs, a better understanding of the perspectives of clients, clinicians, community leaders, and policy-makers is needed. A clear, multi-level understanding of these stakeholders' views will facilitate the development of target policy and programs aimed at addressing common barriers and optimizing uptake. Given the benefit of developing gender-neutral HPV vaccination programs to eliminate cervical cancer and address other HPV associated cancers, we must build knowledge through implementation research around this topic to inform policy-makers and funders for future policy shifts.
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Affiliation(s)
- J Andrew Dykens
- Department of Family and Community Medicine, College of Medicine, University of Illinois Chicago, Chicago, IL, United States.,Center for Global Health, College of Medicine, University of Illinois Chicago, Chicago, IL, United States.,Cancer Center, College of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Caryn E Peterson
- Center for Global Health, College of Medicine, University of Illinois Chicago, Chicago, IL, United States.,Cancer Center, College of Medicine, University of Illinois Chicago, Chicago, IL, United States.,Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Hunter K Holt
- Department of Family and Community Medicine, College of Medicine, University of Illinois Chicago, Chicago, IL, United States.,Cancer Center, College of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Diane M Harper
- Department of Family Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, United States.,Department of Obstetrics & Gynecology, School of Medicine, University of Michigan, Ann Arbor, MI, United States.,Department of Women's Studies, College of Literature, Science and the Arts, University of Michigan, Ann Arbor, MI, United States
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Diakite I, Nguyen S, Sabale U, Pavelyev A, Saxena K, Tajik AA, Wang W, Palmer C. Public health impact and cost-effectiveness of switching from bivalent to nonavalent vaccine for human papillomavirus in Norway: incorporating the full health impact of all HPV-related diseases. J Med Econ 2023; 26:1085-1098. [PMID: 37608730 DOI: 10.1080/13696998.2023.2250194] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/24/2023]
Abstract
AIM The objective of this study was to estimate and compare the cost-effectiveness of switching from a bivalent to a nonavalent human papillomavirus (HPV) vaccination program in Norway, incorporating all nonavalent vaccine-preventable HPV-related diseases and in the context of the latest cervical cancer screening program. METHODS A well-established dynamic transmission model of the natural history of HPV infection and disease was adapted to the Norwegian population. We determined the number of cases of HPV-related diseases and subsequent number of deaths, and the economic burden of HPV-related disease under the current standard of care conditions of bivalent and nonavalent vaccinations of girls and boys aged 12 years. RESULTS Compared to bivalent vaccination, nonavalent vaccination averted an additional 4,357 cases of HPV-related cancers, 421,925 cases of genital warts, and 543 cases of recurrent respiratory papillomatosis (RRP) over a 100-year time horizon. Nonavalent vaccination also averted an additional 1,044 deaths over the 100-year time horizon when compared with bivalent vaccination. Total costs were higher for the nonavalent strategy (10.5 billion NOK [€1.03 billion] vs. 9.3-9.4 billion NOK [€915-925 million] for bivalent vaccination). A switch to nonavalent vaccination had a higher vaccination cost (4.4 billion NOK [€433 million] vs. 2.7 billion NOK [€266 million] for bivalent vaccination) but resulted in a savings of 627-694 million NOK [€62-68 million] in treatment costs. A switch to nonavalent vaccination demonstrated an incremental cost-effectiveness ratio of 102,500 NOK (€10,086) per QALY versus bivalent vaccination. CONCLUSIONS Using a model that incorporated the full range of HPV-related diseases, and the latest cervical cancer screening practices, we found that switching from bivalent to nonavalent vaccination would be considered cost-effective in Norway.
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Affiliation(s)
- Ibrahim Diakite
- Health Economic and Decision Sciences, Merck & Co., Inc., Rahway, NJ, USA
| | | | - Ugne Sabale
- Center for Observational and Real-World Evidence, MSD, Stockholm, Sweden
| | - Andrew Pavelyev
- Health Economic and Decision Sciences, Merck & Co., Inc., Rahway, NJ, USA
| | - Kunal Saxena
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Rahway, NJ, USA
| | | | - Wei Wang
- Health Economic and Decision Sciences, Merck & Co., Inc., Rahway, NJ, USA
| | - Cody Palmer
- Health Economic and Decision Sciences, Merck & Co., Inc., Rahway, NJ, USA
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Abstract
Persistent human papillomavirus infection is the central cause of cervical cancer, the leading cause of cancer death among women worldwide. Clear evidence from both randomized trials and population based studies shows that vaccination against human papillomavirus reduces the incidence of cervical pre-cancer. These data suggest that the vaccine reduces the incidence of cervical cancer. However, human papillomavirus vaccine coverage is inadequate in all countries, especially in low and middle income countries where disease burden is highest. Supply side strategies to improve coverage include increasing the availability of low cost vaccines, school located delivery, single dose vaccine schedules, and development of vaccines that do not need refrigeration. Demand side strategies include enhancing provider recommendations, correcting misinformation, and public awareness campaigns. The near elimination of cervical cancer is achievable through increased uptake of human papillomavirus vaccination and efforts to increase screening for cervical cancer, especially when enacted to reduce disparities in across the world.
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Affiliation(s)
- Lisa Rahangdale
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Chemtai Mungo
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Siobhan O'Connor
- Department of Pathology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Carla J Chibwesha
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Clinical HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Noel T Brewer
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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12
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Sun L, Hu J, Gao H, Wang S, Wang B, Wang J, Li H, Wang J, Yuan C, Zhang X. Long-term effect of mobile phone-based education and influencing factors of willingness to receive HPV vaccination among female freshmen in Shanxi Province, China. Hum Vaccin Immunother 2022; 18:2051990. [PMID: 35446735 PMCID: PMC9225224 DOI: 10.1080/21645515.2022.2051990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND This study was conducted to characterize the long-term effect of mobile-based education on Chinese female freshmen and disclose the possible predictors of their willingness to get vaccinated based on the information-motivation-behavioral skills (IMB) model. METHODS We randomly assigned 509 participants to a 7-day mobile-based educational intervention or control group and collected information about general information, health, and sexual behavior, HPV vaccination intention and action, HPV-related knowledge, cognition, and behavioral skill by an online self-administrated questionnaire at baseline, post-intervention, and at the 1-month and 3-month follow-ups. RESULTS The intervention arm showed an improvement in IMB scores after education. Despite the persistent improvement in knowledge, the improvement in their motivation and behavioral skills decreased at the 1-month and 3-month follow-ups. Participants' vaccination willingness was elevated after the baseline survey in both the intervention and control groups, while the overall appointment/vaccination rate was only 3.73% 3 months later. The intention to get vaccinated was associated with knowing HPV (adjusted OR: 2.37, 95% CI: 1.44 - 3.89), perceiving more barriers (adjusted OR: 2.16, 95% CI: 1.44 - 3.25), higher subjective norms (adjusted OR: 2.05, 95% CI: 1.26 - 3.32), and having more behavioral skills (adjusted OR: 2.95, 95% CI: 1.79 - 4.87). CONCLUSION Seven-day mobile-based education was effective to increase IMB model scores among female freshmen. However, the improvement in motivation and behavioral skills was not persistent. Information, perceived barriers, subjective norms, and behavioral skills were discovered to be influencing factors of vaccination intention. Future research with longer, more convenient, and more tailored education to the main influencing factors is warranted.
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Affiliation(s)
- Liying Sun
- Department of Pediatrics and Adolescent Gynecology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jingjing Hu
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Huihui Gao
- Department of Pediatrics and Adolescent Gynecology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Sunyi Wang
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Binghan Wang
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiawen Wang
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hui Li
- Division of Health Promotion, Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Jianbing Wang
- Department of Epidemiology and Biostatistics at School of Public Health and National Clinical Research Center for Child Health of the Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Changzheng Yuan
- Department of Pediatrics and Adolescent Gynecology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.,School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Xi Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing, China
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13
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Mo ZJ, Bi ZF, Sheng W, Chen Q, Huang T, Li MQ, Cui XL, Wangjiang YH, Lin BZ, Zheng FZ, Sun G, Li YF, Zheng Y, Zhuang SJ, Su YY, Pan HR, Huang SJ, Wu T, Zhang J, Xia NS. Safety and immunogenicity of an Escherichia coli-produced bivalent human papillomavirus type 6/11 vaccine: A dose-escalation, randomized, double-blind, placebo-controlled phase 1 trial. Hum Vaccin Immunother 2022; 18:2092363. [PMID: 35834812 DOI: 10.1080/21645515.2022.2092363] [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: 12/15/2022] Open
Abstract
A dose-escalation, randomized, double-blind, placebo-controlled phase 1 clinical trial enrolled 145 eligible participants aged 18-55 years in March 2015 in Liuzhou, China. Stratified by age and sex, the participants were randomly assigned to receive either 30, 60, or 90 μg of the HPV-6/11 vaccine (n = 41/40/40) or the parallel placebo vaccine (n = 8/8/8) with a 0/1/6-month dose-escalation schedule. Participants were actively followed-up to record local and systemic AEs occurring within 30 days after each vaccination, and SAEs occurred in 7 months. Blood and urine samples of each participant were collected before and 2 days after the first and third vaccination to determine changes in routine blood, serum biochemical, and urine indexes. Serum HPV-6/11-specific IgG and neutralizing antibody levels at month 7 were analyzed. A total of 79 adverse events were reported, and no SAEs occurred. The incidences of total adverse reactions in the 30 μg, 60 μg, and 90 μg HPV vaccine groups and the control group were 31.7%, 50.0%, 42.5%, and 62.5%, respectively. All but one of the adverse reactions was mild or moderate with grade 1 or 2. No vaccine-related changes with clinical significance were found in paired blood and urine indexes before and after vaccinations. All the participants in the per-protocol set seroconverted at month 7 for both IgG and neutralizing antibodies. The candidate novel Escherichia-coli-produced bivalent HPV-6/11 vaccine has been preliminarily proven to be well tolerated and with robust immunogenicity in a phase 1 clinical study, supporting further trials with larger sample size. The study has been registered at ClinicalTrials.gov (NCT02405520).
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Affiliation(s)
- Zhao-Jun Mo
- Expanded Program on Immunization Department, Guangxi Center for Disease Control and Prevention, Nanning, Guangxi, China
| | - Zhao-Feng Bi
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Xiamen University, Xiamen, Fujian, China
| | - Wei Sheng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Xiamen University, Xiamen, Fujian, China
| | - Qi Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Xiamen University, Xiamen, Fujian, China
| | - Teng Huang
- Expanded Program on Immunization Department, Guangxi Center for Disease Control and Prevention, Nanning, Guangxi, China
| | - Ming-Qiang Li
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, China
| | - Xue-Lian Cui
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, China
| | - Ya-Hui Wangjiang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Xiamen University, Xiamen, Fujian, China
| | - Bi-Zhen Lin
- Vaccine R&D Department, Xiamen Innovax Biotech Company, Xiamen, Fujian, China
| | - Feng-Zhu Zheng
- Vaccine R&D Department, Xiamen Innovax Biotech Company, Xiamen, Fujian, China
| | - Guang Sun
- Vaccine R&D Department, Xiamen Innovax Biotech Company, Xiamen, Fujian, China
| | - Ya-Fei Li
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Xiamen University, Xiamen, Fujian, China
| | - Ya Zheng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Xiamen University, Xiamen, Fujian, China
| | - Si-Jie Zhuang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Xiamen University, Xiamen, Fujian, China
| | - Ying-Ying Su
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Xiamen University, Xiamen, Fujian, China
| | - Hui-Rong Pan
- Vaccine R&D Department, Xiamen Innovax Biotech Company, Xiamen, Fujian, China
| | - Shou-Jie Huang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Xiamen University, Xiamen, Fujian, China
| | - Ting Wu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Xiamen University, Xiamen, Fujian, China
| | - Jun Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Xiamen University, Xiamen, Fujian, China
| | - Ning-Shao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, Xiamen University, Xiamen, Fujian, China
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14
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Al-Kassab-Córdova A, Silva-Perez C, Maguiña JL. Spatial distribution, determinants and trends of full vaccination coverage in children aged 12-59 months in Peru: A subanalysis of the Peruvian Demographic and Health Survey. BMJ Open 2022; 12:e050211. [PMID: 36368757 PMCID: PMC9660560 DOI: 10.1136/bmjopen-2021-050211] [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] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess the spatial distribution, trends and determinants of crude full vaccination coverage (FVC) in children aged 12-59 months between 2010 and 2019 in Peru. DESIGN, SETTING AND ANALYSIS A cross-sectional study based on the secondary data analysis of the 2010 and 2019 Peruvian Demographic and Health Surveys (DHSs) was conducted. Logit based multivariate decomposition analysis was employed to identify factors contributing to differences in FVC between 2010 and 2019. The spatial distribution of FVC in 2019 was evaluated through spatial autocorrelation (Global Moran's I), ordinary kriging interpolation (Gaussian process regression) and Bernoulli-based purely spatial scan statistic. OUTCOME MEASURE FVC, as crude coverage, was defined as having completely received BCG; three doses of diphtheria, pertussis, and tetanus, and polio vaccines; and measles vaccine by 12 months of age. PARTICIPANTS A total of 5 751 and 14 144 children aged 12-59 months from 2010 and 2019 DHSs, respectively, were included. RESULTS FVC increased from 53.62% (95% CI 51.75% to 55.49%) in 2010 to 75.86% (95% CI 74.84% to 76.85%) in 2019. Most of the increase (70.39%) was attributable to differences in coefficients effects. Family size, visit of health workers in the last 12 months, age of the mother at first delivery, place of delivery and antenatal care follow-up were all significantly associated with the increase. The trend of FVC was non-linear and increased by 2.22% annually between 2010 and 2019. FVC distribution was heterogeneous at intradepartmental and interdepartmental level. Seven high-risk clusters of incomplete coverage were identified. CONCLUSIONS Although FVC has increased in Peru, it still remains below the recommended threshold. The increase of FVC was mainly attributed to the change in the effects of the characteristics of the population. There was high heterogeneity across Peruvian regions with the presence of high-risk clusters. Interventions must be redirected to reduce these geographical disparities.
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Affiliation(s)
- Ali Al-Kassab-Córdova
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Claudia Silva-Perez
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Jorge L Maguiña
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
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15
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Owusu-Edusei K, Palmer C, Ovcinnikova O, Favato G, Daniels V. Assessing the Health and Economic Outcomes of a 9-Valent HPV Vaccination Program in the United Kingdom. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2022; 9:140-150. [PMID: 35795155 PMCID: PMC9170517 DOI: 10.36469/001c.34721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/20/2022] [Indexed: 06/15/2023]
Abstract
Background: The United Kingdom (UK) switched from using the 4-valent human papillomavirus (HPV) vaccine (Gardasil®) to the 9-valent vaccine (Gardasil 9®) in 2021. Objective: To estimate and compare the health and economic outcomes of 2 HPV vaccination programs in the UK targeting girls and boys aged 12-13 years from the perspective of the UK National Health Service. The 2 vaccination strategies were (1) universal vaccination 4-valent (UV4V), using the 4-valent HPV vaccine (4vHPV), and (2) universal vaccination 9-valent (UV9V), using the 9-valent HPV vaccine (9vHPV). Methods: A deterministic heterosexual compartmental disease transmission model was used to track health and economic outcomes over a 100-year time horizon. Outcomes were discounted at an annual rate of 3.5% and 1.5%. All costs were adjusted to 2020 British pounds (£). Health outcomes were measured in quality-adjusted life-years (QALYs), and the summary results were presented as incremental cost-effectiveness ratios (£/QALY gained) when comparing UV4V with UV9V. Results: Using the same vaccine coverage for both programs, the total cumulative cases of HPV-related health outcomes tracked over the 100-year horizon indicated that the relative number of cases averted (UV9V vs UV4V) ranged from 4% (anal male cancers and deaths) to 56% (cervical intraepithelial neoplasia [CIN1]). Assuming that 9vHPV cost £15.18 more than 4vHPV (a cost differential based on discounted list prices), the estimated incremental cost-effectiveness ratio was £8600/QALY gained when discounted at 3.5%, and £3300/QALY gained when discounted at 1.5%. The estimated incremental cost-effectiveness ratios from the sensitivity analyses remained <£28000/QALY over a wide range of parameter inputs and demonstrated that disease utilities, discount rate, and vaccine efficacy were the 3 most influential parameters. Discussion: Consistent with other published studies, the results from this study found that the 9vHPV vaccine prevented a substantial number of cases when compared with the 4vHPV vaccine and was highly cost-effective. Conclusions: These results demonstrate that replacing universal 4vHPV with 9vHPV can prevent a substantial additional number of HPV-related cases/deaths (in both women and men) and remain cost-effective over a range of 9vHPV price premiums.
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16
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HPV Vaccination: An Underused Strategy for the Prevention of Cancer. Curr Oncol 2022; 29:3780-3792. [PMID: 35621693 PMCID: PMC9140027 DOI: 10.3390/curroncol29050303] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/28/2022] [Accepted: 05/13/2022] [Indexed: 01/08/2023] Open
Abstract
Human papillomavirus (HPV) vaccination prevents cervical, head and neck, and anogenital cancers. However, global HPV vaccine coverage falls short of global targets and has seen unexpected and dramatic declines in some countries. This paper synthesizes the impact of HPV on the global burden of cancer and the potential benefit of HPV vaccination. Approximately 5% of the world’s cancers are specifically attributed to HPV. While the greatest global burden of HPV is cervical cancers in low- and middle-income countries, HPV-associated head and neck cancers are increasing in high-income countries and have surpassed cervical cancer as the primary HPV-associated cancer in some countries. Therefore, it is also critical to improve gender-neutral HPV vaccination. Understanding the modifiable drivers of vaccine acceptance and uptake is important for increasing HPV vaccination. The Behavioural and Social Drivers of Vaccination framework is broadly applied to identify key factors associated with HPV vaccination including domains concerning practical issues, motivation, social processes, and thinking and feeling. Among the behavioural strategies available to reduce the incidence and mortality of cancer, increasing HPV vaccination stands out as having unrealized potential to prevent disease, financial cost, and psychological distress. An understanding of the shifting burden of HPV and the factors associated with vaccination can be leveraged to regularly measure these factors, develop interventions to promote vaccine uptake, and improve global HPV vaccine coverage. Future research in diverse contexts is necessary to investigate the barriers and facilitators of global HPV vaccination.
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17
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HPV Vaccination: Does It Have a Role in Preventing Penile Cancer and Other Preneoplastic Lesions? Semin Oncol Nurs 2022; 38:151284. [DOI: 10.1016/j.soncn.2022.151284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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18
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Tran PT, Riaz M, Chen Z, Truong CB, Diaby V. An Umbrella Review of the Cost Effectiveness of Human Papillomavirus Vaccines. Clin Drug Investig 2022; 42:377-390. [PMID: 35488964 DOI: 10.1007/s40261-022-01155-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Although many systematic reviews for the human papillomavirus vaccines cost effectiveness have been published, they vary in perspectives, methods, and quality. We aimed to condense systematically such evidence to facilitate locating, processing, and learning, not only about the consensus of findings but also how models were built and their evolution over time and across settings. METHODS We conducted an umbrella review of cost-effectiveness studies for human papillomavirus vaccines using three databases (PubMed, Embase, and Cochrane). Based on their objectives, we classified studies into three groups (human papillomavirus vaccines cost effectiveness, model characteristics, and all-type vaccines, including human papillomavirus vaccines). We used the AMTAR2 to assess the quality of the studies. Additionally, we provided a summary of study findings, discussions, and evidence gaps in the literature. RESULTS Though most studies were critically low quality and had a low quality of reporting, the human papillomavirus vaccine was consistently cost effective in young girls and men who have sex with men. Stratified analyses by rated quality did not change the results. The quality assessment of the reviews did not necessarily reflect the quality assessment of underlying studies. The human papillomavirus vaccine models became more complex over time, capturing more realistic disease transmission with different human papillomavirus strains and herd immunities. CONCLUSIONS Additional evidence is needed for vulnerable populations (e.g., childhood cancer survivors) who are at high risk for human papillomavirus vaccine-related cancers and, therefore, may be more cost effective when receiving human papillomavirus vaccines. Quantifying human papillomavirus vaccine cost effectiveness via meta-analyses is feasible if investigators can increase the homogeneity of their populations.
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Affiliation(s)
- Phuong T Tran
- Faculty of Pharmacy, HUTECH University, 475A Dien Bien Phu Street, Ward 25, Binh Thanh District, Ho Chi Minh City, 700000, Vietnam. .,Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.
| | - Munaza Riaz
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Institute of Pharmacy, Lahore College for Women University, Lahore, Pakistan
| | - Ziyan Chen
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Cong Bang Truong
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University, Auburn, AL, USA
| | - Vakaramoko Diaby
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
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Quabius E, Heinrichs A, Kühnel A, Laudien M, Hoppe F, Mlynski R, Ambrosch P, Hoffmann M. Tonsillar swabs and sputum predict SLPI‑ and AnxA2 expression in tonsils: A prospective study on smoking dependent SLPI‑ and AnxA2‑expression, and tonsillar HPV infection. Oncol Lett 2022; 23:164. [DOI: 10.3892/ol.2022.13284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/10/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Elgar Quabius
- Department of Otorhinolaryngology, Head and Neck Surgery, University Clinic Schleswig‑Holstein, D‑24105 Kiel, Germany
| | - Alessa Heinrichs
- Department of Otorhinolaryngology, Head and Neck Surgery ‘Otto Koerner’, University of Rostock, D‑18057 Rostock, Germany
| | - André Kühnel
- Department of Otorhinolaryngology, Head and Neck Surgery, Asklepios Hospital Harburg, D‑21075 Hamburg, Germany
| | - Martin Laudien
- Department of Otorhinolaryngology, Head and Neck Surgery, University Clinic Schleswig‑Holstein, D‑24105 Kiel, Germany
| | - Florian Hoppe
- Department of Otorhinolaryngology‑Head and Neck Surgery, Klinikum Oldenburg, D‑26133 Oldenburg, Germany
| | - Robert Mlynski
- Department of Otorhinolaryngology, Head and Neck Surgery ‘Otto Koerner’, University of Rostock, D‑18057 Rostock, Germany
| | - Petra Ambrosch
- Department of Otorhinolaryngology, Head and Neck Surgery, University Clinic Schleswig‑Holstein, D‑24105 Kiel, Germany
| | - Markus Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Clinic Schleswig‑Holstein, D‑24105 Kiel, Germany
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20
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Logel M, Laurie C, El-Zein M, Guichon J, Franco EL. A review of ethical and legal aspects of gender-neutral human papillomavirus vaccination. Cancer Epidemiol Biomarkers Prev 2022; 31:919-931. [PMID: 35247878 DOI: 10.1158/1055-9965.epi-21-1256] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/12/2022] [Accepted: 02/25/2022] [Indexed: 12/24/2022] Open
Abstract
While launching a campaign to eliminate cervical cancer, the World Health Organization called to halt human papillomavirus (HPV) gender-neutral vaccination (GNV) because of limited vaccine supply, raising ethical and legal questions about female-only vaccination versus GNV. We identified ethical and legal aspects of HPV GNV by searching MEDLINE for records up to February 19, 2021. We also provided an overview of HPV vaccines, the evolution of HPV vaccine recommendations in North America, and a timeline of male HPV vaccination introduction by searching PubMed, Google, and government websites. Four HPV vaccines are available: Cervarix®, Gardasil®, Gardasil®9, and Cecolin®. Vaccine recommendations in North America evolved from female only to eventually include males. Following the Food and Drug Administration's approval of the first HPV vaccine for males (2009), 35 countries began vaccinating males (2011-2020). Based on 56 eligible records out of 652, we identified the following constructs: lower male awareness of HPV and vaccination (n=13), limited economic resources (n=5), shared social responsibility (n=18), unprotected groups from female-only HPV vaccination (n=10), limited screening for HPV-associated noncervical cancers (n=6), consideration of ethical principles (n=17), and HPV vaccine mandates (n=5). Ethical and legal aspects must be considered when recommending vaccination for females only or GNV.
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21
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Tejada RA, Malagón T, Franco EL. Cost-effectiveness of human papillomavirus vaccination in girls living in Latin American countries: A systematic review and meta-analysis. Vaccine 2022; 40:2667-2678. [DOI: 10.1016/j.vaccine.2022.03.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 02/24/2022] [Accepted: 03/18/2022] [Indexed: 01/22/2023]
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22
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Akumbom AM, Lee JJ, Reynolds NR, Thayer W, Wang J, Slade E. Cost and effectiveness of HPV vaccine delivery strategies: A systematic review. Prev Med Rep 2022; 26:101734. [PMID: 35251910 PMCID: PMC8889236 DOI: 10.1016/j.pmedr.2022.101734] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/06/2022] [Accepted: 02/14/2022] [Indexed: 11/28/2022] Open
Abstract
This review focused on implemented HPV vaccine delivery strategies and their costs. Insights on the costs and effectiveness of HPV vaccination strategies are provided. Access was improved by increasing the availability and the uptake of HPV vaccines. Costs varied by vaccine delivery strategy and target population. Lessons learned can inform efficient and equitable allocation of vaccine resources.
Fifteen years following the approval of the first human papillomavirus (HPV) vaccine, cervical cancer continues to be a significant source of morbidity and mortality among women in low-resource settings. It is the second-leading cause of cancer-related deaths in women globally and the leading cause of cancer-related deaths in Sub-Saharan Africa. Vaccine delivery and programmatic costs may hinder the distribution of HPV vaccines in low-resource settings, and ultimately influence access to HPV vaccines. While reviews have been conducted on the cost-effectiveness of HPV vaccines, little is known about the cost and effectiveness of vaccination strategies. The purpose of this systematic review was to synthesize evidence on the cost and cost-effectiveness of vaccination strategies utilized to increase access to HPV vaccines. Search queries were created for CINAHL Plus, Embase, and PubMed. Our search strategy focused on articles that contained information on HPV vaccine uptake/reach, HPV vaccination costs, or the cost-effectiveness of HPV vaccination programs. We retrieved 773 articles from the databases, assessed 251 full-texts, and included 15 articles in our final synthesis. Countries without national HPV vaccination programs aimed to identify and adopt sustainable strategies to make HPV vaccines available to adolescents through demonstration programs. In contrast, countries with national vaccination programs focused on identifying cost-effective interventions to increase vaccination rates to meet nationally recommended standards. There is a dire need for HPV vaccination programs and intervention studies tailored to settings in low- and middle-income countries to increase access to HPV vaccines. Future studies should also evaluate the cost-effectiveness of implemented strategies.
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Nishioka H, Onishi T, Kitano T, Takeyama M, Imakita N, Kasahara K, Kawaguchi R, Masaki JA, Nogami K. A survey of healthcare workers’ recommendations about human papillomavirus vaccination. Clin Exp Vaccine Res 2022; 11:149-154. [PMID: 35799873 PMCID: PMC9200650 DOI: 10.7774/cevr.2022.11.2.149] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/06/2022] [Indexed: 11/15/2022] Open
Abstract
Purpose The human papillomavirus (HPV) vaccine is safe and effective for preventing HPV-related diseases. However, HPV vaccination rates in Japan are low because the “Ministry of Health, Labour and Welfare” had stopped recommending vaccination. We assessed healthcare workers’ (HCWs) current recommendations regarding the HPV vaccine and how the provision of information about HPV vaccination affected their recommendations. Materials and Methods A survey was conducted among nurses and physicians in Nara prefecture from March 2021 to July 2021. The questionnaire asked about their understanding, recommendations, and opinions regarding HPV vaccination. Before answering the last two questions (optional), the HCWs read evidence-based information quantifying the risks and benefits of HPV vaccination. Results A total of 441 HCWs completed the questionnaire. Only 19% of HCWs always recommended HPV vaccination for girls aged 12–16 years. The evidence-based information significantly improved the percentage of HCWs who would “always recommend” vaccination. Conclusion This study showed that the proportion of HCWs who recommend HPV vaccination to adolescent girls remains low in Japan. However, we found that evidence-based information describing the causal relationship between adverse events and vaccination, quantifying the risks and benefits, noting the importance of HCW communications with families, and reporting the recommendations of national societies, might increase HCWs’ recommendations for HPV vaccination.
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Affiliation(s)
- Hitomi Nishioka
- Department of Pediatrics, Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Tomoko Onishi
- Department of Pediatrics, Nara Medical University, Kashihara, Japan
| | - Taito Kitano
- Department of Pediatrics, Nara Medical University, Kashihara, Japan
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Natsuko Imakita
- Center for Infectious Diseases, Nara Medical University, Kashihara, Japan
| | - Kei Kasahara
- Center for Infectious Diseases, Nara Medical University, Kashihara, Japan
| | - Ryuji Kawaguchi
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Japan
| | | | - Keiji Nogami
- Department of Pediatrics, Nara Medical University, Kashihara, Japan
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Colzani E, Johansen K, Johnson H, Pastore Celentano L. Human papillomavirus vaccination in the European Union/European Economic Area and globally: a moral dilemma. Euro Surveill 2021; 26:2001659. [PMID: 34915976 PMCID: PMC8728487 DOI: 10.2807/1560-7917.es.2021.26.50.2001659] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
While many European Union/European Economic Area (EU/EEA) countries recently expanded human papillomavirus (HPV) vaccination to boys, HPV vaccine supply is currently limited for girls in low- and middle-income countries (LMIC) that are severely affected by HPV.Globally, about 50% of countries have introduced HPV vaccination. Some LMIC with high burden of cervical cancer have not yet introduced HPV vaccination, or are reaching suboptimal vaccination coverage. While WHO issued a call for cervical cancer elimination in 2018, a global shortage of HPV vaccines is currently predicted to last at least until 2024.We reviewed national policies of EU/EEA countries and recommendations of the World Health Organization (WHO) Strategic Advisory Group of Experts on immunisation to discuss current challenges and dose-sparing options. Several EU/EEA countries have extended HPV vaccination to boys and the European Cancer Organisation has issued a resolution for elimination of all HPV-associated cancers in both sexes. The European Centre for Disease Prevention and Control concluded in its 2020 guidance that cost-effectiveness of extending routine vaccination to boys depends on several context-specific factors. The extension of HPV vaccination to boys in EU/EEA countries may affect global availability of vaccines. Temporary dose-sparing options could be considered during the COVID-19 post-pandemic period.
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Affiliation(s)
- Edoardo Colzani
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Kari Johansen
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Helen Johnson
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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25
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Drolet M, Laprise JF, Martin D, Jit M, Bénard É, Gingras G, Boily MC, Alary M, Baussano I, Hutubessy R, Brisson M. Optimal human papillomavirus vaccination strategies to prevent cervical cancer in low-income and middle-income countries in the context of limited resources: a mathematical modelling analysis. THE LANCET. INFECTIOUS DISEASES 2021; 21:1598-1610. [PMID: 34245682 PMCID: PMC8554391 DOI: 10.1016/s1473-3099(20)30860-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 11/13/2022]
Abstract
Background Introduction of human papillomavirus (HPV) vaccination has been slow in low-income and middle-income countries (LMICs) because of resource constraints and worldwide shortage of vaccine supplies. To help inform WHO recommendations, we modelled various HPV vaccination strategies to examine the optimal use of limited vaccine supplies and best allocation of scarce resources in LMICs in the context of the WHO global call to eliminate cervical cancer as a public health problem. Methods In this mathematical modelling analysis, we developed HPV-ADVISE LMIC, a transmission-dynamic model of HPV infection and diseases calibrated to four LMICs: India, Vietnam, Uganda, and Nigeria. For different vaccination strategies that encompassed use of a nine-valent vaccine (or a two-valent or four-valent vaccine assuming high cross-protection), we estimated three outcomes: reduction in the age-standardised rate of cervical cancer, number of doses needed to prevent one case of cervical cancer (NNV; as a measure of efficiency), and the incremental cost-effectiveness ratio (ICER; in 2017 international $ per disability-adjusted life-year [DALY] averted). We examined different vaccination strategies by varying the ages of routine HPV vaccination and number of age cohorts vaccinated, the population targeted, and the number of doses used. In our base case, we assumed 100% lifetime protection against HPV-16, HPV-18, HPV-31, HPV-33, HPV-45, HPV-52, and HPV-58; vaccination coverage of 80%; and a time horizon of 100 years. For the cost-effectiveness analysis, we used a 3% discount rate. Elimination of cervical cancer was defined as an age-standardised incidence of less than four cases per 100 000 woman-years. Findings We predicted that HPV vaccination could lead to cervical cancer elimination in Vietnam, India, and Nigeria, but not in Uganda. Compared with no vaccination, strategies that involved vaccinating girls aged 9–14 years with two doses were predicted to be the most efficient and cost-effective in all four LMICs. NNV ranged from 78 to 381 and ICER ranged from $28 per DALY averted to $1406 per DALY averted depending on the country. The most efficient and cost-effective strategies were routine vaccination of girls aged 14 years, with or without a later switch to routine vaccination of girls aged 9 years, and routine vaccination of girls aged 9 years with a 5-year extended interval between doses and a catch-up programme at age 14 years. Vaccinating boys (aged 9–14 years) or women aged 18 years or older resulted in substantially higher NNVs and ICERs. Interpretation We identified two strategies that could maximise efforts to prevent cervical cancer in LMICs given constraints on vaccine supplies and costs and that would allow a maximum of LMICs to introduce HPV vaccination. Funding World Health Organization, Canadian Institute of Health Research, Fonds de recherche du Québec–Santé, Compute Canada, PATH, and The Bill & Melinda Gates Foundation. Translations For the French and Spanish translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Mélanie Drolet
- Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada
| | | | - Dave Martin
- Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada
| | - Mark Jit
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK; Modelling and Economics Unit, Public Health England, London, UK; School of Public Health, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Élodie Bénard
- Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada
| | - Guillaume Gingras
- Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada
| | - Marie-Claude Boily
- Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada; Département de médecine sociale et preventive, Université Laval, Quebec City, QC, Canada; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Michel Alary
- Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada; Département de médecine sociale et preventive, Université Laval, Quebec City, QC, Canada; Institut national de santé publique du Québec, Québec City, QC, Canada
| | | | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Marc Brisson
- Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada; Département de médecine sociale et preventive, Université Laval, Quebec City, QC, Canada; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
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26
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Hoffmann M, Quabius ES. Relevance of Human Papillomaviruses in Head and Neck Cancer-What Remains in 2021 from a Clinician's Point of View? Viruses 2021; 13:v13061173. [PMID: 34207440 PMCID: PMC8235461 DOI: 10.3390/v13061173] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/12/2022] Open
Abstract
Human papillomaviruses (HPV) cause a subset of head and neck cancers (HNSCC). HPV16 predominantly signs responsible for approximately 10% of all HNSCC and over 50% of tonsillar (T)SCCs. Prevalence rates depend on several factors, such as the geographical region where patients live, possibly due to different social and sexual habits. Smoking plays an important role, with non-smoking patients being mostly HPV-positive and smokers being mostly HPV-negative. This is of unparalleled clinical relevance, as the outcome of (non-smoking) HPV-positive patients is significantly better, albeit with standard and not with de-escalated therapies. The results of the first prospective de-escalation studies have dampened hopes that similar superior survival can be achieved with de-escalated therapy. In this context, it is important to note that the inclusion of p16INK4A (a surrogate marker for HPV-positivity) in the 8th TMN-classification has only prognostic, not therapeutic, intent. To avoid misclassification, highest precision in determining HPV-status is of utmost importance. Whenever possible, PCR-based methods, still referred to as the "gold standard”, should be used. New diagnostic antibodies represent some hope, e.g., to detect primaries and recurrences early. Prophylactic HPV vaccination should lead to a decline in HPV-driven HNSCC as well. This review discusses the above aspects in detail.
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Affiliation(s)
- Markus Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, Christian-Albrechts-University Kiel, D24105 Kiel, Germany;
- Quincke-Forschungszentrum (QFZ), Medical Faculty, Christian-Albrechts-University Kiel, D24105 Kiel, Germany
- Correspondence: ; Tel.: +49-431-500-21701; Fax: +49-431-500-19028
| | - Elgar Susanne Quabius
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, Christian-Albrechts-University Kiel, D24105 Kiel, Germany;
- Quincke-Forschungszentrum (QFZ), Medical Faculty, Christian-Albrechts-University Kiel, D24105 Kiel, Germany
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Dorji T, Tshomo U, Gyamtsho S, Tamang ST, Wangmo S, Pongpirul K. Gender-neutral HPV elimination, cervical cancer screening, and treatment: Experience from Bhutan. Int J Gynaecol Obstet 2021; 156:425-429. [PMID: 33930178 DOI: 10.1002/ijgo.13728] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/19/2021] [Accepted: 04/28/2021] [Indexed: 11/10/2022]
Abstract
Cervical cancer is preventable and also curable when detected early and treated adequately, yet it remains a leading cause of morbidity and mortality among women. In Bhutan, cervical cancer is the most common cancer among women. Bhutan was the first country among the low- and middle-income economies to have instituted a national HPV vaccination program, in 2010, and has achieved >90% coverage. In 2019, Bhutan launched a cervical cancer elimination flagship program well ahead of WHO's launch of the global strategy for accelerated elimination of cervical cancer. Bhutan initiated vaccination of adolescent boys and adopted a gender-neutral vaccination program beginning September 2020 through its well-established network of primary healthcare centres. The flagship program aims to screen women aged 30-69 years with HPV testing using liquid-based cytology (LBC) as triaging for screen positive women. For women aged 25-29 years, LBC will be continued as per American Society of Colposcopy and Cervical Pathology guidelines. Colposcopy and treatment will be performed in camps to decrease loss of follow up of screen positive women. This program is also expected to improve early diagnosis of cervical cancer and provide timely and adequate cancer treatment and palliative care services. This article reviews the progress made and the challenges facing the 2030 cervical cancer elimination targets in Bhutan.
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Affiliation(s)
- Thinley Dorji
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.,Kidu Mobile Medical Unit, His Majesty's People's Project, Thimphu, Bhutan
| | - Ugyen Tshomo
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Sonam Gyamtsho
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.,Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu
| | | | - Sangay Wangmo
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.,Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Simoens S, Bento-Abreu A, Merckx B, Joubert S, Vermeersch S, Pavelyev A, Varga S, Morais E. Health Impact and Cost-Effectiveness of Implementing Gender-Neutral Vaccination With the 9-Valent Human Papillomavirus Vaccine in Belgium. Front Pharmacol 2021; 12:628434. [PMID: 33912045 PMCID: PMC8072375 DOI: 10.3389/fphar.2021.628434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/09/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Routine human papillomavirus (HPV) immunization in Belgium is currently regionally managed, with school-aged girls receiving the 9-valent HPV (9vHPV) vaccine in Flanders and Wallonia-Brussels with a national catch-up program for females only. This study will assess whether expanding these programs to gender-neutral vaccination (GNV) with the 9vHPV vaccine is a cost-effective strategy in Belgium. Methods: A validated HPV-type transmission dynamic model estimated the potential health and economic impact of regional vaccination programs, comparing GNV versus female-only vaccination (FOV) with the 9vHPV vaccine in individuals aged 11-12 years in Flanders, GNV with the 9vHPV vaccine versus FOV with the 2-valent HPV (2vHPV) vaccine in individuals aged 12-13 years in Wallonia-Brussels, and national catch-up GNV versus FOV with the 9vHPV vaccine for those aged 12-18 years. Vaccination coverage rates of 90, 50, and 50% in both males and females were used in the base cases for the three programs, respectively, and sensitivity analyses were conducted. All costs are from the third-party payer perspective, and outcome measures were reported over a 100-year time horizon. Results: GNV with the 9vHPV vaccine was projected to decrease the cumulative incidence of HPV 6/11/16/18/31/33/45/52/58-related diseases relative to FOV in both Flanders and Wallonia-Brussels. Further reductions were also projected for catch-up GNV with the 9vHPV vaccine, including reductions of 6.8% (2,256 cases) for cervical cancer, 7.1% (386 cases) and 18.8% (2,784 cases) for head and neck cancer in females and males, respectively, and 30.3% (82,103 cases) and 44.6% (102,936 cases) for genital warts in females and males, respectively. As a result, a GNV strategy would lead to reductions in HPV-related deaths. Both regional and national catch-up GNV strategies were projected to reduce cumulative HPV-related disease costs and were estimated to be cost-effective compared with FOV with incremental cost-effectiveness ratios of €8,062, €4,179, and €6,127 per quality-adjusted life-years in the three programs, respectively. Sensitivity analyses were consistent with the base cases. Conclusions: A GNV strategy with the 9vHPV vaccine can reduce the burden of HPV-related disease and is cost-effective compared with FOV for both regional vaccination programs and the national catch-up program in Belgium.
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Affiliation(s)
- Steven Simoens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | | | | | | | | | - Andrew Pavelyev
- Merck & Co., Inc., Kenilworth, NJ, United States
- HCL America, Inc., Sunnyvale, CA, United States
| | - Stefan Varga
- Merck & Co., Inc., Kenilworth, NJ, United States
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Dorji T, Nopsopon T, Tamang ST, Pongpirul K. Human papillomavirus vaccination uptake in low-and middle-income countries: a meta-analysis. EClinicalMedicine 2021; 34:100836. [PMID: 33997733 PMCID: PMC8102703 DOI: 10.1016/j.eclinm.2021.100836] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/12/2021] [Accepted: 03/24/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The proportion of incident cases of HPV-attributable cancers is highest in the low- and middle-income countries (LMICs) but many are yet to initiate HPV vaccination programs. This meta-analysis was performed to assess the uptake of HPV vaccination in LMICs at the beginning of the global strategy to eliminate cervical cancer and describes the gaps and challenges. METHODS A systematic search was conducted in PubMed, EMBASE, Scopus, Web of Science, and CENTRAL databases for observational studies that reported the uptake of HPV vaccination until October 2020. The meta-analysis was done using a random-effects model to assess the pooled estimate of HPV uptake. CRD42021218429. FINDINGS During 2008-2020, an estimated 3.3 million females received at least one dose of HPV vaccine with 61.69% of the target population vaccinated. In countries with high uptake, the pooled estimate of uptake was higher in females than males (45.48% vs 8.45%) and showed significant decline in 2015-2020 compared to 2006-2014 (89.03% vs 41.48%). In countries with low uptake, the estimate of uptake was low in both males and females (5.31% vs 2.93%) and showed increase in uptake in 2015-2020 compared to 2006-2014 (0.76% vs 5.22%). In countries with high uptake, compared to routine programs, the estimate was higher when delivered through demonstration programs (89.94% vs 59.74%). INTERPRETATION The major concern was a significant drop in the uptake in countries that started with high uptake, challenges in the maintenance of vaccine uptake, sustainability of funding and the lack of standard monitoring and reporting.
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Key Words
- 2vHPV, bivalent HPV vaccine
- 4vHPV, quadrivalent HPV vaccine
- 9vHPV, 9-valent HPV vaccine
- CENTRAL, cochrane central register of controlled trials
- CI, confidence interval
- CIN2+, cervical intra-epithelial neoplasia grade II
- Cervical cancer elimination
- EMBASE, excerpta medica dataBASE
- GNI, gross national income
- HPV vaccine
- HPV, human papillomavirus
- LMICs, Low- and middle-income countries
- Low-and middle-income countries
- MSM, men having sex with men
- Meta-analysis
- RR, relative risk
- STROBE, strengthening the reporting of observational studies in epidemiology
- Systematic review
- US, United States
- Vaccine uptake
- WHO, World Health Organization
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Affiliation(s)
- Thinley Dorji
- Department of Internal Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
- Kidu Mobile Medical Unit, His Majesty's People's Project, Thimphu, Bhutan
| | - Tanawin Nopsopon
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Saran Tenzin Tamang
- Department of Obstetrics and Gynaecology, Central Regional Referral Hospital, Gelegphu, Bhutan
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Bumrungrad International Hospital, Bangkok, Thailand
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30
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Bigaard J, Franceschi S. Vaccination against HPV: boosting coverage and tackling misinformation. Mol Oncol 2021; 15:770-778. [PMID: 33058497 PMCID: PMC7931130 DOI: 10.1002/1878-0261.12808] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/18/2020] [Accepted: 09/25/2020] [Indexed: 11/06/2022] Open
Abstract
The availability of human papillomavirus (HPV) vaccines and screening tests has raised the possibility of globally eliminating cervical cancer, which is caused by HPV. Cervical cancer is a very common malignancy worldwide, especially among deprived women. High vaccination coverage is key to the containment and eventual elimination of the infection. Public HPV vaccination programmes in Italy and Denmark were swiftly established and are among the most successful worldwide. Still, in both countries, it has been challenging to achieve and maintain the recommended coverage of > 80% in girls. In a well-studied Italian region, vaccination coverage in girls at age 15 years (World Health Organization's gold standard) reached 76% in 2015 but decreased to 69% in 2018, likely due to work overload in public immunization centres. In Denmark, doubts about safety and efficacy of the HPV vaccine generated a decline in coverage among girls age 12-17, from 80% in 2013 down to 37% in 2015, when remedial actions made it rise again. Insights from these two countries are shared to illustrate the importance of monitoring coverage in a digital vaccine registry and promptly reacting to misinformation about vaccination.
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Affiliation(s)
- Janne Bigaard
- The Danish Cancer SocietyPrevention & InformationCopenhagenDenmark
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31
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Ver AT, Notarte KI, Velasco JV, Buac KM, Nazareno J, Lozañes JA, Antonio D, Bacorro W. A systematic review of the barriers to implementing human papillomavirus vaccination programs in low- and middle-income countries in the Asia-Pacific. Asia Pac J Clin Oncol 2021; 17:530-545. [PMID: 33636046 DOI: 10.1111/ajco.13513] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/11/2020] [Indexed: 01/04/2023]
Abstract
AIM The increasing burden of human papillomavirus (HPV)-related diseases in low- and middle-income countries (LMICs) could be alleviated by effective HPV vaccination programs. In this systematic review, we examined barriers to introduction, implementation, and/or sustainability of HPV vaccination programs in LMICs in the Asia-Pacific region (AP-LMICs). METHODS A systematic search of literature from the past 10 years (2010-2019) was performed through PubMed, Cochrane CENTRAL, and Google Scholar. Studies were included if they reported barriers to HPV vaccination in AP-LMICs. All study designs were included except commentaries and editorials. The journal articles were assessed using the Joanna Briggs Institute critical appraisal checklists. RESULTS A total of 46 eligible articles were included. An increase in publications was noted from 2010 to 2019. Barriers were diverse and were classified into four levels--government, healthcare providers (HCPs), society, and individual. The top specific barriers that were identified across AP-LMICs are lack of funding and political support at the government level, lack of awareness among HCP and lack of vaccination programs at the level of health providers, and the perceived cost/benefit ratio for the individual level. CONCLUSION Barriers to successful implementation of HPV vaccination programs differ among Asia-Pacific LMICs. Policymakers will need to evaluate the relative importance of these barriers in their target areas and population in order to draft an effective dissemination and implementation strategy.
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Affiliation(s)
| | - Kin Israel Notarte
- Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
| | | | - Kevin Miko Buac
- Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
| | - John Nazareno
- Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
| | - J Alfred Lozañes
- College of Medicine, University of the East - Ramon-Magsaysay Memorial Medical Center, Quezon City, Philippines
| | - Dominic Antonio
- College of Medicine, University of the East - Ramon-Magsaysay Memorial Medical Center, Quezon City, Philippines
| | - Warren Bacorro
- Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines.,Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, Manila, Philippines
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Thomas A, Necchi A, Muneer A, Tobias-Machado M, Tran ATH, Van Rompuy AS, Spiess PE, Albersen M. Penile cancer. Nat Rev Dis Primers 2021; 7:11. [PMID: 33574340 DOI: 10.1038/s41572-021-00246-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 12/27/2022]
Abstract
Penile squamous cell carcinoma (PSCC) is a rare cancer with orphan disease designation and a prevalence of 0.1-1 per 100,000 men in high-income countries, but it constitutes up to 10% of malignancies in men in some African, Asian and South American regions. Risk factors for PSCC include the absence of childhood circumcision, phimosis, chronic inflammation, poor penile hygiene, smoking, immunosuppression and infection with human papillomavirus (HPV). Several different subtypes of HPV-related and non-HPV-related penile cancers have been described, which also have different prognostic profiles. Localized disease can be effectively managed by topical therapy, surgery or radiotherapy. As PSCC is characterized by early lymphatic spread and imaging is inadequate for the detection of micrometastatic disease, correct and upfront surgical staging of the inguinal lymph nodes is crucial in disease management. Advanced stages of disease require multimodal management. Optimal sequencing of treatments and patient selection are still being investigated. Cisplatin-based chemotherapy regimens are the mainstay of systemic therapy for advanced PSCC, but they have poor and non-durable responses and high rates of toxic effects, indicating a need for the development of more effective and less toxic therapeutic options. Localized and advanced penile cancers and their treatment have profound physical and psychosexual effects on the quality of life of patients and survivors by altering sexual and urinary function and causing lymphoedema.
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Affiliation(s)
- Anita Thomas
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Urology, University Hospitals Leuven, Leuven, Belgium.,Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Andrea Necchi
- Genitourinary Medical Oncology, IRCCS San Raffaele Hospital and Scientific Institute, Milan, Italy
| | - Asif Muneer
- Department of Urology, University College London Hospitals, London, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre, University College London Hospitals, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
| | - Marcos Tobias-Machado
- Section of Urologic Oncology, Department of Urology, ABC Medical School, Instituto do Cancer Vieira de Carvalho, São Paulo, Brazil
| | - Anna Thi Huyen Tran
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | | | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Maarten Albersen
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium. .,Department of Urology, University Hospitals Leuven, Leuven, Belgium.
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Cody P, Tobe K, Abe M, Elbasha EH. Public health impact and cost effectiveness of routine and catch-up vaccination of girls and women with a nine-valent HPV vaccine in Japan: a model-based study. BMC Infect Dis 2021; 21:11. [PMID: 33407188 PMCID: PMC7789539 DOI: 10.1186/s12879-020-05632-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/18/2020] [Indexed: 11/18/2022] Open
Abstract
Background Combined with cancer screening programs, vaccination against human papillomavirus (HPV) can significantly reduce the high health and economic burden of HPV-related disease in Japan. The objective of this study was to assess the health impact and cost effectiveness of routine and catch-up vaccination of girls and women aged 11–26 years with a 4-valent (4vHPV) or 9-valent HPV (9vHPV) vaccine in Japan compared with no vaccination. Methods We used a mathematical model adapted to the population and healthcare settings in Japan. We compared no vaccination and routine vaccination of 12–16-year old girls with 1) 4vHPV vaccine, 2) 9vHPV vaccine, and 3) 9vHPV vaccine in addition to a temporary catch-up vaccination of 17–26 years old girls and women with 9vHPV. We estimated the expected number of disease cases and deaths, discounted (at 2% per year) future costs (in 2020 ¥) and discounted quality-adjusted life years (QALY), and incremental cost effectiveness ratios (ICER) of each strategy over a time horizon of 100 years. To test the robustness of the conclusions, we conducted scenario and sensitivity analyses. Results Over 100 years, compared with no vaccination, 9vHPV vaccination was projected to reduce the incidence of 9vHPV-related cervical cancer by 86% (from 15.24 new cases per 100,000 women in 2021 to 2.02 in 2121). A greater number of cervical cancer cases (484,248) and cancer-related deaths (50,102) were avoided through the described catch-up vaccination program. Routine HPV vaccination with 4vHPV or 9vHPV vaccine prevented 5,521,000 cases of anogenital warts among women and men. Around 23,520 and 21,400 diagnosed non-cervical cancers are prevented by catch-up vaccination among women and men, respectively. Compared with no vaccination, the ICER of 4vHPV vaccination was ¥975,364/QALY. Compared to 4vHPV, 9vHPV + Catch-up had an ICER of ¥1,534,493/QALY. Conclusions A vaccination program with a 9-valent vaccine targeting 12 to 16 year-old girls together with a temporary catchup program will avert significant numbers of cases of HPV-related diseases among both men and women. Furthermore, such a program was the most cost effective among the vaccination strategies we considered, with an ICER well below a threshold of ¥5000,000/QALY.
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Affiliation(s)
- Palmer Cody
- Merck &Co., Inc., Kenilworth, NJ, USA. .,Center for Observational and Real-world Evidence (CORE), Merck & Co., Inc., WP37A-150, PO Box 1000, West Point, PA, 19486, USA.
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Kassie AM, Abate BB, Kassaw MW, Aragie TG, Geleta BA, Shiferaw WS. Impact of knowledge and attitude on the utilization rate of cervical cancer screening tests among Ethiopian women: A systematic review and meta-analysis. PLoS One 2020; 15:e0239927. [PMID: 33290426 PMCID: PMC7723289 DOI: 10.1371/journal.pone.0239927] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/15/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Cervical cancer is a major public health problem, particularly in resource-limited settings. The use of vaccination and screening tests has reduced the burden of cervical cancer in developed countries. However, the situation is quite the reverse in developing countries, including Ethiopia. Hence, this study aimed to estimate the pooled impact of knowledge and attitude on the prevalence of cervical cancer screening service utilization rates among Ethiopian women. METHODS Studies that examined cervical cancer screening service utilization among women in Ethiopia were searched from five international databases. Cochran's Q chi-square and the I-squared test statistics were used to check the presence of heterogeneity among the included studies. The funnel plot and Egger's regression tests were also used to assess the presence of publication bias. A weighted DerSimonian and Laird random-effects model was employed. Subgroup analysis was performed by the study population concerning the prevalence of cervical cancer screening service utilization rates. Sensitivity analysis was also conducted to assess the effect of a single study on the pooled estimates. Data analysis was performed using STATA™ Version 14 software. RESULTS A total of 44 studies with 28,186 study participants were included. The estimated pooled prevalence of cervical cancer screening service utilization was 8.11% (95% CI: 7.26, 8.97). After adjustment for publication bias with the trim and fill analysis, the estimated prevalence rate appeared to be 5.47% (95% CI: 4.66, 6.28). The prevalence of cervical cancer screening service utilization was higher among HIV-positive women, 16.85%, and in studies conducted among health care workers, 10.24%, than the general population. The pooled effect of knowledge on the utilization of cervical cancer screening tests among Ethiopian women was statistically significant (AOR = 3.20, 95% CI: 1.63, 6.31). Similarly, the pooled estimated odds of utilizing cervical cancer screening tests were 6.1 times higher (AOR = 6.09, 95% CI: 1.09, 34.36) among women who had a favorable attitude towards the screening tests. CONCLUSION Knowledge and attitude had a significant impact on the prevalence of cervical cancer screening test utilization rates among women in Ethiopia. However, the prevalence of cervical cancer screening service utilization among Ethiopian women is very low. Hence, large-scale awareness programs and situation-based strategies need to be designed to increase the uptake of cervical cancer screening services in the country.
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Affiliation(s)
- Ayelign Mengesha Kassie
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Amhara Regional State, Ethiopia
| | - Biruk Beletew Abate
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Amhara Regional State, Ethiopia
| | - Mesfin Wudu Kassaw
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Amhara Regional State, Ethiopia
| | - Teshome Gebremeskel Aragie
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Amhara Regional State, Ethiopia
| | - Bonsa Amsalu Geleta
- Department of Nursing, College of Health Sciences, Metu University, Metu, Oromia Regional State, Ethiopia
| | - Wondimeneh Shibabaw Shiferaw
- Department of Nursing, College of Health Sciences, Debre Berhan University, Debre Berhan, Amhara Regional State, Ethiopia
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Soares A, de Carvalho IT, da Fonseca AG, Alencar AM, Leite CHB, Bastos DA, Soares JPH, Leite KRM, Filho MRB, Coelho RWP, Cavallero SRDA, de Cassio Zequi S, de Ribamar Rodrigues Calixto J. Penile cancer: a Brazilian consensus statement for low- and middle-income countries. J Cancer Res Clin Oncol 2020; 146:3281-3296. [PMID: 33104884 PMCID: PMC7679332 DOI: 10.1007/s00432-020-03417-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/29/2020] [Indexed: 02/05/2023]
Abstract
Purpose Penile cancer is highly prevalent in low- and middle-income countries, with significant morbidity and mortality rates. The first Brazilian consensus provides support to improve penile cancer patients’ outcomes, based on expert’s opinion and evidence from medical literature. Methods Fifty-one Brazilian experts (clinical oncologists, radiation oncologists, urologists, and pathologists) assembled and voted 104 multiple-choice questions, confronted the results with the literature, and ranked the levels of evidence. Results Healthcare professionals need to deliver more effective communication about the risk factors for penile cancer. Staging and follow-up of patients include physical examination, computed tomography, and magnetic resonance imaging. Close monitoring is crucial, because most recurrences occur in the first 2–5 years. Lymph-node involvement is the most important predictive factor for survival, and management depends on the location (inguinal or pelvic) and the number of lymph nodes involved. Conservative treatment may be helpful in selected patients without compromising oncological outcomes; however, surgery yields the lowest rate of local recurrence. Conclusion This consensus provides an essential decision-making orientation regarding this challenging disease. Electronic supplementary material The online version of this article (10.1007/s00432-020-03417-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrey Soares
- Department of Oncology, Centro Paulista de Oncologia-Oncoclínicas, Av. Brigadeiro Faria Lima, 4300, Vila Olímpia, São Paulo, SP, 01452-000, Brazil. .,Department of Oncology, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Morumbi, São Paulo, SP, 05652-900, Brazil. .,Latin American Cooperative Oncology Group, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Icaro Thiago de Carvalho
- Department of Radiotherapy, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil.,Instituto Abathon, São Paulo, São Paulo, Brazil
| | | | - Antonio Machado Alencar
- Department of Oncology, Hospital Universitário da Universidade Federal do Maranhão, São Luís, Maranhão, Brazil.,Department of Oncology, Hospital São Domingos, São Luís, Maranhão, Brazil
| | | | - Diogo Assed Bastos
- Latin American Cooperative Oncology Group, Porto Alegre, Rio Grande do Sul, Brazil.,Department of Oncology, Hospital Sírio-Libanês, São Paulo, São Paulo, Brazil
| | | | - Katia Ramos Moreira Leite
- Medical Research Laboratory of the Discipline of Urology, Faculdade de Medicina da USP, São Paulo, São Paulo, Brazil
| | | | - Ronald Wagner Pereira Coelho
- Latin American Cooperative Oncology Group, Porto Alegre, Rio Grande do Sul, Brazil.,Department of Oncology, Hospital do Câncer Aldenora Bello, São Luís, Maranhão, Brazil
| | - Sandro Roberto de A Cavallero
- Latin American Cooperative Oncology Group, Porto Alegre, Rio Grande do Sul, Brazil.,Department of Oncology, Hospital Adventista de Belém, Belém, Pará, Brazil.,Department of Oncology, Centro de Tratamento Do Pará, Belém, Pará, Brazil
| | - Stênio de Cassio Zequi
- Department of Urology, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil.,National Institute for Science and Technology in Oncogenomics and Therapeutic Innovation, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil
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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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Incidence, Persistence, Clearance, and Correlates of Genital Human Papillomavirus Infection and Anogenital Warts in a Cohort of Men Living With Human Immunodeficiency Virus in South Africa. Sex Transm Dis 2020; 46:347-353. [PMID: 30985636 PMCID: PMC6485297 DOI: 10.1097/olq.0000000000000979] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
A cohort study of human immunodeficiency virus–positive men in Johannesburg, South Africa found that they have high persistence of genital human papillomavirus infection and anogenital warts. A combination of early and effective use of antiretroviral therapy and human papillomavirus vaccination could reduce this burden. Objective To estimate the incidence; persistence and correlates of human papillomavirus (HPV) infection and anogenital warts (AGW) among men living with human immunodeficiency virus (MLHIV). Methods Overall, 304 MLHIV 18 years or older were enrolled and attended follow-up visits at 6, 12, and 18 months. Clinicians examined for AGW, collected blood, and penile swabs for HPV testing (Roche Linear Array) at each visit. Time to AGW incidence or clearance was estimated by Kaplan-Meier method. Factors associated with persistent HPV infection and AGW clearance were evaluated with generalized estimating equations and Cox regression, respectively. Results Mean age of participants was 38 years (standard deviation, 8 years); 25% reported more than 1 sexual partner in the past 3 months. Most (65%) participants were on antiretroviral treatment (ART) with a median CD4+ count of 445 cells/μL (interquartile range, 328–567). Prevalence of HPV infection and AGW at enrolment were 79% (224 of 283) and 12% (36 of 304), respectively. Two hundred fifty-nine men were followed up for a median (interquartile range) 1.4 years (0.5–1.7 years). Incidence of any-genital HPV infection was 2.9 (95% confidence interval, 1.5–5.5) per 100 person-years. Persistence of any-genital HPV infection was 35% (68 of 192) and was higher among MLHIV with low CD4+ count (adjusted odds ratio, 3.54; 95% confidence interval, 2.07–6.05). Incidence of AGW was 1.4 per 100 person-years. Men living with human immunodeficiency virus with high CD4+ count were more likely to clear AGW than those with low CD4 count (adjusted hazard ratio, 3.69; 95% confidence interval, 1.44–9.47). No associations were observed between persistent genital HPV infection, AGW clearance with enrolment ART status or duration. Conclusions Human immunodeficiency virus–positive men have a high burden of genital HPV infection and AGW. The ART and HPV vaccine could reduce this burden.
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Kruse MH, Bednarczyk RA, Evans DP. A human rights approach to understanding provider knowledge and attitudes toward the human papillomavirus vaccine in São Paulo, Brazil. PAPILLOMAVIRUS RESEARCH 2020; 9:100197. [PMID: 32275960 PMCID: PMC7153286 DOI: 10.1016/j.pvr.2020.100197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 03/29/2020] [Accepted: 03/30/2020] [Indexed: 11/25/2022]
Abstract
Objective To determine the extent to which human rights considerations influence the attitudes of healthcare providers in Brazil with regard to access to the human papillomavirus (HPV) vaccine for females over 13 and males of all ages. Methods From May to August 2015, we conducted a cross-sectional study among healthcare providers in eight public health clinics in the city of Mauá, Brazil. Frequency analysis was conducted across three subject areas: access, knowledge, and attitudes. Results A total of 154 surveys were analyzed. Providers reported their perception that Brazilians do not have equal access to health (80%) and the vaccine exclusions limit an individual's right to health (72%). Providers stated it is medically effective to vaccinate females over the age of 13 (77%), these females should be vaccinated (84%), and they would vaccinate them (82%). Similar responses were reported for males. Conclusion Cervical cancer is the 4th leading cause of cancer among females in Brazil. Most cervical cancer cases are caused by persistent HPV infection, preventable through HPV vaccination. Limiting access to the HPV vaccine when medically efficacious is a perceived infringement of an individual's right to health. Brazil has a constitutional responsibility to reduce these access barriers.
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Affiliation(s)
- Meredith H Kruse
- Emory University, Rollins School of Public Health, Hubert Department of Global Health, Atlanta, USA
| | - Robert A Bednarczyk
- Emory University, Rollins School of Public Health, Hubert Department of Global Health, Atlanta, USA; Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, USA; Emory University, Emory Vaccine Center, Atlanta, USA; Emory University, Winship Cancer Institute, Cancer Prevention and Control Program, Atlanta, USA
| | - Dabney P Evans
- Emory University, Rollins School of Public Health, Hubert Department of Global Health, Atlanta, USA.
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Assessment of Knowledge, Attitudes, and Propensity towards HPV Vaccine of Young Adult Students in Italy. Vaccines (Basel) 2020; 8:vaccines8010074. [PMID: 32046039 PMCID: PMC7157590 DOI: 10.3390/vaccines8010074] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 01/01/2023] Open
Abstract
Background: Human Papillomavirus (HPV) is a common sexually transmitted infection (STI), representing the main cause of genital warts and cervical cancer. This cross-sectional study evaluated knowledge and attitudes about HPV infection, related diseases, and prevention and propensity towards HPV vaccine among undergraduate students. Methods: An online and written survey about HPV and its prevention, targeted to young adults of both genders, was addressed to students attending health sciences and other schools at Universities of Genoa and Bari. Results: The overall median knowledge and attitude scores were 56.3% (25–75 p = 40–68.8%) and four out of five (25–75 p = 4–5), respectively. In the multivariate analysis, attending a health sciences university, using social networks ≤2 h a day, a history of STI, having heard about HPV and HPV vaccine previously resulted as predictors of higher knowledge scores. Having heard about HPV previously also predicted a high attitude score, together with a perceived economic status as good. Having Italian and healthcare worker parents, being employed, and following a specific diet, instead, predicted lower attitude score. Conclusions: Poor knowledge and good attitudes were found among undergraduates about HPV. In order to increase HPV vaccine compliance and the counselling skills of future healthcare workers, the improvement of training on HPV is needed.
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Verheijen RHM, Mahmood T, Donders G, Redman CWE, Wood P. EBCOG position statement: Gender neutral HPV vaccination for young adults. Eur J Obstet Gynecol Reprod Biol 2020; 246:187-189. [PMID: 31992466 DOI: 10.1016/j.ejogrb.2020.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 01/10/2020] [Indexed: 11/30/2022]
Abstract
Human Papilloma Virus (HPV) has been implicated in the initiation of several types of cancers in both females and males. Therefore, it is imperative that national immunization programs should ensure that both young women and young men receive full immunization for herd immunity in their teenage years. A recent review confirmed that vaccination of boys and girls would be most cost-effective under the circumstances that both individual costs and coverage are low. By doing so, it would be possible to reduce the incidence of HPV-related malignancies to a large extent at later age in both sexes.
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Affiliation(s)
- Rene H M Verheijen
- Emeritus Professor of Gynaecological Oncology, Formerly Dept. of Gynaecological Oncology, Cancer Centre, University Medical Centre Utrecht, the Netherlands
| | - Tahir Mahmood
- EBCOG Standards of Care and Position Statements Working Group, Victoria Hospital, Kirkcaldy, Scotland, United Kingdom.
| | - Gilbert Donders
- Dept. of Obstetrics and Gynaecology, University Hospital Antwerp, Femicare Tienen, and Regional Hospital H Hart Tienen, Tienen, Belgium; International Society of infectious Diseases in Obstetrics and Gynaecology (ISIDOG)
| | | | - Paul Wood
- European Association of Paediatric andAdolescent Gynaecology (EURAPAG)
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Dynamic factors affecting HPV-attributable fraction for head and neck cancers. Curr Opin Virol 2019; 39:33-40. [DOI: 10.1016/j.coviro.2019.07.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 07/26/2019] [Indexed: 12/24/2022]
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Kim M, Lee H, Kiang P, Allison J. Development and acceptability of a peer-paired, cross-cultural and cross-generational storytelling HPV intervention for Korean American college women. HEALTH EDUCATION RESEARCH 2019; 34:483-494. [PMID: 31298268 PMCID: PMC6758644 DOI: 10.1093/her/cyz022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 06/18/2019] [Indexed: 05/04/2023]
Abstract
Although Korean American women have a higher risk of developing cervical cancer, currently there are limited culturally relevant intervention strategies for improving primary prevention of cervical cancer by promoting HPV vaccination in this population. This study reports the development of a cross-cultural, cross-generational storytelling HPV intervention using a peer-paired method, in which two storytellers interactively share their stories, as a particular innovation that might resonate with Korean American young women. The acceptability of the intervention was assessed by self-reported satisfaction and endorsement with the intervention in a pilot randomized control trial (RCT). We compared participants' responses to the intervention by their generation and cultural identity. One hundred and four Korean college women between the ages of 18-26 were recruited from the Northeastern US Participants randomized to the intervention group received a storytelling video (n = 54); the comparison group received written information (n = 50). The acceptability of the intervention was measured immediately post-intervention. The intervention group had significantly greater satisfaction than the comparison group (P < 0.05). Participants reported greater endorsement for videos that reflected their cultural and generational experiences. Future study is needed to examine the impact of such interventions on objective follow-up on HPV vaccination in a large-scale RCT.
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Affiliation(s)
- Minjin Kim
- Division of Preventive Medicine and Behavior, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School
- Correspondence to: M. Kim. E-mail:
| | - Haeok Lee
- College of Nursing and Health Sciences, University of Massachusetts Boston
| | - Peter Kiang
- School for Global Inclusion and Social Development, University of Massachusetts Boston
| | - Jeroan Allison
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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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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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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[The health economics of cancer screening in Germany: Which population-based interventions are cost-effective?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 61:1559-1568. [PMID: 30397723 DOI: 10.1007/s00103-018-2839-3] [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] [Indexed: 12/11/2022]
Abstract
Only a small proportion of German health expenditure is spent on prevention and early detection (screening). The rationale for screening is to identify persons with disease precursors or at the early stage of diseases when they are still asymptomatic, in order to decrease disease-specific morbidity and mortality. In Germany, the economic evidence is one of the evaluation criteria for screening measures, which, among other things, takes into account the additional cost per additional case detected or per case-related event avoided, as well as a cost-benefit balance.For this purpose, cost-effectiveness analyses, which report marginal or incremental cost effectiveness ratios, comparing a measure with its appropriate alternatives, may be a useful tool. Their application requires a defensible benchmark (threshold) for cost effectiveness and a supplementary analysis of the necessary infrastructure and the budgetary impact associated with program implementation. Also (albeit not only) because of the usually long time required to observe the clinical outcomes of a screening measure, the economic evaluation of such programs regularly involves the application of decision analytic simulation models. With regard to cancer screening programs, the available models indicate an excellent cost-benefit ratio for the fecal occult blood test and colonoscopy for colorectal cancer screening and, similarly, for the use of mammography for breast cancer screening. On the other hand, the economic evidence in favor of low-dose computed tomography for lung cancer screening does not yet appear sufficiently strong, and the currently available health economic evidence does not support the use of PSA testing for prostate screening.
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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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