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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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Hong K, Leidner AJ, Tsai Y, Tang Z, Cho BH, Stokley S. Costs of Interventions to Increase Vaccination Coverage Among Children in the United States: A Systematic Review. Acad Pediatr 2021; 21:S67-S77. [PMID: 33958096 PMCID: PMC9998236 DOI: 10.1016/j.acap.2020.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/15/2020] [Accepted: 11/08/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The Community Preventive Services Task Force (CPSTF) has recommended several interventions that have been demonstrated to be effective at increasing vaccination coverage. OBJECTIVE Conduct a systematic review to examine the costs of interventions designed to increase vaccination coverage among children and adolescents in the United States. DATA SOURCES PubMed, EconLit, Embase, and Cochrane. STUDY ELIGIBILITY, PARTICIPANTS, AND INTERVENTIONS Peer-reviewed articles from January 1, 2009 to August 31, 2019. APPRAISAL AND SYNTHESIS METHODS Studies were identified with systematic searches of the literature, reviewed for inclusion criteria, abstracted for data on intervention, target population, costs, and risk of bias. Cost measures were reported as costs per child in the target population, costs per vaccinated child, incremental costs per vaccinated child, and costs per vaccine dose administered. Results were stratified by intervention type, vaccine, and age group. RESULTS Thirty-seven studies were identified for full-text review. Across all interventions and age groups, the cost per child ranged from $0.10 to $537.38, and the incremental cost per vaccinated child ranged from $6.52 to $5,098.57. Provider assessment and feedback interventions had the lowest (median) cost per child ($0.17) and a healthcare system-based combined intervention with multiple components had the lowest (median) incremental cost per vaccinated child ($26.65). A community-based combined intervention with multiple components had the highest median cost per child ($537.38) and the highest median incremental cost per vaccinated child ($5,098.57). LIMITATIONS A small number of included intervention types and inconsistent cost definition. CONCLUSIONS There is substantial variability in the costs of CPSTF-recommended interventions.
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Affiliation(s)
- Kai Hong
- Immunization Service Division, National Center for Immunization and Respiratory Diseases (NCIRD) (K Hong, AJ Leidner, Y Tsai, B-H Cho, and S Stokley), Centers for Disease Control and Prevention (CDC), Atlanta, Ga.
| | - Andrew J Leidner
- Immunization Service Division, National Center for Immunization and Respiratory Diseases (NCIRD) (K Hong, AJ Leidner, Y Tsai, B-H Cho, and S Stokley), Centers for Disease Control and Prevention (CDC), Atlanta, Ga
| | - Yuping Tsai
- Immunization Service Division, National Center for Immunization and Respiratory Diseases (NCIRD) (K Hong, AJ Leidner, Y Tsai, B-H Cho, and S Stokley), Centers for Disease Control and Prevention (CDC), Atlanta, Ga
| | - Zhaoli Tang
- Berry Technology Solutions (Z Tang), Atlanta, Ga
| | - Bo-Hyun Cho
- Immunization Service Division, National Center for Immunization and Respiratory Diseases (NCIRD) (K Hong, AJ Leidner, Y Tsai, B-H Cho, and S Stokley), Centers for Disease Control and Prevention (CDC), Atlanta, Ga
| | - Shannon Stokley
- Immunization Service Division, National Center for Immunization and Respiratory Diseases (NCIRD) (K Hong, AJ Leidner, Y Tsai, B-H Cho, and S Stokley), Centers for Disease Control and Prevention (CDC), Atlanta, Ga
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Zhong C, Xu L, Peng HL, Tam S, Xu L, Dahlstrom KR, Wu CF, Fu S, Chan W, Sturgis EM, Ramondetta LM, Rong L, Lairson DR, Miao H. An economic and disease transmission model of human papillomavirus and oropharyngeal cancer in Texas. Sci Rep 2021; 11:1802. [PMID: 33469199 PMCID: PMC7815750 DOI: 10.1038/s41598-021-81375-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/06/2021] [Indexed: 11/09/2022] Open
Abstract
In 2017, 46,157 and 3,127 new oropharyngeal cancer (OPC) cases were reported in the U.S. and Texas, respectively. About 70% of OPC were attributed to human papillomavirus (HPV). However, only 51% of U.S. and 43.5% of Texas adolescents have completed the HPV vaccine series. Therefore, modeling the demographic dynamics and transmission of HPV and OPC progression is needed for accurate estimation of the economic and epidemiological impacts of HPV vaccine in a geographic area. An age-structured population dynamic model was developed for the U.S. state of Texas. With Texas-specific model parameters calibrated, this model described the dynamics of HPV-associated OPC in Texas. Parameters for the Year 2010 were used as the initial values, and the prediction for Year 2012 was compared with the real age-specific incidence rates in 23 age groups for model validation. The validated model was applied to predict 100-year age-adjusted incidence rates. The public health benefits of HPV vaccine uptake were evaluated by computer simulation. Compared with current vaccination program, increasing vaccine uptake rates by 50% would decrease the cumulative cases by 4403, within 100 years. The incremental cost-effectiveness ratio of this strategy was $94,518 per quality-adjusted life year (QALY) gained. Increasing the vaccine uptake rate by 50% can: (i) reduce the incidence rates of OPC among both males and females; (ii) improve the quality-adjusted life years for both males and females; (iii) be cost-effective and has the potential to provide tremendous public health benefits in Texas.
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Affiliation(s)
- Chengxue Zhong
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler Street, Houston, TX, 77030, USA
| | - Li Xu
- Department of Statistics, School of Mathematical and Statistics, Guangdong University of Foreign Studies, Xiaoguwei Street, Guangzhou, Guangdong, China
| | - Ho-Lan Peng
- Department of Management, Policy, and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler Street, Houston, TX, USA
| | - Samantha Tam
- Department of Otolaryngology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, USA
| | - Li Xu
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA
| | - Kristina R Dahlstrom
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA
| | - Chi-Fang Wu
- Department of Management, Policy, and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler Street, Houston, TX, USA
| | - Shuangshuang Fu
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler Street, Houston, TX, USA
| | - Wenyaw Chan
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler Street, Houston, TX, 77030, USA
| | - Erich M Sturgis
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA.,Division of Cancer Prevention and Population Sciences, Department of Epidemiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX, USA
| | - Lois M Ramondetta
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, USA
| | - Libin Rong
- Department of Mathematics, University of Florida, 1400 Stadium Rd, Gainesville, FL, USA
| | - David R Lairson
- Department of Management, Policy, and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler Street, Houston, TX, USA
| | - Hongyu Miao
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler Street, Houston, TX, 77030, USA.
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Eska JS, Lairson DR, Savas LS, Shegog R, Healy CM, Spinner SW, Fernandez ME, Vernon SW. Implementation costs of a multi-component program to increase human papillomavirus (HPV) vaccination in a network of pediatric clinics. THE JOURNAL OF APPLIED RESEARCH ON CHILDREN : INFORMING POLICY FOR CHILDREN AT RISK 2019; 10:8. [PMID: 32782853 PMCID: PMC7416872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION HPV vaccination is both a clinically and cost-effective way to prevent HPV-related cancers. Increased focus on preventing HPV infection and HPV-related cancers has motivated development of strategies to increase adolescent vaccination rates. This analysis estimates the average cost associated with implementing programs aimed at increasing HPV vaccination from the perspective of the clinic decision makers. As providers and healthcare organizations consider vaccination initiatives, it is important for them to understand the costs associated with implementing these programs. METHODS Healthcare provider assessment and feedback, reminders, and education; and parent education/reminder strategies were implemented in a large pediatric clinic network between October 2015 and February 2018 to improve HPV vaccination rates. A micro-costing method was used in 2018 to prospectively estimate program implementation costs with the clinic as the unit of analysis. A sensitivity analysis assessed the effects of variability in levels of participation. RESULTS Assessment and feedback reports and provider education were implemented among 51 clinics at average per clinic cost of $786 and $368 respectively. Electronic vaccination reminders were delivered to providers and parents at a per clinic cost of $824. The parent education implementation cost was $2,126 per clinic. CONCLUSION The four complimentary HPV evidence-based strategies were delivered at a total cost of $157,534 or $4,749 per clinic, including staff training and participant recruitment, reaching 155,000 HPV vaccine eligible adolescents.
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Affiliation(s)
- Jarrod S Eska
- University of Texas Health Science Center-Houston, Center for Health Promotion and Prevention Research, Houston, TX
| | - David R Lairson
- University of Texas Health Science Center-Houston, Center for Health Services Research, Houston, TX
| | - L S Savas
- University of Texas Health Science Center-Houston, Center for Health Promotion and Prevention Research, Houston, TX
| | - Ross Shegog
- University of Texas Health Science Center-Houston, Center for Health Promotion and Prevention Research, Houston, TX
| | - C Mary Healy
- Baylor College of Medicine, Pediatric Medicine- Infectious Disease, Houston, TX
| | | | - Maria E Fernandez
- University of Texas Health Science Center-Houston, Center for Health Promotion and Prevention Research, Houston, TX
| | - Sally W Vernon
- University of Texas Health Science Center-Houston, Center for Health Promotion and Prevention Research, Houston, TX
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Rodriguez SA, Roncancio AM, Savas LS, Lopez DM, Vernon SW, Fernandez ME. Using Intervention Mapping to Develop and Adapt Two Educational Interventions for Parents to Increase HPV Vaccination Among Hispanic Adolescents. Front Public Health 2018; 6:164. [PMID: 29963542 PMCID: PMC6013574 DOI: 10.3389/fpubh.2018.00164] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 05/14/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction: Effective interventions to increase HPV vaccination are needed to reach national vaccination goals and to reduce later HPV-related cancer disparities. We used Intervention Mapping (IM) to develop and adapt a theory- and evidence-based educational intervention targeting parents of Hispanic adolescents to increase HPV vaccination. Methods: We followed IM steps 1–6 to: (1) develop a logic model and identify modifiable factors associated with vaccination among Hispanic adolescents by conducting literature reviews, focus groups, and in-depth interviews with Hispanic parents; (2) develop outcomes, write performance objectives, and develop a matrix of change objectives; (3) develop and identify a program theme, program components, theoretical methods, and practical applications; (4) develop an intervention design plan; (5) develop implementation strategies; and (6) develop an evaluation plan. We completed Steps 1–6 for to develop an intervention targeting parents of females, and we followed the steps again to adapt the program once HPV vaccine recommendations included males. Results: The program Por Nuestras Hijas (For Our Daughters) included two components: a print fotonovela and a tailored interactive multimedia intervention (TIMI). The program utilized the methods tailoring, targeting, framing, anticipated regret, modeling, skill building, and education and counseling to target the following determinants: parental knowledge, attitudes, self-efficacy, skills, perceived benefits/barriers, perceived susceptibility, perceived norms, and outcome expectations as modifiable factors influencing HPV vaccination. Lay health workers implemented the program in community clinics. A logic model of change guided evaluation planning. We later adapted the outcome and intervention content for parents of Hispanic adolescent males and changed the theme to Por Nuestros Hijos (For Our Children). Throughout the development and adaptation processes, we relied on theory, empirical evidence, and new data to make decisions. Discussion: IM provided a systematic methodology for program development and adaptation. Tasks in each step built upon one another integrating findings from the literature, previous research, qualitative findings, and theory to develop two educational programs for parents to increase HPV vaccination. The systematic process allowed us to develop messages and materials targeting factors beyond HPV knowledge or awareness to create behavior change.
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Affiliation(s)
- Serena A Rodriguez
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Angelica M Roncancio
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Lara S Savas
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Diana M Lopez
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Sally W Vernon
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Maria E Fernandez
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
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Nwanodi O, Salisbury H, Bay C. Multimodal Counseling Interventions: Effect on Human Papilloma Virus Vaccination Acceptance. Healthcare (Basel) 2017; 5:healthcare5040086. [PMID: 29113137 PMCID: PMC5746720 DOI: 10.3390/healthcare5040086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 10/27/2017] [Accepted: 10/29/2017] [Indexed: 12/25/2022] Open
Abstract
Human papilloma virus (HPV) vaccine was developed to reduce HPV-attributable cancers, external genital warts (EGW), and recurrent respiratory papillomatosis. Adolescent HPV vaccination series completion rates are less than 40% in the United States of America, but up to 80% in Australia and the United Kingdom. Population-based herd immunity requires 80% or greater vaccination series completion rates. Pro-vaccination counseling facilitates increased vaccination rates. Multimodal counseling interventions may increase HPV vaccination series non-completers’ HPV-attributable disease knowledge and HPV-attributable disease prophylaxis (vaccination) acceptance over a brief 14-sentence counseling intervention. An online, 4-group, randomized controlled trial, with 260 or more participants per group, found that parents were more likely to accept HPV vaccination offers for their children than were childless young adults for themselves (68.2% and 52.9%). A combined audiovisual and patient health education handout (PHEH) intervention raised knowledge of HPV vaccination purpose, p = 0.02, and HPV vaccination acceptance for seven items, p < 0.001 to p = 0.023. The audiovisual intervention increased HPV vaccination acceptance for five items, p < 0.001 to p = 0.006. That HPV causes EGW, and that HPV vaccination prevents HPV-attributable diseases were better conveyed by the combined audiovisual and PHEH than the control 14-sentence counseling intervention alone.
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Affiliation(s)
- Oroma Nwanodi
- Obstetrics and Gynecology Locum Tenens, Salinas, CA 93902, USA.
| | - Helen Salisbury
- College of Graduate Health Studies, A. T. Still University, Mesa, AZ 85206, USA.
| | - Curtis Bay
- Department of Interdisciplinary Sciences, A. T. Still University, Mesa, AZ 85026, USA.
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