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Wu YH, Lai CH, Chien L, Pan YC, Lin YJ, Feng C, Chang CJ. Economic Burden of Cervical and Head and Neck Cancer in Taiwan from a Societal Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3717. [PMID: 36834412 PMCID: PMC9967678 DOI: 10.3390/ijerph20043717] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/03/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Head and neck cancers (HNC) are increasingly recognized as important human papillomavirus (HPV)-related malignancies in addition to cervical cancer (CC). However, data on the socioeconomic impact of HNC and CC in Taiwan are limited. METHODS A retrospective cohort study was conducted to estimate the total direct medical cost and indirect productivity loss from CC and HNC between 2014 and 2015. Patient data from the Taiwan National Cancer Registry were analyzed, with matched non-cancer controls from the Taiwan National Healthcare Reimbursement Database. Indirect costs due to premature deaths were calculated using public data from Taiwanese government reports. RESULTS In the direct cost analysis, 2083 patients with newly diagnosed CC and 11,078 with newly diagnosed HNC (10,036 males) were identified between 2014 and 2015 and followed up through the end of 2016 or until death. The total direct medical costs incurred in 2014 and 2015 due to HNC were 11.54 times higher in males than in females, and 4.55 times higher than CC. Indirect cost analysis showed the total annual productivity loss was New Taiwan Dollar (NTD) $12 billion in 2019, and 79.99% was attributed to male HNC. CONCLUSION In Taiwan, the socioeconomic burden associated with male HNC is high and greater than that seen with CC. While not all HNCs are attributable to HPV infection, prevention of HNC through HPV vaccination should be considered for both sexes.
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Affiliation(s)
| | - Chyong-Huey Lai
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan 33305, Taiwan
| | | | | | - Yu-Jr Lin
- Research Service Center for Health Information, Chang Gung University, Taoyuan 33302, Taiwan
| | | | - Chee-Jen Chang
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
- Research Service Center for Health Information, Chang Gung University, Taoyuan 33302, Taiwan
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan 33302, Taiwan
- Graduate Institute of Clinical Medical Science, Department of Biomedical Science, Chang Gung University, Taoyuan 33302, Taiwan
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Ngcamphalala C, Östensson E, Ginindza TG. The economic burden of cervical cancer in Eswatini: Societal perspective. PLoS One 2021; 16:e0250113. [PMID: 33857233 PMCID: PMC8049330 DOI: 10.1371/journal.pone.0250113] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 03/31/2021] [Indexed: 12/24/2022] Open
Abstract
Background Cervical cancer imposes considerable economic burden on societies and individuals. There is lack of evidence regarding this from the developing world and particularly from sub-Saharan Africa. Therefore, the study aimed to estimate the societal costs of cervical cancer in Eswatini. Materials and methods The cost of illness study (CoI) was applied using national specific clinical and registry data from hospitals, registries and reports to determine the prevalence of cervical intraepithelial neoplasia (CIN) and cervical cancer in Eswatini in 2018. Cost data included direct medical costs (health care utilization in inpatient and outpatient care), direct non-medical costs (patient costs for traveling) and indirect costs based on productivity loss due to morbidity (patient time during diagnosis and treatment) and premature mortality. Results The estimated total annual cost for cervical cancer was $19 million (ranging between $14 million and $24 million estimated with lower and upper bounds). Direct cost represented the majority of the costs at 72% ($13.7 million) out of which total pre-cancerous treatment costs accounted for 0.7% ($94,161). The management of invasive cervical cancer was the main cost driver with costs attributable to treatment for FIGO III and FIGO IV representing $1.7 million and $8.7 million respectively. Indirect costs contributed 27% ($5.3 million) out of which productivity loss due to premature mortality represented the majority at 67% ($3.5 million). Conclusion The economic burden of cervical cancer in Eswatini is substantial. National public health prevention strategies with prophylactic HPV vaccine and screening for cervical lesions should therefore be prioritized to limit the extensive costs associated with cervical cancer.
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Affiliation(s)
- Cebisile Ngcamphalala
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- * E-mail:
| | - Ellinor Östensson
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Themba G. Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Rumisha SF, George J, Bwana VM, Mboera LEG. Years of potential life lost and productivity costs due to premature mortality from six priority diseases in Tanzania, 2006-2015. PLoS One 2020; 15:e0234300. [PMID: 32516340 PMCID: PMC7282655 DOI: 10.1371/journal.pone.0234300] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/22/2020] [Indexed: 01/14/2023] Open
Abstract
Background Mortality statistics are traditionally used to quantify the burden of disease and to determine the relative importance of the various causes of death. Some of the most frequently used indices to quantify the burden of disease are the years of potential life lost (YPLL) and years of potential productive life lost (YPPLL). These two measures reflect the mortality trends in younger age groups and they provide a more accurate picture of premature mortality. This study was carried out to determine YPLL, YPPLL and cost of productivity lost (CPL) due to premature mortality caused by selected causes of deaths in Tanzania. Methods and findings Malaria, respiratory diseases, HIV/AIDS, tuberculosis, cancers and injuries were selected for this analysis. The number of deaths by sex and age groups were obtained from hospital death registers and ICD-10 reporting forms in 39 public hospitals in Tanzania, covering a period of 2006–2015. The life expectancy method and human capital approach were used to estimate the YPLL, YPPLL and CPL due to premature mortality. During 2006–2015, malaria, HIV/AIDS, tuberculosis, respiratory diseases, HIV+tuberculosis, cancer and injury were responsible for a total of 96,834 hospital deaths, of which 46.4% (n = 57,508) were among individuals in the productive age groups (15–64 years). The reported deaths contributed to 2,850,928 YPLL (female = 1,326,724; male = 1,524,205) with an average of 29 years per death. The average YPLL among females (32) was higher than among males (28). Malaria (YPLL = 38 per death) accounted for over one-third (35%) of the total YPLL. There was a significant increase in YPLL due to the selected underlying causes of death over the 10-year period. Deaths from the selected causes resulted into 1,207,499 YPPLL (average = 21 per death). Overall, HIV/AIDS contributed to the highest YPPLL (323,704), followed by malaria (243,490) and injuries (196,505). While there was a general decrease in YPPLL due to malaria, there was an increase of YPPLL due to HIV/AIDS, respiratory diseases, cancer and injuries during the 10-year period. The total CPL due to the six diseases was US$ 148,430,009 for 10 years. The overall CPL was higher among males than females by 29.1%. Over half (58%) of the losses were due to deaths among males. HIV/AIDS accounted for the largest (29.2%) CPL followed by malaria (17.8%) and respiratory diseases (14.6%). The CPL increased from US$11.4 million in 2006 to US$17.9 million in 2016. Conclusions The YPLL, YPPLL and CPL due to premature death associated with the six diseases in Tanzania are substantially high. While malaria accounted for highest YPLL, HIV/AIDS accounted for highest YPPLL and CPL. The overall CPL was higher among males than among females. Setting resource allocation priorities to malaria, HIV/AIDS and respiratory diseases that are responsible for the majority of premature deaths could potentially reduce the costs of productivity loss in Tanzania.
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Affiliation(s)
- Susan F. Rumisha
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Janeth George
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Veneranda M. Bwana
- National Institute for Medical Research, Amani Research Centre, Muheza, Tanzania
| | - Leonard E. G. Mboera
- National Institute for Medical Research, Dar es Salaam, Tanzania
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
- * E-mail:
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Corman S, Nwankwo C. Lost Annual Productivity Costs Due to Uterine Cancer Deaths in the United States in 2014. J Womens Health (Larchmt) 2019; 28:929-933. [DOI: 10.1089/jwh.2018.7554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ashing KT, Carrington A, Ragin C, Roach V. Examining HPV- and HPV vaccine-related cognitions and acceptability among US-born and immigrant hispanics and US-born and immigrant non-Hispanic Blacks: a preliminary catchment area study. Cancer Causes Control 2017; 28:1341-1347. [PMID: 29098504 DOI: 10.1007/s10552-017-0973-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/24/2017] [Indexed: 01/23/2023]
Abstract
PURPOSE Disparities in HPV vaccination exist. Therefore, we investigated the distinction and disparities in HPV- and HPV vaccine-related cognitions and acceptability among US-born African Americans (AA) and Black immigrants, and between US-born Latinas and Latina immigrants. METHODS Secondary data analyses were conducted with 383 female adults divided into non-Hispanic Blacks-(1) AA born in the US (n = 129) and (2) Black immigrants (n = 53), and Hispanics-(3) Latinas born in the US (n = 57) and (4) Latina immigrants (n = 144). HPV-related cognitions are assessed by measuring HPV-related knowledge and HPV vaccine-related awareness, beliefs, accessibility, and acceptability. RESULTS Black and Latina immigrants were less likely to know where they can get/refer for HPV vaccine (p = .007) than their US-born counterparts. Latina immigrants were less likely to have heard of HPV vaccine (p = .033), know where they can get more information about HPV vaccine (p = .045), and know where they can get/refer for HPV vaccine (p = .001) than US-born Latinas. Both immigrant groups (Black: p = .046; Latina: p = .044) were more likely to report cost concerns than their counterparts. US-born AA were the least likely to endorse HPV vaccine safety (31.0%) and efficacy (39.7%), whereas US-born Latinas endorsed efficacy (63.2%) but less safety (44.6%). Overall, vaccine acceptability was low across all groups. CONCLUSIONS Group disparities in HPV vaccine cognitions emerged, but they all had notable HPV vaccine acceptability (safety and efficacy) barriers. HPV vaccine safety and efficacy were highly unfavorable in US-born AA. The HPV vaccine safety concerns are demonstrated with only 31-54% reporting that the "HPV vaccine is safe"-potentially increasing their risk of HPV vaccine negation. With regards to HPV vaccine efficacy, only 40-63% of this study population endorsed HPV vaccine efficacy. Additionally, immigrants reported greater HPV vaccine cost barriers and healthcare access concerns-increasing their risk for HPV vaccine naiveté. Therefore, our findings on HPV vaccine cognitions and acceptability can inform targeted strategies to increase vaccination among US and immigrant Hispanics and non-Hispanic Blacks who are at elevated risk for HPV-related cancers.
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Affiliation(s)
- Kimlin Tam Ashing
- Center of Community Alliance for Research and Education, Division of Health Equity, City of Hope National Medical Center, 1500 East Duarte Rd., Duarte, CA, 91010, USA.
| | - Agatha Carrington
- Secretary of Health, Wellness and Family Development, Tobago House of Assembly, Port-of-Spain, Trinidad and Tobago
| | | | - Veronica Roach
- Registrar Emeritus, National Cancer Registry of Trinidad and Tobago, The Ministry of Health, Port-of-Spain, Trinidad and Tobago
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Analysis of Productivity Costs in Cancer: A Systematic Review. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2017. [DOI: 10.5301/grhta.5000262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Karami-Matin B, Najafi F, Rezaei S, Khosravi A, Soofi M. Estimating the Economic Burden of Premature Mortality Caused by Cancer in Iran: 2006-2010. Asian Pac J Cancer Prev 2016; 17:2131-6. [DOI: 10.7314/apjcp.2016.17.4.2131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Gandhi PK, Gentry WM, Kibert JL, Lee EY, Jordan W, Bottorff MB, Huang IC. The relationship between four health-related quality-of-life indicators and use of mammography and Pap test screening in US women. Qual Life Res 2015; 24:2113-28. [PMID: 25804316 PMCID: PMC4531104 DOI: 10.1007/s11136-015-0968-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2015] [Indexed: 01/13/2023]
Abstract
PURPOSE Limited evidence is available to explain the role of four components of health-related quality of life (HRQoL) on breast and cervical cancer screening. The objective of this study was to determine the relationship between four HRQoL aspects and use of mammography and Pap test screening in US women. METHODS Data were obtained from the 2012 Behavioral Risk Factor Surveillance System (BRFSS). The outcome variables were receiving mammogram <2 versus ≥2 years in women aged 50-74 years, and receiving Pap test <3 versus ≥3 years in women aged 18-64 years. Eight logistic regression models were conducted to test the role of four HRQoL aspects (general health status, physical HRQoL, mental HRQoL, and activity limitation) on the two screening variables, after adjusting for covariates. Statistical analysis accounted for the complex sampling design of the BRFSS, and the a priori alpha error was set at p ≤ 0.05. RESULTS Among respondents, approximately 74 and 78 % of the women received mammography and Pap test, respectively. Three HRQoL aspects (general health status, physical HRQoL, and activity limitation) were significantly associated with mammography use (all p values < 0.05), whereas two HRQoL aspects (general health status and physical HRQoL) were significantly associated with Pap test (p values ≤ 0.05). All significant relationships demonstrated higher cancer screening rates among individuals with better HRQoL. CONCLUSIONS HRQoL is an important factor associated with use of mammography and Pap test. Future studies should explore the mechanisms associated with an individual's HRQoL and use HRQoL assessment as an avenue to influence adherence to use of mammography and Pap tests.
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Affiliation(s)
- Pranav K Gandhi
- Department of Pharmacy Practice, South College School of Pharmacy, 400 Goodys Lane, Knoxville, TN, 37922, USA,
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Marsh K, Chapman R, Baggaley RF, Largeron N, Bresse X. Mind the gaps: what's missing from current economic evaluations of universal HPV vaccination? Vaccine 2014; 32:3732-9. [PMID: 24837538 DOI: 10.1016/j.vaccine.2014.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/24/2014] [Accepted: 05/01/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Since the original licensing of human papilloma virus (HPV) vaccination for women, evidence is accumulating of its effectiveness in preventing HPV-related conditions in men, and universal vaccination (vaccinating men and women) is now recommended in some countries. Several models of the cost-effectiveness of universal HPV vaccination have been published, but results have been mixed. This article assesses the extent to which economic studies have captured the range of values associated with universal HPV vaccination, and how this influences estimates of its cost-effectiveness. METHODS Eight published economic evaluations of universal HPV vaccination were reviewed to identify which of the values associated with universal HPV vaccination were included in each analysis. RESULTS Studies of the cost-effectiveness of universal HPV vaccination capture only a fraction of the values generated. Most studies focused on impacts on health and health system cost, and only captured these partially. A range of values is excluded from most studies, including impacts on productivity, patient time and costs, carers and family costs, and broader social values such as the right to access treatment. Further, those studies that attempted to capture these values only did so partially. DISCUSSION Decisions to invest in universal HPV vaccination need to be based on a complete assessment of the value that it generates. This is not provided by existing economic evaluations. Further work is required to understand this value. First, research is required to understand how HPV-related health outcomes impact on society including, for instance, their impact on productivity. Second, consideration should be given to alternative approaches to capture this broader set of values in a manner useful to decisions-makers, such as multi-criteria decision analysis.
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Affiliation(s)
- Kevin Marsh
- Evidera, Metro Building, 6th Floor, 1 Butterwick, London W6 8DL, United Kingdom
| | - Ruth Chapman
- Evidera, Metro Building, 6th Floor, 1 Butterwick, London W6 8DL, United Kingdom
| | - Rebecca F Baggaley
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E HT, United Kingdom
| | | | - Xavier Bresse
- Sanofi Pasteur MSD, 8, rue Jonas Salk, 69367 Lyon Cedex 07, France
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Hanly P, Pearce A, Sharp L. The cost of premature cancer-related mortality: a review and assessment of the evidence. Expert Rev Pharmacoecon Outcomes Res 2014; 14:355-77. [DOI: 10.1586/14737167.2014.909287] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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de Peuter MA, Littlewood KJ, Annemans L, Largeron N, Quilici S. Cost–effectiveness of catch-up programs in human papillomavirus vaccination. Expert Rev Vaccines 2014; 9:1187-201. [DOI: 10.1586/erv.10.108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Low JJH, Ko Y, Ilancheran A, Zhang XH, Singhal PK, Tay SK. Health and Economic Burden of HPV-related Diseases in Singapore. Asian Pac J Cancer Prev 2012; 13:305-8. [DOI: 10.7314/apjcp.2012.13.1.305] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Herse F, Reissell E. The annual costs associated with human papillomavirus types 6, 11, 16, and 18 infections in Finland. ACTA ACUST UNITED AC 2010; 43:209-15. [PMID: 21171829 DOI: 10.3109/00365548.2010.541492] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES It is known that infections with human papillomavirus (HPV) types 6, 11, 16, and 18, cause cervical cancers (CC), cervical intraepithelial neoplastic lesions (types 1 to 3; CIN 1-3), and genital warts (GW). Together with equivocal cytological abnormalities (ECA), these place a considerable burden on society, but the costs and resource usage are not easily estimated. Therefore, we undertook this study to estimate the burden and costs associated with HPV-related diseases. METHODS We used Finnish registry-based data for CC, CIN 1-3 and ECA. Data on GW were estimated from associated procedures and medications. The annual burden of disease was estimated from hospitalizations, visits to specialists and primary level care, and pharmaceutical use. The evaluation of costs included health care and screening costs, and productivity lost (separately). Due to the data obtained being fragmented, 2 cost scenarios were constructed. RESULTS The follow-up of ECA appears to be the most important cost driver. GW should not be underestimated as they affect both genders at an early age. CONCLUSIONS HPV infections are a burden to society, not only as a result of cancer-related costs, but also costs related to other diseases and indirect costs in the form of lost productivity.
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The Impact of Precancerous Cervical Lesions on Functioning at Work and Work Productivity. J Occup Environ Med 2010; 52:926-33. [DOI: 10.1097/jom.0b013e3181f12fb0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fernández ME, Allen JD, Mistry R, Kahn JA. Integrating clinical, community, and policy perspectives on human papillomavirus vaccination. Annu Rev Public Health 2010; 31:235-52. [PMID: 20001821 PMCID: PMC2925431 DOI: 10.1146/annurev.publhealth.012809.103609] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Infection with genital human papillomavirus (HPV) may cause anogenital cancers, oropharyngeal cancers, anogenital warts, and respiratory papillomas. Two prophylactic vaccines (a bivalent and a quadrivalent vaccine) are now licensed and currently in use in a number of countries. Both vaccines prevent infection with HPV-16 and HPV-18, which together cause approximately 70% of cervical cancers, and clinical trials have demonstrated 90%-100% efficacy in preventing precancerous cervical lesions attributable to HPV-16 and HPV-18. One vaccine also prevents HPV-6 and HPV-11, which cause 90% of genital warts. A growing literature describes psychosocial, interpersonal, organizational, and societal factors that influence HPV vaccination acceptability. This review summarizes the current literature and presents an integrated perspective, taking into account these diverse influences. The resulting integrated framework can be used as a heuristic tool for organizing factors at multiple levels to guide intervention development and future research.
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Affiliation(s)
- María E Fernández
- School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas 77030, USA.
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Affiliation(s)
- Jessica A Kahn
- Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Abstract
PURPOSE OF REVIEW Recommendations for human papillomavirus (HPV) vaccination during adolescence primarily for a disease, cancer, that occurs only during adulthood is a paradigm shift for pediatricians. Additional postlicensure data and guidelines about HPV biology and epidemiology, disease association, adverse effects, vaccination during pregnancy, and cost-benefit analyses are now available to inform pediatricians and guide HPV vaccination recommendations. RECENT FINDINGS The prespecified, end-of-study combined analysis of HPV vaccine efficacy studies for prevention of cervical cancer, and now also for prevention of vulvar and vaginal cancers, confirmed 98-100% vaccine efficacy. Postlicensure surveillance identified a new association of vaccine administration with syncope, and provides assurance of the safety of inadvertent vaccination during pregnancy. Several cost-effectiveness analyses consistently demonstrated that HPV vaccination of 12-year-old girls and catch-up vaccination through 18 years of age, and possibly to 26 years of age, is cost-effective, although the thresholds of affordability vary by study. The downward trend in age of initial HPV infection and the need to educate parents and patients about HPV disease and vaccination underscore the essential role of pediatricians in managing HPV illness. SUMMARY It is critical for pediatricians to thoroughly understand HPV biology and disease and champion HPV vaccination to prevent cervical, vulvar, and vaginal cancers, even though these benefits accrue during adulthood and will likely require 2-4 decades to realize the financial and public health benefits. Several new developments are expected in the near future, including licensure for use in boys and men and the approval of a second, bivalent HPV vaccine.
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Ekwueme DU, Chesson HW, Zhang KB, Balamurugan A. Years of potential life lost and productivity costs because of cancer mortality and for specific cancer sites where human papillomavirus may be a risk factor for carcinogenesis-United States, 2003. Cancer 2008; 113:2936-45. [PMID: 18980277 DOI: 10.1002/cncr.23761] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Although years of potential life lost (YPLL) and mortality-related productivity costs comprise a substantial portion of the burden of cancers where human papillomavirus (HPV) may be a risk factor for carcinogenesis (called HPV-associated cancers in this report), estimates of these costs are limited. The authors estimated the mortality-related burden (in terms of YPLL and productivity costs) of HPV-associated cancers (without regard to the percentage of each of these cancers that could be attributed to HPV) and all malignant cancers in the United States in 2003. METHODS The authors used 2003 national mortality data and US life tables to estimate YPLL for HPV-associated cancers and all malignant cancers. YPLL was estimated by using the life expectancy method. The human capital approach was used to estimate the value of the expected future lifetime productivity losses caused by premature deaths from HPV-associated cancers and all malignant cancers. Indirect mortality costs were estimated as the product of the number of deaths and the expected value of individuals' future earnings, including an imputed value of housekeeping services. RESULTS In 2003, HPV-associated cancers accounted for 181,026 YPLL, which represented 2.4% of the estimated 7.5 million YPLL attributable to all malignant cancers in the United States. The average number of YPLL was 21.8 per HPV-associated cancer death and 16.3 per death from overall malignant cancers. Overall, HPV-associated cancers had the largest relative contribution to YPLL in women ages 30 to 34 years. The lifetime productivity cost from mortality in 2003 was $3.7 billion for HPV-associated cancer mortality and $133.5 billion for overall malignant cancer mortality. CONCLUSIONS HPV-associated cancers impose a considerable burden in terms of premature deaths and productivity losses.
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Affiliation(s)
- Donatus U Ekwueme
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Integrating epidemiology, psychology, and economics to achieve HPV vaccination targets. Proc Natl Acad Sci U S A 2008; 105:19018-23. [PMID: 19015536 DOI: 10.1073/pnas.0808114105] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Human papillomavirus (HPV) vaccines provide an opportunity to reduce the incidence of cervical cancer. Optimization of cervical cancer prevention programs requires anticipation of the degree to which the public will adhere to vaccination recommendations. To compare vaccination levels driven by public perceptions with levels that are optimal for maximizing the community's overall utility, we develop an epidemiological game-theoretic model of HPV vaccination. The model is parameterized with survey data on actual perceptions regarding cervical cancer, genital warts, and HPV vaccination collected from parents of vaccine-eligible children in the United States. The results suggest that perceptions of survey respondents generate vaccination levels far lower than those that maximize overall health-related utility for the population. Vaccination goals may be achieved by addressing concerns about vaccine risk, particularly those related to sexual activity among adolescent vaccine recipients. In addition, cost subsidizations and shifts in federal coverage plans may compensate for perceived and real costs of HPV vaccination to achieve public health vaccination targets.
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Rogers NM, Cantu AG. The Nurse’s Role in the Prevention of Cervical Cancer Among Underserved and Minority Populations. J Community Health 2008; 34:135-43. [DOI: 10.1007/s10900-008-9134-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dowling TS. Mandating a human papillomavirus vaccine: an investigation into whether such legislation is constitutional and prudent. AMERICAN JOURNAL OF LAW & MEDICINE 2008; 34:65-84. [PMID: 18512537 DOI: 10.1177/009885880803400103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Merck’s recently released vaccine, Gardasil, may revolutionize cervical cancer prevention. With the rate of detected cervical cancer cases and associated deaths rising rapidly, cervical cancer is a major public health concern. Infection with the human papillomavirus, a sexually transmitted disease, is a necessary cause of cervical cancer. Gardasil protects against two specific “high risk” strains of HPV, associated with about 70% of cervical cancer cases, and blocks infection by two other strains of HPV, responsible for 90% of genital warts cases. Proponents of Gardasil believe that vaccination of women between the ages of 12 and 26 can slow the spread of cervical cancer by eradicating the two major HPV strands associated with the cancer’s development.
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Insinga RP, Dasbach EJ, Elbasha EH, Puig A, Reynales-Shigematsu LM. Cost-effectiveness of quadrivalent human papillomavirus (HPV) vaccination in Mexico: a transmission dynamic model-based evaluation. Vaccine 2007; 26:128-39. [PMID: 18055075 DOI: 10.1016/j.vaccine.2007.10.056] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Revised: 10/17/2007] [Accepted: 10/18/2007] [Indexed: 11/16/2022]
Abstract
We examined the potential health outcomes and cost-effectiveness of quadrivalent human papillomavirus (HPV) 6/11/16/18 vaccination strategies in the Mexican population using a multi-HPV type dynamic transmission model. Assuming similar cervical screening practices, with or without vaccination, we examined the incremental cost-effectiveness of vaccination strategies for 12 year-old females, with or without male vaccination, and temporary age 12-24 catch-up vaccination for females or both sexes. The most effective strategy therein was vaccination of 12-year-olds, plus a temporary 12-24-year-old catch-up program covering both sexes; whereby HPV 6/11/16/18-related cervical cancer, high-grade cervical precancer, and genital wart incidence was reduced by 84-98% during year 50 following vaccine introduction. Incremental cost-effectiveness ratios in the primary analyses ranged from approximately 3000 dollars (U.S.) per quality-adjusted life year (QALY) gained for female vaccination strategies to approximately 16000 dollars /QALY for adding male vaccination with catch-up.
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Affiliation(s)
- Ralph P Insinga
- Department of Health Economic Statistics UG1C-60, Merck Research Laboratories, PO Box 1000, North Wales, PA 19454-1099, USA.
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