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Fackler MJ, Pleas M, Li Y, Soni A, Xing D, Cope L, Ali S, Van Le Q, Van Nguyen C, Pham HT, Duong LM, Vanden Berg E, Wadee R, Michelow P, Chen WC, Joffe M, Fjeldbo CS, Lyng H, Sukumar S. Discovery and technical validation of high-performance methylated DNA markers for the detection of cervical lesions at risk of malignant progression in low- and middle-income countries. Clin Epigenetics 2024; 16:56. [PMID: 38643219 PMCID: PMC11032610 DOI: 10.1186/s13148-024-01669-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/04/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Cervical cancer remains a leading cause of death, particularly in developing countries. WHO screening guidelines recommend human papilloma virus (HPV) detection as a means to identify women at risk of developing cervical cancer. While HPV testing identifies those at risk, it does not specifically distinguish individuals with neoplasia. We investigated whether a quantitative molecular test that measures methylated DNA markers could identify high-risk lesions in the cervix with accuracy. RESULTS Marker discovery was performed in TCGA-CESC Infinium Methylation 450 K Array database and verified in three other public datasets. The panel was technically validated using Quantitative Multiplex-Methylation-Specific PCR in tissue sections (N = 252) and cervical smears (N = 244) from the USA, South Africa, and Vietnam. The gene panel consisted of FMN2, EDNRB, ZNF671, TBXT, and MOS. Cervical tissue samples from all three countries showed highly significant differential methylation in squamous cell carcinoma (SCC) with a sensitivity of 100% [95% CI 74.12-100.00], and specificity of 91% [95% CI 62.26-99.53] to 96% [95% CI 79.01-99.78], and receiver operating characteristic area under the curve (ROC AUC) = 1.000 [95% CI 1.00-1.00] compared to benign cervical tissue, and cervical intraepithelial neoplasia 2/3 with sensitivity of 55% [95% CI 37.77-70.84] to 89% [95% CI 67.20-98.03], specificity of 93% [95% CI 84.07-97.38] to 96% [95% CI 79.01-99.78], and a ROC AUC ranging from 0.793 [95% CI 0.68-0.89] to 0.99 [95% CI 0.97-1.00] compared to CIN1. In cervical smears, the marker panel detected SCC with a sensitivity of 87% [95% CI 77.45-92.69], specificity 95% [95% CI 88.64-98.18], and ROC AUC = 0.925 [95% CI 0.878-0.974] compared to normal, and high-grade squamous intraepithelial lesion (HSIL) at a sensitivity of 70% (95% CI 58.11-80.44), specificity of 94% (95% CI 88.30-97.40), and ROC AUC = 0.884 (95% CI 0.822-0.945) compared to low-grade intraepithelial lesion (LSIL)/normal in an analysis of pooled data from the three countries. Similar to HPV-positive, HPV-negative cervical carcinomas were frequently hypermethylated for these markers. CONCLUSIONS This 5-marker panel detected SCC and HSIL in cervical smears with a high level of sensitivity and specificity. Molecular tests with the ability to rapidly detect high-risk HSIL will lead to timely treatment for those in need and prevent unnecessary procedures in women with low-risk lesions throughout the world. Validation of these markers in prospectively collected cervical smear cells followed by the development of a hypermethylated marker-based cervical cancer detection test is warranted.
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Affiliation(s)
- Mary Jo Fackler
- Women's Malignancies Program, Department of Oncology, Johns Hopkins University School of Medicine, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 1650 Orleans Street, Rm 144, CRB1, Baltimore, MD, 21231, USA
| | - Madison Pleas
- Women's Malignancies Program, Department of Oncology, Johns Hopkins University School of Medicine, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 1650 Orleans Street, Rm 144, CRB1, Baltimore, MD, 21231, USA
| | - Youran Li
- Women's Malignancies Program, Department of Oncology, Johns Hopkins University School of Medicine, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 1650 Orleans Street, Rm 144, CRB1, Baltimore, MD, 21231, USA
| | - Anushri Soni
- Women's Malignancies Program, Department of Oncology, Johns Hopkins University School of Medicine, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 1650 Orleans Street, Rm 144, CRB1, Baltimore, MD, 21231, USA
| | - Deyin Xing
- Women's Malignancies Program, Department of Oncology, Johns Hopkins University School of Medicine, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 1650 Orleans Street, Rm 144, CRB1, Baltimore, MD, 21231, USA
| | - Leslie Cope
- Women's Malignancies Program, Department of Oncology, Johns Hopkins University School of Medicine, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 1650 Orleans Street, Rm 144, CRB1, Baltimore, MD, 21231, USA
| | - Syed Ali
- Division of Cytopathology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Quang Van Le
- Hanoi Medical University, National Cancer Hospital, Hanoi, Vietnam
| | - Chu Van Nguyen
- Department of Quansu Pathology, National Cancer Hospital, Hanoi, Vietnam
| | - Han Thi Pham
- Department of Quansu Pathology, National Cancer Hospital, Hanoi, Vietnam
| | - Long Minh Duong
- Department of Quansu Pathology, National Cancer Hospital, Hanoi, Vietnam
| | - Eunice Vanden Berg
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand/National Health Laboratory Service, Johannesburg, South Africa
| | - Reubina Wadee
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand/National Health Laboratory Service, Johannesburg, South Africa
| | - Pamela Michelow
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand/National Health Laboratory Service, Johannesburg, South Africa
| | - Wenlong Carl Chen
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maureen Joffe
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Christina Saetan Fjeldbo
- Department of Radiation Biology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Heidi Lyng
- Department of Radiation Biology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
- Department of Physics, University of Oslo, Oslo, Norway
| | - Saraswati Sukumar
- Women's Malignancies Program, Department of Oncology, Johns Hopkins University School of Medicine, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 1650 Orleans Street, Rm 144, CRB1, Baltimore, MD, 21231, USA.
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Kim M, Kim E. Effective vaccination strategies for human papillomavirus (HPV) infection and cervical cancer based on the mathematical model with a stochastic process. J Med Virol 2024; 96:e29558. [PMID: 38533898 DOI: 10.1002/jmv.29558] [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: 12/13/2023] [Revised: 03/04/2024] [Accepted: 03/12/2024] [Indexed: 03/28/2024]
Abstract
Human papillomavirus (HPV) infection poses a significant risk to women's health by causing cervical cancer. In addition to HPV, cervical cancer incidence rates can be influenced by various factors, including human immunodeficiency virus and herpes, as well as screening policy. In this study, a mathematical model with stochastic processes was developed to analyze HPV transmission between genders and its subsequent impact on cervical cancer incidence. The model simulations suggest that both-gender vaccination is far more effective than female-only vaccination in preventing an increase in cervical cancer incidence. With increasing stochasticity, the difference between the number of patients in the vaccinated group and the number in the nonvaccinated group diminishes. To distinguish the patient population distribution of the vaccinated from the nonvaccinated, we calculated effect size (Cohen's distance) in addition to Student's t-test. The model analysis suggests a threshold vaccination rate for both genders for a clear reduction of cancer incidence when significant stochastic factors are present.
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Affiliation(s)
- Minsoo Kim
- Natural Product Informatics Research Center, Korea Institute of Science and Technology, Gangneung, Republic of Korea
| | - Eunjung Kim
- Natural Product Informatics Research Center, Korea Institute of Science and Technology, Gangneung, Republic of Korea
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Dixit J, Gupta N, Kataki A, Roy P, Mehra N, Kumar L, Singh A, Malhotra P, Gupta D, Goyal A, Rajsekar K, Krishnamurthy MN, Gupta S, Prinja S. Health-related quality of life and its determinants among cancer patients: evidence from 12,148 patients of Indian database. Health Qual Life Outcomes 2024; 22:26. [PMID: 38481231 PMCID: PMC10938809 DOI: 10.1186/s12955-024-02227-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 01/02/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Cancer survivors experience a decrement in health-related quality of life (HRQoL) resulting from the disease as well as adverse effects of therapy. We evaluated the HRQoL of cancer patients, stratified by primary cancer site, stage, treatment response and associated adverse events, along with its determinants. METHODS Data were collected from 12,148 patients, sampled from seven purposively chosen leading cancer hospitals in India, to elicit HRQoL using the EuroQol questionnaire comprising of 5-dimensions and 5-levels (EQ-5D-5L). Multiple linear regression was used to determine the association between HRQoL and various socio-demographic as well as clinical characteristics. RESULTS Majority outpatients (78.4%) and inpatients (81.2%) had solid cancers. The disease was found to be more prevalent among outpatients (37.5%) and inpatients (40.5%) aged 45-60 years and females (49.3-58.3%). Most patients were found to be in stage III (40-40.6%) or stage IV (29.4-37.3%) at the time of recruitment. The mean EQ-5D-5 L utility score was significantly higher among outpatients [0.630 (95% CI: 0.623, 0.637)] as compared to inpatients [0.553 (95% CI: 0.539, 0.567)]. The HRQoL decreased with advancing cancer stage among both inpatients and outpatients, respectively [stage IV: (0.516 & 0.557); stage III (0.609 & 0.689); stage II (0.677 & 0.713); stage I (0.638 & 0.748), p value < 0.001]. The outpatients on hormone therapy (B = 0.076) showed significantly better HRQoL in comparison to patients on chemotherapy. However, palliative care (B=-0.137) and surgery (B=-0.110) were found to be associated with significantly with poorer HRQoL paralleled to chemotherapy. The utility scores among outpatients ranged from 0.305 (bone cancer) to 0.782 (Leukemia). Among hospitalized cases, the utility score was lowest for multiple myeloma (0.255) and highest for testicular cancer (0.771). CONCLUSION Older age, lower educational status, chemotherapy, palliative care and surgery, advanced cancer stage and progressive disease were associated with poor HRQoL. Our study findings will be useful in optimising patient care, formulating individualized treatment plan, improving compliance and follow-up.
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Affiliation(s)
- Jyoti Dixit
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Amal Kataki
- Dr. B. Booroah Cancer Institute, Guwahati, Assam, India
| | - Partha Roy
- Dr. B. Booroah Cancer Institute, Guwahati, Assam, India
| | - Nikita Mehra
- Department of Medical Oncology, Adyar Cancer Institute, Chennai, Tamil Nadu, India
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Pankaj Malhotra
- Department of Clinical Haematology and Medical Oncology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Dharna Gupta
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aarti Goyal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kavitha Rajsekar
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | | | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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Harper DM, Yu TM, Fendrick AM. Lives Saved Through Increasing Adherence to Follow-Up After Abnormal Cervical Cancer Screening Results. O&G OPEN 2024; 1:e001. [PMID: 38533459 PMCID: PMC10964775 DOI: 10.1097/og9.0000000000000001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/30/2024] [Accepted: 02/08/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To model the potential number of cancers prevented and life-years saved over a range of adherence rates to cervical cancer screening, surveillance follow-up, and follow-up colposcopy that may result from removing financial barriers to these essential clinical services. METHODS A previously validated decision-analytic Markov microsimulation model was used to evaluate the increase in adherence to screening, surveillance, and colposcopy after an abnormal cervical cancer screening result. For each incremental increase in adherence, we modeled the number of cervical cancer cases avoided, the stages at which the cancers were detected, the number of cervical cancer deaths avoided, and the number of life-years gained. RESULTS Compared with current adherence rates, the model estimated that an optimized scenario of perfect screening, surveillance, and colposcopy adherence per 100,000 women currently eligible for screening in the United States was 128 (95% CI, 66-199) fewer cervical cancers detected (23%), 62 (95% CI, 7-120) fewer cervical cancer deaths (20%), and 2,135 (95% CI, 1,363-3,057) more life-years saved. Sensitivity analysis revealed that any increase in adherence led to clinically meaningful health benefits. CONCLUSION The consequences of not attending routine screening or follow-up after an abnormal cervical cancer screening result are associated with preventable cervical cancer morbidity and premature mortality. Given the potential for the removal of consumer cost sharing to increase the use of necessary follow-up after abnormal screening results and to ultimately reduce cervical cancer morbidity and mortality, public and private payers should remove cost barriers to these essential services.
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Affiliation(s)
- Diane M Harper
- Department of Obstetrics and Gynecology, the Department of Family Medicine, the Department of Bioengineering, School of Engineering, and the Center for Value-Based Design, University of Michigan, and the Department of Women's and Gender Studies, University of Michigan College of Literature, Science and the Arts, Ann Arbor, Michigan; and Guidehouse, Inc, San Francisco, California
| | - Tiffany M Yu
- Department of Obstetrics and Gynecology, the Department of Family Medicine, the Department of Bioengineering, School of Engineering, and the Center for Value-Based Design, University of Michigan, and the Department of Women's and Gender Studies, University of Michigan College of Literature, Science and the Arts, Ann Arbor, Michigan; and Guidehouse, Inc, San Francisco, California
| | - A Mark Fendrick
- Department of Obstetrics and Gynecology, the Department of Family Medicine, the Department of Bioengineering, School of Engineering, and the Center for Value-Based Design, University of Michigan, and the Department of Women's and Gender Studies, University of Michigan College of Literature, Science and the Arts, Ann Arbor, Michigan; and Guidehouse, Inc, San Francisco, California
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5
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Choi W, Shim E. Evaluating the cost-effectiveness of HPV vaccination for adolescent girls in Japan: A comparison of 2-valent, 4-valent, and 9-valent HPV vaccines with consideration of cross-protection. Prev Med 2024; 178:107743. [PMID: 37866695 DOI: 10.1016/j.ypmed.2023.107743] [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: 04/18/2023] [Revised: 10/04/2023] [Accepted: 10/19/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE In April 2023, the Japanese Health Ministry panel approved the inclusion of the 9-valent human papillomavirus (9vHPV) vaccine in the National Immunization Program, alongside the 2-valent (2vHPV) and 4-valent HPV (4vHPV) vaccines. In response to this, we evaluated the cost-effectiveness of these three vaccines for routine immunization of girls aged 12-16 in Japan, considering the cross-protection of 2vHPV and 4vHPV vaccines. METHODS We constructed an age-structured mathematical model for HPV transmission, aiming to quantify the economic and epidemiological effects of various HPV vaccination strategies over a 70-year period in Japan. We determined incremental costs and quality-adjusted life years (QALYs) for each strategy, applying a 3% annual discount. Univariate and probabilistic sensitivity analyses were conducted to assess the uncertainty of our model results, with all evaluations done in 2023. RESULTS Our projections indicate that the HPV vaccination program in Japan will significantly reduce the incidence of HPV-related diseases. All HPV vaccination strategies, using the 2vHPV, 4vHPV, and 9vHPV vaccines, were found to be cost-effective compared to no vaccination, with incremental cost-effectiveness ratios of ¥971,447/QALY, ¥1,237,297/QALY, and ¥742,084/QALY, respectively. Direct comparisons between vaccines demonstrated that the 9vHPV vaccination was more cost-effective than the 2vHPV vaccination, whereas 4vHPV vaccination was dominated by 2vHPV vaccination. CONCLUSIONS Our study validates the cost-effectiveness of implementing the 9vHPV vaccine as the primary option over the 2vHPV or 4vHPV vaccine for girls in Japan. These findings underscore the need to improve the acceptance rate and coverage of HPV vaccinations in the country.
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Affiliation(s)
- Wongyeong Choi
- Department of Mathematics, Soongsil University, 369 Sangdoro, Dongjak-gu, Seoul 06978, Republic of Korea.
| | - Eunha Shim
- Department of Mathematics, Soongsil University, 369 Sangdoro, Dongjak-gu, Seoul 06978, Republic of Korea.
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Peremiquel-Trillas P, Gómez D, Martínez JM, Fernández-González S, Frias-Gomez J, Paytubi S, Pelegrina B, Pineda M, Brunet J, Ponce J, Matias-Guiu X, Bosch X, de Sanjosé S, Bruni L, Alemany L, Costas L, Díaz M. Cost-effectiveness analysis of molecular testing in minimally invasive samples to detect endometrial cancer in women with postmenopausal bleeding. Br J Cancer 2023; 129:325-334. [PMID: 37165201 PMCID: PMC10338433 DOI: 10.1038/s41416-023-02291-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 04/05/2023] [Accepted: 04/19/2023] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION New approaches are being developed to early detect endometrial cancer using molecular biomarkers. These approaches offer high sensitivities and specificities, representing a promising horizon to develop early detection strategies. OBJECTIVE To evaluate the effectiveness and cost-effectiveness of introducing molecular testing to detect endometrial cancer in women with postmenopausal bleeding compared to the current strategy using the national healthcare service perspective. METHODS A Markov model was developed to assess the two early detection strategies. The model predicts the number of hysterectomies, lifetime expectancy, quality-adjusted life-years, endometrial cancer prevalence and incidence, mortality from endometrial cancer and the lifetime cost of screening, diagnosis, and treatment. Strategies were compared using the incremental cost-effectiveness ratio. RESULTS The molecular strategy reduces 1.9% of the overall number of hysterectomies and the number of undetected cancer cases by 65%. Assuming a molecular test cost of 310€, the molecular strategy has an incremental cost of -32,952€ per QALY gained, being more effective and less expensive than the current strategy. CONCLUSIONS The introduction of molecular testing to diagnose endometrial cancer in women presenting postmenopausal bleeding provides more health benefit at a lower cost, and therefore has the potential to be cost-effective.
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Affiliation(s)
- Paula Peremiquel-Trillas
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Faculty of Medicine, University of Barcelona. C/ Casanova, 143, 08036, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
| | - David Gómez
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
| | - José Manuel Martínez
- Department of Gynecology and Obstetrics, Hospital Universitari de Bellvitge, IDIBELL. Hospitalet de Llobregat, Barcelona, Spain
| | - Sergi Fernández-González
- Department of Gynecology and Obstetrics, Hospital Universitari de Bellvitge, IDIBELL. Hospitalet de Llobregat, Barcelona, Spain
| | - Jon Frias-Gomez
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Faculty of Medicine, University of Barcelona. C/ Casanova, 143, 08036, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
| | - Sonia Paytubi
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
| | - Beatriz Pelegrina
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Pineda
- Hereditary Cancer Program, IDIBELL. Catalan Institute of Oncology. Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Cancer-CIBERONC. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
| | - Joan Brunet
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Hereditary Cancer Program, IDIBELL. Catalan Institute of Oncology. Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Cancer-CIBERONC. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
- Medical Oncology Department. Catalan Institute of Oncology, Doctor Josep Trueta Girona University Hospital. Av. França-Sant Ponç s/n, 17007, Girona, Spain
| | - Jordi Ponce
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Hereditary Cancer Program, IDIBELL. Catalan Institute of Oncology. Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Matias-Guiu
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Cancer-CIBERONC. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
- Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL. Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Bosch
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Faculty of Health Sciences, UOC - Open University of Barcelona, Barcelona, Spain
| | - Silvia de Sanjosé
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
- ISGlobal, Barcelona, Spain
- Consultant National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Laia Bruni
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
| | - Laia Alemany
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
| | - Laura Costas
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
| | - Mireia Díaz
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain.
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain.
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain.
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Cordoba-Sanchez V, Lemos M, Tamayo-Lopera DA, Sheinfeld Gorin S. HPV-Vaccine Hesitancy in Colombia: A Mixed-Methods Study. Vaccines (Basel) 2022; 10:1187. [PMID: 35893836 PMCID: PMC9332743 DOI: 10.3390/vaccines10081187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 12/24/2022] Open
Abstract
In Colombia, the uptake rate of the HPV vaccine dropped from 96.7% after its introduction in 2013 to 9% in 2020. To identify the behavioural components of HPV-vaccine hesitancy in females aged 15 and under and their families, we conducted a convergent mixed-methods study in which 196 parents/caregivers responded to an online questionnaire and 10 focus groups were held with 13 of these parents/caregivers, and 50 age-eligible girls. The study is novel as it is the first to explore the factors influencing HPV-vaccine hesitancy alongside the COVID vaccine within an integrative model of behaviour change, the capability-opportunity-motivation-behaviour (COM-B) model. We found that COVID-19 has had an impact on the awareness of HPV and HPV vaccination. Lack of information about the vaccination programs, concerns about vaccine safety and the relationship between HPV and sexuality could be related to vaccine hesitancy. Trust in medical recommendations and campaigns focused on the idea that vaccination is a way of protecting daughters from cervical cancer could improve HPV vaccine uptake.
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Affiliation(s)
- Veronica Cordoba-Sanchez
- Department of Psychology, School of Social Sciences, Institucion Universitaria de Envigado, Envigado 055422, Colombia;
| | - Mariantonia Lemos
- Department of Psychology, School of Arts and Social Sciences, Universidad EAFIT, Medellín 050022, Colombia;
| | - Diego Alfredo Tamayo-Lopera
- Department of Psychology, School of Social Sciences, Institucion Universitaria de Envigado, Envigado 055422, Colombia;
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Cost-Effectiveness of Bivalent, Quadrivalent, and Nonavalent HPV Vaccination in South Africa. Clin Drug Investig 2022; 42:333-343. [PMID: 35294726 PMCID: PMC8989937 DOI: 10.1007/s40261-022-01138-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES In South Africa, the prevalence of human papillomavirus (HPV) and associated diseases, such as cervical cancer and genital warts, is among the highest in the world. This study evaluates the cost-effectiveness of bivalent, quadrivalent, and nonavalent HPV vaccination for 9- to 14-year-old girls from the South African healthcare system perspective. METHODS A Markov model portraying the natural HPV disease progression from high-risk infection to cervical intraepithelial neoplasia (CIN) I, CIN II/III, or cervical cancer and from low-risk infection to genital warts was built. Transition probability, utility, and efficacy data were sourced from peer-reviewed literature. Vaccination costs were calculated based on the World Health Organization (WHO) guidelines. The model was populated with a cohort of 520,000 9-year-old girls to calculate incremental cost-effectiveness ratios (ICER) in South African Rand (R) per quality-adjusted life-years (QALYs) gained for each vaccination strategy. RESULTS All HPV vaccination strategies dominate the no vaccine strategy. Compared with the bivalent vaccine, the nonavalent strategy increases QALYs by 0.14 and costs by R1793 (ICER: R13,013 per QALY) per person, while the quadrivalent vaccination provides -0.02 incremental QALYs and R1748 costs (ICER: -R116,397 per QALY). Consequently, at the South African willingness-to-pay threshold of R23,630 per QALY, nonavalent vaccination is the preferred strategy, with a probability of 90.2%. Scenario analysis demonstrated that results are influenced by vaccine coverage, efficacy, and duration of efficacy. CONCLUSIONS The introduction of nonavalent for bivalent HPV vaccination is a cost-effective intervention in South Africa. HPV vaccination should be part of a multifaceted public health strategy entailing screening, condoms, and education of all stakeholders to reduce the significant burden of sexual transmitted diseases in South Africa. Sex-neutral and catch-up vaccinations are subjects for further research.
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Dixit J, Jyani G, Prinja S, Sharma Y. Health related quality of life among Rheumatic Fever and Rheumatic Heart Disease patients in India. PLoS One 2021; 16:e0259340. [PMID: 34714892 PMCID: PMC8555809 DOI: 10.1371/journal.pone.0259340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/19/2021] [Indexed: 11/18/2022] Open
Abstract
Background Measurement of health-related quality of life (HRQOL) of people with chronic illnesses has become extremely important as the mortality rates associated with such illnesses have decreased and survival rates have increased. Thereby, such measurements not only provide insights into physical, mental and social dimensions of patient’s health, but also allow monitoring of the results of interventions, complementing the traditional methods based on morbidity and mortality. Objective The present study was conducted to describe the HRQOL of patients suffering from Rheumatic Fever (RF) and Rheumatic Heart Disease (RHD), and to identify socio-demographic and clinical factors as predictors of HRQOL. Methodology A cross-sectional study was conducted to assess the HRQOL among 702 RF and RHD patients using EuroQol 5-dimensions 5-levels instrument (EQ-5D-5L), EuroQol Visual Analogue Scale and Time Trade off method. Mean EQ-5D-5L quality of life scores were calculated using EQ5D index value calculator across different stages of RF and RHD. Proportions of patients reporting problems in different attributes of EQ-5D-5L were calculated. The impact of socio-economic determinants on HRQOL was assessed. Results The mean EQ-5D-5L utility scores among RF, RHD and RHD with Congestive heart failure patients (CHF) were estimated as 0.952 [95% Confidence Interval (CI): 0.929–0.975], 0.820 [95% CI: 0.799–0.842] and 0.800 [95% CI: 0.772–0.829] respectively. The most frequently reported problem among RF/RHD patients was pain/discomfort (33.8%) followed by difficulty in performing usual activities (23.9%) patients, mobility (22.7%) and anxiety/depression (22%). Patients with an annual income of less than 50,000 Indian National Rupees (INR) reported the highest EQ-5D-5L score of 0.872, followed by those in the income group of more than INR 200,000 (0.835), INR 50,000–100,000 (0.832) and INR 100,000–200,000 (0.828). Better HRQOL was reported by RHD patients (including RHD with CHF) who underwent balloon valvotomy (0.806) as compared to valve replacement surgery (0.645). Conclusion RF and RHD significantly impact the HRQOL of patients. Interventions aiming to improve HRQOL of RF/RHD patients should focus upon ameliorating pain and implementation of secondary prevention strategies for reducing the progression from ARF to RHD and prevention of RHD-related complications.
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Affiliation(s)
- Jyoti Dixit
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Jyani
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- * E-mail:
| | - Yashpaul Sharma
- Department of Cardiology, Advanced Cardiac Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Dzobo K. The Role of Viruses in Carcinogenesis and Molecular Targeting: From Infection to Being a Component of the Tumor Microenvironment. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2021; 25:358-371. [PMID: 34037476 DOI: 10.1089/omi.2021.0052] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
About a tenth of all cancers are caused by viruses or associated with viral infection. Recent global events including the coronavirus disease-2019 (COVID-19) pandemic means that human encounter with viruses is increased. Cancer development in individuals with viral infection can take many years after infection, demonstrating that the involvement of viruses in cancer development is a long and complex process. This complexity emanates from individual genetic heterogeneity and the many steps involved in cancer development owing to viruses. The process of tumorigenesis is driven by the complex interaction between several viral factors and host factors leading to the creation of a tumor microenvironment (TME) that is ideal and promotes tumor formation. Viruses associated with human cancers ensure their survival and proliferation through activation of several cellular processes including inflammation, migration, and invasion, resistance to apoptosis and growth suppressors. In addition, most human oncoviruses evade immune detection and can activate signaling cascades including the PI3K-Akt-mTOR, Notch and Wnt pathways associated with enhanced proliferation and angiogenesis. This expert review examines and synthesizes the multiple biological factors related to oncoviruses, and the signaling cascades activated by these viruses contributing to viral oncogenesis. In particular, I examine and review the Epstein-Barr virus, human papillomaviruses, and Kaposi's sarcoma herpes virus in a context of cancer pathogenesis. I conclude with a future outlook on therapeutic targeting of the viruses and their associated oncogenic pathways within the TME. These anticancer strategies can be in the form of, but not limited to, antibodies and inhibitors.
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Affiliation(s)
- Kevin Dzobo
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town Component, Cape Town, South Africa.,Division of Medical Biochemistry and Institute of Infectious Disease and Molecular Medicine, Department of Integrative Biomedical Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Vale DB, Silva MT, Discacciati MG, Polegatto I, Teixeira JC, Zeferino LC. Is the HPV-test more cost-effective than cytology in cervical cancer screening? An economic analysis from a middle-income country. PLoS One 2021; 16:e0251688. [PMID: 33989331 PMCID: PMC8121350 DOI: 10.1371/journal.pone.0251688] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/01/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To report a modelling study using local health care costs and epidemiological inputs from a population-based program to access the cost-effectiveness of adopting hrHPV test. METHODS A cost-effectiveness analysis based on a microsimulation dynamic Markov model. Data and costs were based on data from the local setting and literature review. The setting was Indaiatuba, Brazil, that has adopted the hrHPV test in place of cytology since 2017. After calibrating the model, one million women were simulated in hypothetical cohorts. Three strategies were tested: cytology to women aged 25 to 64 every three years; hrHPV test to women 25-64 every five years; cytology to women 25-29 years every three years and hrHPV test to women 30-64 every five years (hybrid strategy). Outcomes were Quality-adjusted life-years (QALY) and Incremental Cost-Effectiveness Ratio (ICER). RESULTS The hrHPV testing and the hybrid strategy were the dominant strategies. Costs were lower and provided a more effective option at a negative incremental ratio of US$ 37.87 for the hybrid strategy, and negative US$ 6.16 for the HPV strategy per QALY gained. Reduction on treatment costs would influence a decrease in ICER, and an increase in the costs of the hrHPV test would increase ICER. CONCLUSIONS Using population-based data, the switch from cytology to hrHPV testing in the cervical cancer screening program of Indaiatuba is less costly and cost-effective than the old cytology program.
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Affiliation(s)
- Diama Bhadra Vale
- Obstetrics and Gynecology Department, State University of Campinas, Campinas, Brazil
- * E-mail:
| | | | | | - Ilana Polegatto
- Obstetrics and Gynecology Department, State University of Campinas, Campinas, Brazil
| | - Julio Cesar Teixeira
- Obstetrics and Gynecology Department, State University of Campinas, Campinas, Brazil
| | - Luiz Carlos Zeferino
- Obstetrics and Gynecology Department, State University of Campinas, Campinas, Brazil
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Lewis RM, Laprise JF, Gargano JW, Unger ER, Querec TD, Chesson HW, Brisson M, Markowitz LE. Estimated Prevalence and Incidence of Disease-Associated Human Papillomavirus Types Among 15- to 59-Year-Olds in the United States. Sex Transm Dis 2021; 48:273-277. [PMID: 33492097 PMCID: PMC10037549 DOI: 10.1097/olq.0000000000001356] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Human papillomavirus (HPV) can cause anogenital warts and several types of cancer, including cervical cancers and precancers. We estimated the prevalence, incidence, and number of persons with prevalent and incident HPV infections in the United States in 2018. METHODS Prevalence and incidence were estimated for infections with any HPV (any of 37 types detected using Linear Array) and disease-associated HPV, 2 types that cause anogenital warts plus 14 types detected by tests used for cervical cancer screening (HPV 6/11/16/18/31/33/35/39/45/51/52/56/58/59/66/68). We used the 2013-2016 National Health and Nutrition Examination Survey to estimate prevalence among 15- to 59-year-olds, overall and by sex. Incidences in 2018 were estimated per 10,000 persons using an individual-based transmission-dynamic type-specific model calibrated to US data. We estimated number of infected persons by applying prevalences and incidences to 2018 US population estimates. RESULTS Prevalence of infection with any HPV was 40.0% overall, 41.8% in men, and 38.4% in women; prevalence of infection with disease-associated HPV was 24.2% in men and 19.9% in women. An estimated 23.4 and 19.2 million men and women had a disease-associated HPV type infection in 2018. Incidences of any and disease-associated HPV infection were 1222 and 672 per 10,000 persons; incidence of disease-associated HPV infection was 708 per 10,000 men and 636 per 10,000 women. An estimated 6.9 and 6.1 million men and women had an incident infection with a disease-associated HPV type in 2018. CONCLUSIONS We document a high HPV burden of infection in the United States in 2018, with 42 million persons infected with disease-associated HPV and 13 million persons acquiring a new infection. Although most infections clear, some disease-associated HPV type infections progress to disease. The HPV burden highlights the need for continued monitoring of HPV-associated cancers, cervical cancer screening, and HPV vaccination to track and prevent disease.
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Affiliation(s)
| | | | - Julia W Gargano
- From the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Elizabeth R Unger
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Troy D Querec
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Harrell W Chesson
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Marc Brisson
- Centre de Recherche du CHU de Québec, Université Laval, Quebec, Canada
| | - Lauri E Markowitz
- From the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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Thanasas I, Lavranos G, Gkogkou P, Paraskevis D. Understanding of Young Adolescents About HPV Infection: How Health Education Can Improve Vaccination Rate. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:850-859. [PMID: 31925677 DOI: 10.1007/s13187-019-01681-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The purpose of this systematic review was to identify adolescents' awareness on the human papillomavirus (HPV), the HPV vaccine, and the willingness to undergo the vaccination. A systematic review of studies concerning the adolescent's knowledge and education on the admission of the HPV vaccine was carried out, through the Medline/PubMed and the Google Scholar databases, covering information on adolescent attitudes towards HPV vaccination, as well as their perceptions regarding the vaccination and the need for more training, towards the public information about the HPV and the HPV vaccine. This study concludes that adolescents are poorly informed about the HPV and the preventive vaccination issues, underestimating the likelihood of the infection by the virus. The way to improve their knowledge about the HPV and the implications of the HPV infection is to provide information through the framework of compulsory schooling, primary health care, and the development of informative interactive interventions. The awareness for the need of training about the HPV and its implications should be broadened to address the major barrier to vaccination, which is regarded to be the lack of adequate information. The knowledge and the perceptible susceptibility to the HPV infection and HPV-related diseases among adolescents demonstrate the need for a well-designed training program to bridge the gap of information about the HPV virus and to accept the HPV vaccine.
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Affiliation(s)
- Ioannis Thanasas
- Department of Obstetrics & Gynecology, General Hospital in Trikala, Trikala, Greece.
| | - Giagkos Lavranos
- Medical School and Department of Health Sciences, European University Cyprus, Nicosia, Cyprus
| | - Pinelopi Gkogkou
- Oncology Department, Norfolk and Norwich University Hospital, Norwich, UK
| | - Dimitrios Paraskevis
- Department of Hygiene Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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MacCosham A, El-Zein M, Burchell AN, Tellier PP, Coutlée F, Franco EL. Transmission reduction and prevention with HPV vaccination (TRAP-HPV) study protocol: a randomised controlled trial of the efficacy of HPV vaccination in preventing transmission of HPV infection in heterosexual couples. BMJ Open 2020; 10:e039383. [PMID: 32788190 PMCID: PMC7422656 DOI: 10.1136/bmjopen-2020-039383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) is a causal agent of malignancies including cervical, vulvar, vaginal, penile, anal and oropharyngeal cancer, as well as benign conditions such as anogenital warts. HPV vaccination protects individuals against infections with the target HPV types and their clinical outcomes. However, little is known about the protection an immunised individual confers to their sexual partner or its impact on HPV transmission dynamics. In this context, the Transmission Reduction and Prevention with HPV vaccination (TRAP-HPV) study was designed to determine the efficacy of an HPV vaccine in reducing transmission of genital and oral HPV infection in sexual partners of vaccinated individuals. METHODS AND ANALYSIS The TRAP-HPV study is an ongoing randomised controlled trial among heterosexual couples living in Montreal, Canada. Sexually active couples, aged between 18 and 45 years, who have been in a relationship no longer than 6 months are considered eligible. Participants are independently randomised to receive either the intervention HPV vaccine, Gardasil 9, or a placebo hepatitis A vaccine, Avaxim, creating four vaccination groups among couples: intervention-intervention, intervention-placebo, placebo-intervention and the placebo-placebo. Participants provide genital (vaginal/penile) and oral samples at baseline and five follow-up visits over a 1-year duration. Linear Array HPV genotyping is used to detect 36 HPV types. Cox proportional hazard regression models will be used to estimate the effect of vaccination on HPV transmission. ETHICS AND DISSEMINATION The TRAP-HPV study received ethical approval by institutional review boards McGill University, Concordia University and Centre Hospitalier de l'Université de Montréal. Before enrolment, all participants provide informed written consent. Results will be published in peer-reviewed journals and presented at national and international conferences. The generated empirical evidence could be used in mathematical models of vaccination to inform policymakers in Canada and elsewhere. TRIAL REGISTRATION NUMBER NCT01824537.
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Affiliation(s)
- Aaron MacCosham
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Mariam El-Zein
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Ann N Burchell
- Department of Family and Community Medicine and Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | | | - François Coutlée
- Service de Microbiologie Médicale et Service d'Infectiologie, Départements de Médecine et de Médecine de Laboratoire, Centre Hospitalier de L'Universite de Montreal, Montreal, Quebec, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
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Jyani G, Chauhan AS, Rai B, Ghoshal S, Srinivasan R, Prinja S. Health-related quality of life among cervical cancer patients in India. Int J Gynecol Cancer 2020; 30:1887-1892. [PMID: 32788265 DOI: 10.1136/ijgc-2020-001455] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Estimation of health-related quality of life of cervical cancer patients in India is important in assessing the well-being of patients, monitor treatment outcomes, and conduct health technology assessments. However, health-related quality of life estimates for different stages of cervical cancer are not available for the Indian population. This study aims to generate stage-specific quality of life scores for cervical cancer patients in India. METHODS A cross-sectional study using the EQ-5D (EuroQol 5-dimensions) instrument, that consists of the EQ-5D-5L descriptive system and the EuroQol Visual Analog Scale (EQ-VAS) was conducted. A total of 159 cervical cancer patients were interviewed. Mean EQ-5D-5L quality of life scores (utility scores) were calculated using the EQ-5D-5L index value calculator across different stages of cervical cancer. The proportion of patients reporting problems in different attributes of EQ-5D-5L was assessed. The impact of socio-economic determinants on health-related quality of life was evaluated using multiple linear regression. RESULTS The mean EQ-5D-5L and EQ-VAS utility scores among patients of cervical cancer were 0.64 [95% CI=0.61-0.67] and 67.6 [95% CI=65.17-70.03], respectively. The most frequently reported problem among cervical cancer patients was pain/discomfort (61.88%), followed by difficulty in performing usual activities (53.81%), and anxiety/depression (41.26%). CONCLUSION Cervical cancer significantly impacts the health-related quality of life of the patients in India. Clinical interventions should focus on the control of pain and relief of anxiety. The measurement of health-related quality of life should be an integral component of the effectiveness of interventions as well as health technology assessment.
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Affiliation(s)
- Gaurav Jyani
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Akashdeep Singh Chauhan
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhavana Rai
- Department of Radiation Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sushmita Ghoshal
- Department of Radiation Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Alternative New Mono-scaled Quantitative Benefit-Risk Assessment of Human Papillomavirus Vaccine in Japan. Ther Innov Regul Sci 2020; 55:48-55. [PMID: 32572770 DOI: 10.1007/s43441-020-00189-1] [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: 12/19/2019] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The human papillomavirus (HPV) vaccine coverage is very low in Japan since the government suspended the active encouragement of the vaccination. We aimed to conduct a benefit-risk assessment of HPV vaccination and explore different consequent scenarios to identify potential improvements to the current Japanese immunization program. METHODS To calculate social benefit-risk of HPV vaccine, we used the Markov model to represent the natural history of HPV and adverse events (AEs) using disability-adjusted life year (DALY) as the outcome. Benefits and risks were calculated as the sum of negative and positive outcomes corresponding to all preventable diseases and AEs associated with HPV vaccination, respectively. The benefit-risk balance in 2050 was estimated using published data. RESULTS Our model was confirmed by published cervical cancer incidence and mortality rates. The benefit-risk balance in 2050 showed that the most effective scenario was the introduction of 9-valent HPV vaccine targeting female individuals aged 10-29 years for routine vaccination starting in 2020, although there is possibility of increased risks of AEs for the vaccinated age group post resumption of recommendations. CONCLUSION Our benefit-risk assessment of HPV vaccine helped estimate various scenarios pertaining to HPV vaccination and identify the best strategy regarding HPV vaccination. This benefit-risk assessment approach may be used for other vaccines and vaccination programs.
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Wilson KJ, Brown HS, Patel U, Tucker D, Becker K. Cost-effectiveness of a comprehensive immunization program serving high-risk, uninsured adults. Prev Med 2020; 130:105860. [PMID: 31678176 DOI: 10.1016/j.ypmed.2019.105860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 10/01/2019] [Accepted: 10/08/2019] [Indexed: 10/25/2022]
Abstract
Despite the numerous social and economic benefits of vaccination, adult immunization rates fall far short of recommended levels costing the United States $9 billion annually in health care expenditures and reduced productivity. While it is well recognized that childhood immunization is highly cost-effective, the economic impact of adult immunization programs varies by disease and is influenced by population demographics. This study aimed to assess the cost-effectiveness of a comprehensive adult immunization program serving high-need populations delivered by a local health department (LHD) in partnership with community organizations. We modeled incremental cost-effectiveness taking the payer perspective of each vaccine separately in simulated cohorts of 100,000 over a 20-year horizon using data provided by the LHD and data from the published literature. We adjusted the results to align with actual program delivery and used them to estimate an incremental cost-effectiveness ratio (ICER) for the entire program. We assessed the effects of varying our base model parameters in univariate sensitivity analyses. We discounted benefits and life years saved (LYS) at 3% and adjusted results to 2016 US$. Four of seven disease models were cost-effective (using a $100,000 CE threshold) with ICERS ranging from $14,260 to $79,022/LYS. Sensitivity analyses did not substantially impact the results. The ICER for program as a whole was $67,940/LYS. A community-delivered comprehensive immunization program serving uninsured, low income, high-risk adults is a cost-effective investment even when most do not receive the full regimen of some vaccines.
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Affiliation(s)
- Kimberly J Wilson
- University of Texas Health Science Center School of Public Health, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, United States of America.
| | - H Shelton Brown
- University of Texas Health Science Center School of Public Health, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, United States of America.
| | - Ujas Patel
- University of Texas Health Science Center School of Public Health, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, United States of America
| | - Debbie Tucker
- Austin Public Health, 15 Waller Street, Austin, TX 78701, United States of America.
| | - Kurt Becker
- Austin Public Health, 15 Waller Street, Austin, TX 78701, United States of America.
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Alsabbagh A, Robins TL, Harriman A, Jackson-Boeters L, Darling MR, Khan ZA, McCord C. Surrogate markers for high-risk human papillomavirus infection in oral epithelial dysplasia: A comparison of p16, Ki-67, and ProExC. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 129:246-259.e1. [PMID: 31902664 DOI: 10.1016/j.oooo.2019.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/28/2019] [Accepted: 09/29/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The aim of this study was to determine the utility of surrogate markers of human papillomavirus (HPV) infection in the diagnosis of HPV-associated oral epithelial dysplasia (OED). STUDY DESIGN Twelve cases of oral dysplasia with histologic features of HPV infection were stained with surrogate markers for HPV (p16, Ki-67, and ProExC) on immunohistochemistry. A second group of 12 cases of oral dysplasia without histologic features of HPV infection was used for comparison. Reverse transcriptase polymerase chain reaction (RT-PCR) was used to confirm the presence of high-risk HPV (HR HPV) in p16-positive cases. RESULTS All of the surrogate markers showed a statistically significant association with HPV-positive OED (P < .001). The agreement between p16 and HPV positivity was the strongest (κ = 1.00), whereas Ki-67 showed very good association with HPV (κ = 0.83), and ProExC showed good association (κ = 0.75). In each case, the agreement was statistically significant (P < .001). Overall, each of the 3 markers showed good sensitivity; however, ProExC showed the lowest specificity. CONCLUSIONS The clinicopathologic features of 12 cases of HPV OED are reported. Diffuse p16 positivity is an accurate and reliable method for predicting HR HPV infection in both high and low grade cases of epithelial dysplasia with histopathologic features of HPV OED. The use of Ki-67 and ProExC did not demonstrate any additional diagnostic benefit in the diagnosis HPV OED.
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Affiliation(s)
- Amr Alsabbagh
- Department of Dentistry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Terry L Robins
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Ariel Harriman
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Linda Jackson-Boeters
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Mark R Darling
- Department of Dentistry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Zia A Khan
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Christina McCord
- Department of Dentistry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada.
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Tang CH, Cheng WF, Jiang JH, You SL, Huang LW, Hsieh JY, Mukherjee P, Van Kriekinge G, Lee C. Cost-Effectiveness Analysis of Human Papillomavirus Vaccination in Adolescent Girls in Taiwan. Asian Pac J Cancer Prev 2019; 20:1377-1387. [PMID: 31127896 PMCID: PMC6857899 DOI: 10.31557/apjcp.2019.20.5.1377] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective: Three vaccines are available to Taiwanese young girls for cervical cancer (CC) prevention. Here we evaluate the cost-effectiveness of the two-dose (2D) AS04-adjuvanted HPV-16/18 vaccine (2D-AS04-HPV-16/18v)+screening compared with a screening programme alone, with 2D human papillomavirus 6/11/16/18 vaccine (2D-4vHPVv)+screening, and with 2D/three-dose (3D) human papillomavirus 6/11/16/18/31/33/45/52/58 vaccine (9vHPVv)+screening, for Taiwan universal mass vaccination. Methods: A static Markov cohort model simulated the natural history of human papillomavirus (HPV) infection and CC screening for a 12-year-old cohort of Taiwanese girls (N=120,000). The model ran in 1-year cycles over the cohort’s lifetime. Vaccine efficacy irrespective of HPV type was considered in the analysis for each vaccine. Input data were obtained from published literature, local databases, government reports and websites, and expert opinion. The analysis incorporated direct medical costs only, with an annual discount rate of 3.0%. The threshold was determined as 1 Gross Domestic Product per capita (New Taiwan dollar [NT$] 727,818; year 2016). Results: The 2D-AS04-HPV-16/18v+screening yielded 0.0365 quality-adjusted life year (QALY) gained at an additional cost of NT$ 5,770 per person compared with the screening programme alone. This resulted in an incremental cost-effectiveness ratio well below the threshold. Compared with 2D-4vHPVv+screening and 2D/3D-9vHPVv+screening, discounted results demonstrated additional QALYs gained at lower cost for 2D-AS04-HPV-16/18v+screening, making it dominant over both 2D-4vHPVv+screening and 2D/3D-9vHPVv+screening. Conclusions: Vaccinating Taiwanese girls with 2D-AS04-HPV-16/18v in addition to screening to prevent CC is cost-effective compared with using a screening programme alone and the dominant option compared with 2D-4vHPVv+screening and 2D/3D-9vHPVv+screening.
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Affiliation(s)
- Chao-Hsiun Tang
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Wen Fang Cheng
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jhih-Hua Jiang
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - San Lin You
- School of Medicine, College of Medicine, Big Data Research Centre, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Lee-Wen Huang
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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20
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HPV vaccine status and sexual behavior among young sexually-active women in the US: evidence from the National Health and Nutrition Examination Survey, 2007-2014. HEALTH ECONOMICS POLICY AND LAW 2019; 15:477-495. [PMID: 31109388 DOI: 10.1017/s1744133119000136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Concern has been expressed that human papillomavirus (HPV) vaccination programs might promote risky sexual behavior through mechanisms such as risk compensation, behavioral disinhibition, or perceived endorsement of sexual activity. This study assesses whether HPV vaccination status is associated with any differences in selected sexual behaviors among young sexually-active women in the US. Our dataset includes young, adult female respondents from questionnaire data collected in the National Center for Health Statistics' National Health and Nutrition Examination Survey from 2007 to 2014. The empirical approach implements a doubly robust estimation procedure, based on inverse probability of treatment weighting. For robustness, we implement several specifications for the propensity model and the outcomes model. We find no consistent association between HPV vaccination and condom usage or frequency of sex. Specifically, we find no evidence that HPV vaccination is associated with condom usage or with whether a person had sex more than 52 or more than 104 times per year. We find inconsistent evidence that HPV vaccination is associated with a person having sex more than 12 times per year. As in previous research, HPV vaccination does not appear to have a substantive effect on sexual behavior among young sexually-active women in the US.
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21
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Bains I, Choi YH, Soldan K, Jit M. Clinical impact and cost-effectiveness of primary cytology versus human papillomavirus testing for cervical cancer screening in England. Int J Gynecol Cancer 2019; 29:ijgc-2018-000161. [PMID: 31018938 DOI: 10.1136/ijgc-2018-000161] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/20/2019] [Accepted: 03/06/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES In England, human papillomavirus (HPV) testing is to replace cytological screening by 2019-2020. We conducted a model-based economic evaluation to project the long-term clinical impact and cost-effectiveness of routine cytology versus HPV testing. METHODS An individual-based model of HPV acquisition, natural history, and cervical cancer screening was used to compare cytological screening and HPV testing with cytology triage for women aged 25-64 years (with either 3- or 5-year screening intervals for women aged under 50 years). The model was fitted to data from England's National Health Service Cervical Screening Programme. Both clinical and economic outcomes were projected to inform cost-effectiveness analyses. RESULTS HPV testing is likely to decrease annual cytology testing (by 2.76 million), cervical cancer incidence (by 290 cases), and health system costs (by £13 million). It may increase the number of colposcopies, although this could be reduced without leading to more cancers compared with primary cytology by increasing the interval between screens to 5 years. The impact in terms of quality-adjusted life-years (QALYs) depends on the quality of life weight given to colposcopies versus cancer. CONCLUSIONS England's move from cytology to HPV screening may potentially be life-saving and cost-effective. Cost-effectiveness can be improved further by extending the interval between screens or using alternative triage methods such as partial or full genotyping.
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Affiliation(s)
- Irenjeet Bains
- Modelling and Economics Unit, Public Health England, London, UK
| | - Yoon Hong Choi
- Modelling and Economics Unit, Public Health England, London, UK
| | - Kate Soldan
- HIV & STI Department, Public Health England, London, UK
| | - Mark Jit
- Modelling and Economics Unit, Public Health England, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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22
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Peron M, Llewellyn A, Moe-Byrne T, Walker S, Walton M, Harden M, Palmer S, Simmonds M. Adjunctive colposcopy technologies for assessing suspected cervical abnormalities: systematic reviews and economic evaluation. Health Technol Assess 2019; 22:1-260. [PMID: 30284968 DOI: 10.3310/hta22540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Dynamic Spectral Imaging System (DySIS)map (DySIS Medical Ltd, Edinburgh, UK) and ZedScan (Zilico Limited, Manchester, UK) can be used adjunctively with conventional colposcopy, which may improve the detection of cervical intraepithelial neoplasia (CIN) and cancer. OBJECTIVES To systematically review the evidence on the diagnostic accuracy, clinical effectiveness and implementation of DySISmap and ZedScan as adjuncts to standard colposcopy, and to develop a cost-effectiveness model. METHODS Four parallel systematic reviews were performed on diagnostic accuracy, clinical effectiveness issues, implementation and economic analyses. In January 2017 we searched databases (including MEDLINE and EMBASE) for studies in which DySISmap or ZedScan was used adjunctively with standard colposcopy to detect CIN or cancer in women referred to colposcopy. Risk of bias was assessed with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. Summary estimates of diagnostic accuracy were calculated using bivariate and other regression models when appropriate. Other outcomes were synthesised narratively. A patient-level state-transition model was developed to evaluate the cost-effectiveness of DySISmap and ZedScan under either human papillomavirus (HPV) triage or the HPV primary screening algorithm. The model included two types of clinics ['see and treat' and 'watchful waiting' (i.e. treat later after confirmatory biopsy)], as well as the reason for referral (low-grade or high-grade cytological smear). Sensitivity and scenario analyses were undertaken. RESULTS Eleven studies were included in the diagnostic review (nine of DySISmap and two of ZedScan), three were included in the clinical effectiveness review (two of DySISmap and one of ZedScan) and five were included in the implementation review (four of DySISmap and one of ZedScan). Adjunctive DySISmap use was found to have a higher sensitivity for detecting CIN grade 2+ (CIN 2+) lesions [81.25%, 95% confidence interval (CI) 72.2% to 87.9%] than standard colposcopy alone (57.91%, 95% CI 47.2% to 67.9%), but with a lower specificity (70.40%, 95% CI 59.4% to 79.5%) than colposcopy (87.41%, 95% CI 81.7% to 91.5%). (Confidential information has been removed.) The base-case cost-effectiveness results showed that adjunctive DySISmap routinely dominated standard colposcopy (it was less costly and more effective). The only exception was for high-grade referrals in a watchful-waiting clinic setting. The incremental cost-effectiveness ratio for ZedScan varied between £272 and £4922 per quality-adjusted life-year. ZedScan also dominated colposcopy alone for high-grade referrals in see-and-treat clinics. These findings appeared to be robust to a wide range of sensitivity and scenario analyses. LIMITATIONS All but one study was rated as being at a high risk of bias. There was no evidence directly comparing ZedScan with standard colposcopy. No studies directly compared DySIS and ZedScan. CONCLUSIONS The use of adjunctive DySIS increases the sensitivity for detecting CIN 2+, so it increases the number of high-grade CIN cases that are detected. However, it also reduces specificity, so that more women with no or low-grade CIN will be incorrectly judged as possibly having high-grade CIN. The evidence for ZedScan was limited, but it appears to increase sensitivity and decrease specificity compared with colposcopy alone. The cost-effectiveness of both adjunctive technologies compared with standard colposcopy, under both the HPV triage and primary screening algorithms, appears to be favourable when compared with the conventional thresholds used to determine value in the NHS. FUTURE WORK More diagnostic accuracy studies of ZedScan are needed, as are studies assessing the diagnostic accuracy for women referred to colposcopy as part of the HPV primary screening programme. STUDY REGISTRATION This study is registered as PROSPERO CRD42017054515. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Mathilde Peron
- Department of Economics and Related Studies, University of York, York, UK
| | - Alexis Llewellyn
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Simon Walker
- Centre for Health Economics, University of York, York, UK
| | - Matthew Walton
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Melissa Harden
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK
| | - Mark Simmonds
- Centre for Reviews and Dissemination, University of York, York, UK
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Self-Collection and Molecular Diagnosis for Detection of Human Papillomavirus: Why Incorporate It? Curr Infect Dis Rep 2019; 21:13. [PMID: 30888517 DOI: 10.1007/s11908-019-0674-9] [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: 10/27/2022]
Abstract
PURPOSE OF REVIEW Cervical cancer, the third cause of death by cancer among Brazil's women, is associated with human papillomavirus (HPV) infection. In some countries of South America, North America, Europe, and Oceania, initial screening for HPV DNA and subsequent follow-up with HPV-positive patients using colposcopy and cytological testing are used as preventative measures. RECENT FINDINGS For HPV DNA detection, it is necessary to obtain cervical cells by conventional clinical collection method or self-collection of the cells that flake off from the uterine cervix and vaginal canal. Self-collection has been shown to be a viable option for obtaining samples and is a less invasive method that is more accepted by women. Thus, it can potentially decrease the limitations of the conventional clinical collection methods. The efficiency of the self-collection method aligned with the implementation of HPV molecular testing, if adopted by public and private health care systems, may extend the reach of current cervical cancer prevention efforts. In addition, considering all phases from triage to treatment, this method may reduce health care costs and the time spent by patients and health care teams to conduct examinations and collect samples.
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Kuguyo O, Tsikai N, Thomford NE, Magwali T, Madziyire MG, Nhachi CFB, Matimba A, Dandara C. Genetic Susceptibility for Cervical Cancer in African Populations: What Are the Host Genetic Drivers? OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2019; 22:468-483. [PMID: 30004844 DOI: 10.1089/omi.2018.0075] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Human papillomavirus (HPV) is an essential but not a sufficient cervical cancer etiological factor. Cancer promoters, such as host genetic mutations, significantly modulate therapeutic responses and susceptibility. In cervical cancer, of interest have been viral clearing genes and HPV oncoprotein targets, for which conflicting data have been reported among different populations. This expert analysis evaluates cervical cancer genetic susceptibility biomarkers studied in African populations. Notably, the past decade has seen Africa as a hotbed of biomarker and precision medicine innovations, thus potentially informing worldwide biomarker development strategies. We conducted a critical literature search in PubMed/MEDLINE, Google Scholar, and Scopus databases for case-control studies reporting on cervical cancer genetic polymorphisms among Africans. We found that seven African countries conducted cervical cancer molecular epidemiology studies in one of Casp8, p53, CCR2, FASL, HLA, IL10, TGF-beta, and TNF-alpha genes. This analysis reveals a remarkable gap in cervical cancer molecular epidemiology among Africans, whereas cervical cancer continues to disproportionately have an impact on African populations. Genome-wide association, whole exome- and whole-genome sequencing studies confirmed the contribution of candidate genes in cervical cancer. With such advances and omics technologies, the role of genetic susceptibility biomarkers can be exploited to develop novel interventions to improve current screening, diagnostic and prognostic methods worldwide. Exploring these genetic variations is crucial because African populations are genetically diverse and some variants or their combined effects are yet to be discovered and translated into tangible clinical applications. Thus, translational medicine and flourishing system sciences in Africa warrant further emphasis in the coming decade.
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Affiliation(s)
- Oppah Kuguyo
- 1 Department of Clinical Pharmacology, College of Health Sciences, University of Zimbabwe , Harare, Zimbabwe
| | - Nomsa Tsikai
- 2 Chemotherapy and Radiotherapy Center, Parirenyatwa Group of Hospitals , Harare, Zimbabwe
| | - Nicholas E Thomford
- 3 Pharmacogenetics and Drug Metabolism Research Group, Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town , Cape Town, South Africa
| | - Thulani Magwali
- 4 Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe , Harare, Zimbabwe
| | - Mugove G Madziyire
- 4 Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe , Harare, Zimbabwe
| | - Charles F B Nhachi
- 1 Department of Clinical Pharmacology, College of Health Sciences, University of Zimbabwe , Harare, Zimbabwe
| | - Alice Matimba
- 1 Department of Clinical Pharmacology, College of Health Sciences, University of Zimbabwe , Harare, Zimbabwe
| | - Collet Dandara
- 3 Pharmacogenetics and Drug Metabolism Research Group, Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town , Cape Town, South Africa
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25
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Samwel K, Kahesa C, Mwaiselage J, Gonzalez D, West JT, Wood C, Palefsky J, Angeletti PC. Analytical performance of a low-cost multiplex polymerase chain reaction human papillomavirus genotyping assay for use in Sub-Saharan Africa. J Med Virol 2019; 91:308-316. [PMID: 30281790 PMCID: PMC6519259 DOI: 10.1002/jmv.25329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/25/2018] [Indexed: 12/12/2022]
Abstract
We have tested a multiplex polymerase chain reaction (PCR) human papillomavirus (HPV) genotyping assay to fill the need for rapid and low-cost HPV detection in Sub-Saharan Africa. This method allows high throughput genotyping and simultaneous detection of 14 high-risk and two low-risk HPV types, by PCR amplification of HPV DNAs in a single reaction tube. In this study, we describe stepwise experiments to validate the multiplex HPV PCR assay for determination of HPV genotypes from 104 cervical brush samples from Tanzanian women. Assay performance was evaluated by determination of intra-laboratory reproducibility, sensitivity, and specificity. Further performance was assessed by comparison with the widely accepted and validated HPV My09/My11 amplification and hybridization assay. Statistics; the Cohen kappa (κ) and McNemar P values were used to analyze interobserver and intermethod agreement. Overall concordance between the multiplex and line blot hybridization assays was 99% (per sample) with a κ value equal to 0.95; and 96.49% (per detection event) with a κ value of 0.92. Interobserver reproducibility of the assay per sample was 95.76% with κ of 0.91. These results demonstrate that the multiplex HPV PCR assay has high analytical sensitivity and specificity in detecting as many as 16 different HPV genotypes and that its simplicity and low cost makes it well suited for sub-Saharan Africa.
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Affiliation(s)
- Kandali Samwel
- Nebraska Center for Virology, School of Biological Sciences, University of NebraskaLincolnNebraska
| | | | | | - Daniela Gonzalez
- Nebraska Center for Virology, School of Biological Sciences, University of NebraskaLincolnNebraska
| | - John T. West
- Nebraska Center for Virology, School of Biological Sciences, University of NebraskaLincolnNebraska
| | - Charles Wood
- Nebraska Center for Virology, School of Biological Sciences, University of NebraskaLincolnNebraska
| | - Joel Palefsky
- University of California San FranciscoSan FranciscoCalifornia
| | - Peter C. Angeletti
- Nebraska Center for Virology, School of Biological Sciences, University of NebraskaLincolnNebraska
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Karasu AFG, Adanir I, Aydin S, Ilhan GK, Ofli T. Nurses' Knowledge and Opinions on HPV Vaccination: a Cross-Sectional Study from Istanbul. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:98-104. [PMID: 28822089 DOI: 10.1007/s13187-017-1272-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Implementing a HPV vaccination program is currently under evaluation by the Turkish health ministry. For screening and vaccination programs to be successful, the cooperation of nurses is essential. We aimed to evaluate (1) basic knowledge of nurses and nursing interns regarding HPV infection and cervical cancer, (2) their attitudes towards smear testing and HPV vaccination, and (3) their viewpoint on vaccination of school age children. This cross-sectional study was undertaken at Bezmialem Vakif University. The survey was designed to assess knowledge about HPV infection, Pap smear testing, cervical cancer, HPV vaccine, attitudes towards HPV vaccination, and school-based vaccination programs. Validity content was determined by expert gynecologists, and a pilot study was performed on 10 nurses. A total of 550 questionnaires were handed out; 499 were completed. Our response rate was 90.7%. Fifty-nine participants answered all the knowledge questions correctly. The calculated knowledge score of the female participants was 6.99 ± 2.22, the male participants was 5.89 ± 2.92. Female participants were more knowledgeable (p < 0.0001). Out of the 353 female participants, 18.6% (n = 66) had undergone smear testing. There were 20 (5.6%) female and 6 (4%) male participants who were vaccinated against HPV. The leading answer for not having a HPV vaccine was "I'm not at risk for a HPV infection" (n = 106, 34.9%). There was a statistical relationship between "HPV knowledge score" and answering "Yes" to "Do you want your children/future children to be vaccinated? (p = 0.001) and "Do you think including the vaccine in the Turkish immunization program is necessary?" (p = 0.001). Nurses in our cohort seem to have satisfactory basic knowledge regarding HPV infection; however, their viewpoints on vaccination were not favorable. Strategies and intervention materials for HPV vaccination will be necessary if a national immunization program will be initiated.
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Affiliation(s)
- Ayse Filiz Gokmen Karasu
- Faculty of Medicine, Department of Obstetrics and Gynecology, Bezmialem Vakif University, Adnan Menderes Bulvarı Vatan Caddesi, Fatih, 34093, İstanbul, Turkey.
| | - Ilknur Adanir
- Faculty of Medicine, Department of Obstetrics and Gynecology, Bezmialem Vakif University, Adnan Menderes Bulvarı Vatan Caddesi, Fatih, 34093, İstanbul, Turkey
| | - Serdar Aydin
- Faculty of Medicine, Department of Obstetrics and Gynecology, Bezmialem Vakif University, Adnan Menderes Bulvarı Vatan Caddesi, Fatih, 34093, İstanbul, Turkey
| | - Gulsah Keskin Ilhan
- Department of Obstetrics and Gynecology, Suleymaniye Maternity Training and Research Hospital, Istanbul, Turkey
| | - Tugba Ofli
- Faculty of Medicine, Department of Obstetrics and Gynecology, Bezmialem Vakif University, Adnan Menderes Bulvarı Vatan Caddesi, Fatih, 34093, İstanbul, Turkey
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27
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Kostaras D, Karampli E, Athanasakis K. Vaccination against HPV virus: a systematic review of economic evaluation studies for developed countries. Expert Rev Pharmacoecon Outcomes Res 2018; 19:147-158. [PMID: 30501434 DOI: 10.1080/14737167.2019.1555039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION During the last years, a significant number economic evaluations of HPV vaccination has been published. Given that cost-effectiveness constitutes an essential part of decision-making with regards to the reimbursement of a health technology, the purpose of this study is to provide a supportive tool to decision-makers regarding the economic efficiency of the introduction of HPV vaccination to national immunization programs. AREAS COVERED The PubMed database was searched in order to identify cost-effectiveness studies for HPV vaccination. A total of 42 articles were finally retrieved. All retrieved cost-effectiveness ratios (ICERs) were converted in the same currency unit (I$) and then inflated to the same year (2015) in order to facilitate cross-country comparisons. RESULTS Overall, vaccination against HPV 6,11,16,18 types appears to have a ICER with mean value of I$25132/QALY, whereas the mean ICER of vaccination against oncogenic HPV 16,18 types is estimated at I$38,253/QALY. EXPERT COMMENTARY HPV vaccination would be a cost-effective intervention in the setting of high-income countries and could reduce the incidence of HPV-related diseases.
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Affiliation(s)
- Dimitris Kostaras
- a Department of Health Economics , National School of Public Health , Athens , Greece.,b Vaccines Department , Athens , MSD Greece
| | - Eleftheria Karampli
- a Department of Health Economics , National School of Public Health , Athens , Greece
| | - Kostas Athanasakis
- a Department of Health Economics , National School of Public Health , Athens , Greece
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Viscondi JYK, Faustino CG, Campolina AG, Itria A, de Soárez PC. Simple but not simpler: a systematic review of Markov models for economic evaluation of cervical cancer screening. Clinics (Sao Paulo) 2018; 73:e385. [PMID: 29995100 PMCID: PMC6024522 DOI: 10.6061/clinics/2018/e385] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 02/26/2018] [Indexed: 12/21/2022] Open
Abstract
The aim of this study was to critically evaluate the quality of the models used in economic evaluations of screening strategies for cervical cancer prevention. We systematically searched multiple databases, selecting model-based full economic evaluations (cost-effectiveness analyses, cost-utility analyses, and cost-benefit analyses) of cervical cancer screening strategies. Two independent reviewers screened articles for relevance and performed data extraction. Methodological assessment of the quality of the models utilized formal checklists, and a qualitative narrative synthesis was performed. Thirty-eight articles were reviewed. The majority of the studies were conducted in high-income countries (82%, n=31). The Pap test was the most used screening strategy investigated, which was present in 86% (n=33) of the studies. Half of the studies (n=19) used a previously published Markov model. The deterministic sensitivity analysis was performed in 92% (n=35) of the studies. The mean number of properly reported checklist items was 9 out of the maximum possible 18. Items that were better reported included the statement of decision problem, the description of the strategies/comparators, the statement of time horizon, and information regarding the disease states. Compliance with some items of the checklist was poor. The Markov models for economic evaluation of screening strategies for cervical cancer varied in quality. The following points require improvement: 1) assessment of methodological, structural, heterogeneity, and parameter uncertainties; 2) model type and cycle length justification; 3) methods to account for heterogeneity; and 4) report of consistency evaluation (through calibration and validation methods).
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Affiliation(s)
| | | | - Alessandro Gonçalves Campolina
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Alexander Itria
- Instituto de Patologia Tropical e Saude Publica, Departamento de Saude Coletiva, Nucleo de Economia e Avaliacoes da Saude, Instituto de Avaliacao de Tecnologia em Saude, Universidade Federal de Goias, Goias, GO, BR
| | - Patricia Coelho de Soárez
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Malagón T, Laurie C, Franco EL. Human papillomavirus vaccination and the role of herd effects in future cancer control planning: a review. Expert Rev Vaccines 2018; 17:395-409. [PMID: 29715059 DOI: 10.1080/14760584.2018.1471986] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Vaccine herd effects are the indirect protection that vaccinated persons provide to those who remain susceptible to infection, due to the reduced transmission of infections. Herd effects have been an important part of the discourse on how to best implement human papillomavirus (HPV) vaccines and prevent HPV-related diseases. AREAS COVERED In this paper, we review the theory of HPV vaccine herd effects derived from mathematical models, give an account of observed HPV vaccine herd effects worldwide, and examine the implications of vaccine herd effects for future cervical cancer screening efforts. EXPERT COMMENTARY HPV vaccine herd effects improve the cost-effectiveness of vaccinating preadolescent girls, but contribute to making gender-neutral vaccination less economically efficient. Vaccination coverage and sexual mixing patterns by age are strong determinants of herd effects. Many countries worldwide are starting to observe reductions in HPV-related outcomes likely attributable to herd effects, most notably declining anogenital warts in young men, and declining HPV-16/18 infection prevalence in young unvaccinated women. Policy makers making recommendations for cervical cancer screening will have to consider HPV vaccination coverage and herd effects, as these will affect the positive predictive value of screening and the risk of cervical cancer in unvaccinated women.
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Affiliation(s)
- Talía Malagón
- a Division of Cancer Epidemiology, Faculty of Medicine , McGill University , Montréal , Canada
| | - Cassandra Laurie
- a Division of Cancer Epidemiology, Faculty of Medicine , McGill University , Montréal , Canada
| | - Eduardo L Franco
- a Division of Cancer Epidemiology, Faculty of Medicine , McGill University , Montréal , Canada
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Leng T, Keeling MJ. Concurrency of partnerships, consistency with data, and control of sexually transmitted infections. Epidemics 2018; 25:35-46. [PMID: 29798812 DOI: 10.1016/j.epidem.2018.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/18/2018] [Accepted: 05/13/2018] [Indexed: 11/28/2022] Open
Abstract
Sexually transmitted infections (STIs) are a globally increasing public health problem. Mathematical models, carefully matched to available epidemiological and behavioural data, have an important role to play in predicting the action of control measures. Here, we explore the effect of concurrent sexual partnerships on the control of a generic STI with susceptible-infected-susceptible dynamics. Concurrency refers to being in more than one sexual partnership at the same time, and is difficult to measure accurately. We assess the impact of concurrency through the development of three nested pair-formation models: one where infection can only be transmitted via stable sexual partnerships, one where infection can also be transmitted via casual partnerships between single individuals, and one where those individuals in stable partnerships can also acquire infection from casual partnerships. For each model, we include the action of vaccination before sexual debut to inform about the ability to control. As expected, for a fixed transmission rate, concurrency increases both the endemic prevalence of infection and critical level of vaccination required to eliminate the disease significantly. However, when the transmission rate is scaled to maintain a fixed endemic prevalence across models, concurrency has a far smaller impact upon the critical level of vaccination required. Further, when we also constrain the models to have a fixed number of new partnerships over time (both long-term and casual), then increasing concurrency can slightly decrease the critical level of vaccination. These results highlight that accurate measures and models of concurrency may not always be needed for reliable forecasts when models are closely matched to prevalence data. We find that, while increases in concurrency within a population are likely to generate public-health problems, the inclusion of concurrency may be unnecessary when constructing models to determine the efficacy of the control of STIs by vaccination.
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Affiliation(s)
- Trystan Leng
- EPSRC & MRC Centre for Doctoral Training in Mathematics for Real-World Systems, University of Warwick, United Kingdom.
| | - Matt J Keeling
- Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, Mathematics Institute and School of Life Sciences, University of Warwick, United Kingdom
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Righolt CH, Pabla G, Mahmud SM. The Direct Medical Costs of Diseases Associated with Human Papillomavirus Infection in Manitoba, Canada. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:195-205. [PMID: 29299769 DOI: 10.1007/s40258-017-0367-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The total direct cost of screening and treating all human papillomavirus-related diseases (HPV-RD) has not been measured in a single study. Accurate cost estimates are needed to inform decisions on intervention priorities and evaluate the cost-effectiveness of existing programs. We used province-wide clinical, administrative, and accounting databases to measure direct medical costs of HPV infection in Manitoba (Canada). METHODS All persons 9 years or older with health insurance coverage in Manitoba between April 2000 and March 2015 were eligible. We identified all persons with an incident HPV-RD and aggregated all medical costs (in 2014 Canadian dollars) related to that condition, including prescription drugs, diagnostic procedures, in-hospital and outpatient treatment, and physician visits. RESULTS We found that the median cost of treating a case of anogenital warts was $130. An episode of cervical dysplasia had a median cost of $220, compared to $1300 for an episode of cervical carcinoma in situ. The cost of treating HPV-related invasive cancer varied from $15,000 for cervical cancer to $33,000 for oral cavity cancer. Overall, 80% ($145 million) of the total cost was attributable to HPV infection. Cervical screening and follow-up accounted for $96 million (66%) of all costs and this cost component has declined following the introduction of new screening guidelines. CONCLUSIONS Overall, the average direct medical cost of HPV infection was $720 per newborn. The economic burden of HPV remains significant, although changes in cervical screening guidelines, prompted by the introduction of a public HPV vaccine program, appear to have promoted a promising trend towards lower costs.
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Affiliation(s)
- Christiaan H Righolt
- Department of Community Health Sciences, Vaccine and Drug Evaluation Centre, University of Manitoba, 337-750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada
| | - Gurpreet Pabla
- Department of Community Health Sciences, Vaccine and Drug Evaluation Centre, University of Manitoba, 337-750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada
| | - Salaheddin M Mahmud
- Department of Community Health Sciences, Vaccine and Drug Evaluation Centre, University of Manitoba, 337-750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada.
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Markowitz LE, Gee J, Chesson H, Stokley S. Ten Years of Human Papillomavirus Vaccination in the United States. Acad Pediatr 2018; 18:S3-S10. [PMID: 29502635 DOI: 10.1016/j.acap.2017.09.014] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 09/06/2017] [Accepted: 09/15/2017] [Indexed: 01/19/2023]
Abstract
Since human papillomavirus (HPV) vaccine was first introduced for females in the United States in 2006, vaccination policy has evolved as additional HPV vaccines were licensed and new data became available. The United States adopted a gender neutral routine HPV immunization policy in 2011, the first country to do so. Vaccination coverage is increasing, although it remains lower than for other vaccines recommended for adolescents. There are various reasons for low coverage, and efforts are ongoing to increase vaccine uptake. The safety profile of HPV vaccine has been well established from 10 years of postlicensure monitoring. Despite low coverage, the early effects of the HPV vaccination program have exceeded expectations.
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Affiliation(s)
- Lauri E Markowitz
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga.
| | - Julianne Gee
- Immunization Safety Office, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Harrell Chesson
- National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Shannon Stokley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga
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Trogdon JG, Shafer P, Lindsay B, Coyne-Beasley T. Determinants of the receipt of the 9-valent human papillomavirus vaccine in the first year after introduction in North Carolina. Vaccine 2018; 36:1310-1315. [PMID: 29366705 DOI: 10.1016/j.vaccine.2018.01.014] [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: 08/25/2017] [Revised: 12/01/2017] [Accepted: 01/03/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objective of this study was to describe the transition from bi- and quadrivalent HPV vaccines to 9vHPV in aggregate and identify determinants of the receipt of 9vHPV among youth following the introduction of 9vHPV in North Carolina. METHODS The study used a retrospective cohort design with data from the North Carolina Immunization Registry (NCIR). Our sample included all doses of HPV vaccine administered between July 2015 and October 2016 to age-eligible youth (ages 9-17). We used a logistic regression model to associate individual child-level and ZIP Code Tabulation Area (ZCTA)-level characteristics with an indicator variable for receiving 9vHPV (vs. other HPV vaccines). RESULTS Youth receiving the HPV vaccine were more likely to receive 9vHPV if they lived in a ZCTA with a larger age-eligible (i.e., 9-17) population, a health professional shortage area, or a higher number of annual outpatient visits per capita. They were less likely to receive 9vHPV if they were older, received a publicly-funded dose, or lived in a ZCTA with a higher percentage of the population with less than a high-school education or a higher number of religious organizations. CONCLUSIONS While the transition from other HPV vaccines to 9vHPV was relatively quick, there were disparities in the diffusion of 9vHPV across North Carolina.
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Affiliation(s)
- Justin G Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1101 McGavran-Greenberg Hall, Campus Box 7411, Chapel Hill, NC 27599-7411, United States.
| | - Paul Shafer
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1101 McGavran-Greenberg Hall, Campus Box 7411, Chapel Hill, NC 27599-7411, United States.
| | - Brianna Lindsay
- University of Pennsylvania, School of Arts and Sciences, Philadelphia, PA 19104-6018, United States.
| | - Tamera Coyne-Beasley
- Department of Pediatrics, University of North Carolina at Chapel Hill, 260 MacNider Building, Campus Box 7220, 321 S. Columbia St., Chapel Hill, NC 27599-7220, United States.
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Trogdon JG, Shafer P, Lindsay B, Coyne-Beasley T. Impact of introduction of the 9-valent human papillomavirus vaccine on vaccination coverage of youth in North Carolina. Vaccine 2018; 36:1304-1309. [PMID: 29395530 DOI: 10.1016/j.vaccine.2018.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/01/2017] [Accepted: 01/03/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The objective of this study was to evaluate the impact of introduction of 9vHPV vaccine on HPV vaccination uptake (doses per capita) and initiation (≥1 doses), completion (≥3 doses) and compliance (≥3 doses within 12 months) by adolescents. METHODS We used a retrospective cohort analysis using North Carolina Immunization Registry (NCIR) data from January 2008 through October 2016. The sample included Vaccines for Children eligible adolescents aged 9 to 17 years in 2016, for whom the NCIR contains complete vaccination history. We applied an interrupted time series design to measure associations between ZIP Code Tabulation Area (ZCTA)-level HPV vaccination outcomes over time with the introduction of 9vHPV in North Carolina (NC) in July 2015. RESULTS Each outcome displayed a linear upward trend over time with large seasonal spikes near August of each year, corresponding to the time when adolescents often receive other vaccines required for school entry. After accounting for these underlying trends, introduction of 9vHPV was not associated with a change in publicly funded HPV vaccination rates in NC. CONCLUSIONS Our results indicate that 9vHPV substituted for 4vHPV in the first year after release in NC, but the release of 9vHPV was not associated with an overall change in HPV vaccination.
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Affiliation(s)
- Justin G Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1101 McGavran-Greenberg Hall, Campus Box 7411, Chapel Hill, NC 27599-7411, United states.
| | - Paul Shafer
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1101 McGavran-Greenberg Hall, Campus Box 7411, Chapel Hill, NC 27599-7411, United states.
| | - Brianna Lindsay
- University of Pennsylvania, School of Arts and Sciences, Philadelphia, PA 19104-6018, United states.
| | - Tamera Coyne-Beasley
- Department of Pediatrics, University of North Carolina at Chapel Hill, 260 MacNider Building, Campus Box 7220, 321 S. Columbia St., Chapel Hill, NC 27599-7220, United states.
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Ekwunife OI, Lhachimi SK. Cost-effectiveness of Human Papilloma Virus (HPV) vaccination in Nigeria: a decision analysis using pragmatic parameter estimates for cost and programme coverage. BMC Health Serv Res 2017; 17:815. [PMID: 29216880 PMCID: PMC5721469 DOI: 10.1186/s12913-017-2758-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/23/2017] [Indexed: 02/06/2023] Open
Abstract
Background World Health Organisation recommends routine Human Papilloma Virus (HPV) vaccination for girls when its cost-effectiveness in the country or region has been duly considered. We therefore aimed to evaluate cost-effectiveness of HPV vaccination in Nigeria using pragmatic parameter estimates for cost and programme coverage, i.e. realistically achievable in the studied context. Methods A microsimulation frame-work was used. The natural history for cervical cancer disease was remodelled from a previous Nigerian model-based study. Costing was based on health providers’ perspective. Disability adjusted life years attributable to cervical cancer mortality served as benefit estimate. Suitable policy option was obtained by calculating the incremental costs-effectiveness ratio. Probabilistic sensitivity analysis was used to assess parameter uncertainty. One-way sensitivity analysis was used to explore the robustness of the policy recommendation to key parameters alteration. Expected value of perfect information (EVPI) was calculated to determine the expected opportunity cost associated with choosing the optimal scenario or strategy at the maximum cost-effectiveness threshold. Results Combination of the current scenario of opportunistic screening and national HPV vaccination programme (CS + NV) was the only cost-effective and robust policy option. However, CS + NV scenario was only cost-effective so far the unit cost of HPV vaccine did not exceed $5. EVPI analysis showed that it may be worthwhile to conduct additional research to inform the decision to adopt CS + NV. Conclusions National HPV vaccination combined with opportunist cervical cancer screening is cost-effective in Nigeria. However, adoption of this strategy should depend on its relative efficiency when compared to other competing new vaccines and health interventions.
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Affiliation(s)
- Obinna I Ekwunife
- Collaborative Research Group for Evidence-Based Public Health, Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS / University of Bremen, Bremen, Germany. .,Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Nigeria.
| | - Stefan K Lhachimi
- Collaborative Research Group for Evidence-Based Public Health, Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS / University of Bremen, Bremen, Germany.,Institute for Public Health and Nursing Research - IPP, Health Sciences Bremen, University of Bremen, Bremen, Germany
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Viral Oncology: Molecular Biology and Pathogenesis. J Clin Med 2017; 6:jcm6120111. [PMID: 29186062 PMCID: PMC5742800 DOI: 10.3390/jcm6120111] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 11/17/2017] [Accepted: 11/22/2017] [Indexed: 02/06/2023] Open
Abstract
Oncoviruses are implicated in approximately 12% of all human cancers. A large number of the world's population harbors at least one of these oncoviruses, but only a small proportion of these individuals go on to develop cancer. The interplay between host and viral factors is a complex process that works together to create a microenvironment conducive to oncogenesis. In this review, the molecular biology and oncogenic pathways of established human oncoviruses will be discussed. Currently, there are seven recognized human oncoviruses, which include Epstein-Barr Virus (EBV), Human Papillomavirus (HPV), Hepatitis B and C viruses (HBV and HCV), Human T-cell lymphotropic virus-1 (HTLV-1), Human Herpesvirus-8 (HHV-8), and Merkel Cell Polyomavirus (MCPyV). Available and emerging therapies for these oncoviruses will be mentioned.
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Tay SK, Lee BW, Sohn WY, Lee IH, Mathur G, Sanicas M, Van Kriekinge G. Cost-effectiveness of two-dose human papillomavirus vaccination in Singapore. Singapore Med J 2017; 59:370-382. [PMID: 28983579 DOI: 10.11622/smedj.2017085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Cervical cancer is the tenth most common cancer and the eighth most frequent cause of death among women in Singapore. As human papillomavirus (HPV) infection is the necessary cause of cervical cancer, the risk of cervical cancer can be substantially reduced through vaccination. This study was conducted to evaluate the cost-effectiveness of two-dose HPV vaccination as part of a national vaccination programme for 12-year-old girls in Singapore, from the perspective of the healthcare payer. METHODS A lifetime Markov cohort model was used to evaluate the cost-effectiveness of introducing the AS04-adjuvanted HPV-16/18 vaccine (AS04-HPV-16/18v) to the current cervical screening programme in Singapore. Furthermore, the cost-effectiveness of the AS04-HPV-16/18v was compared with the HPV-6/11/16/18 vaccine (4vHPV). Model inputs were derived from local data, where possible, and validated by clinical experts in Singapore. RESULTS Introduction of the AS04-HPV-16/18v in Singapore was shown to prevent 137 cervical cancer cases and 48 cervical cancer deaths when compared with screening alone. This resulted in an incremental cost-effectiveness ratio of SGD 12,645 per quality-adjusted life year (QALY) gained, which is cost-effective according to the World Health Organization threshold for Singapore. When discounted at 3%, AS04-HPV-16/18v was dominant over 4vHPV, with cost savings of SGD 80,559 and 28 additional QALYs gained. In the one-way sensitivity analysis, AS04-HPV-16/18v remained cost-effective compared with screening alone and dominant compared with 4vHPV. CONCLUSION AS04-HPV-16/18v is the most cost-effective choice for reducing the burden of cervical cancer through universal mass vaccination for 12-year-old girls in Singapore.
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Affiliation(s)
- Sun Kuie Tay
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore.,Duke-NUS Medical School, Singapore
| | - Bee-Wah Lee
- Department of Paediatrics, NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Bird Y, Obidiya O, Mahmood R, Nwankwo C, Moraros J. Human Papillomavirus Vaccination Uptake in Canada: A Systematic Review and Meta-analysis. Int J Prev Med 2017; 8:71. [PMID: 28983400 PMCID: PMC5625360 DOI: 10.4103/ijpvm.ijpvm_49_17] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 11/06/2017] [Indexed: 11/21/2022] Open
Abstract
Human papillomavirus (HPV) is the most commonly sexually transmitted infection in the world and the primary cause of cervical cancer. Canada introduced publicly funded HPV vaccination programs in 2006. The objectives of this study are twofold and aim to (1) determine the levels and (2) examine the various factors influencing vaccine uptake among the general Canadian population. A literature search was conducted on seven databases, followed by screening, methodological quality review (using modified Newcastle-Ottawa Scale), and data extraction. Pooled meta-analysis and a subgroup analysis were conducted stratifying by a number of variables (age, sex, type of program, and method of payment) determined apriori. A total of 718 peer-reviewed articles were initially identified with 12 remaining after screening and underwent methodological quality review. HPV vaccination uptake in Canada varied from 12.40% (95% confidence interval [CI] 6.77–20.26) to 88.20% (95% CI 85.72–90.39). The pooled random effects model showed the HPV vaccination uptake to be 55.92% (95% CI 44.87–66.65). The subgroup analysis showed that vaccination uptake was 66.95% (95% CI 55.00–77.89) in participants ≤ 18 years as compared to 13.58% (95% CI 10.93–16.46) in participants > 18 years. Uptake for females was higher 57.23% (95% CI: 45.40–68.66) when compared to that of 47.01% (95% CI: 0.82–97.75) in males. HPV vaccine uptake among school-based programs was 69.62% (95% CI 57.27–80.68) as compared to 18.66% (95% CI 6.66–34.92) for community-based programs. Vaccination uptake for publicly funded programs was significantly higher 66.95% (95% CI 55.00–77.89) when compared to 13.58% (95% CI 10.92–16.46) for programs where participants had to pay out of pocket. To prevent infections and reduce the burden of HPV-related diseases (including cervical cancer), communities should be made aware and encouraged to vaccinate their children. There is a documented need to direct effort and focus interventions toward improving HPV vaccination uptake in Canada.
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Affiliation(s)
- Yelena Bird
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - Olatunji Obidiya
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - Razi Mahmood
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - Chijioke Nwankwo
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - John Moraros
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
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Damm O, Horn J, Mikolajczyk RT, Kretzschmar MEE, Kaufmann AM, Deleré Y, Ultsch B, Wichmann O, Krämer A, Greiner W. Cost-effectiveness of human papillomavirus vaccination in Germany. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2017; 15:18. [PMID: 28878573 PMCID: PMC5583986 DOI: 10.1186/s12962-017-0080-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 08/23/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the cost-effectiveness of human papillomavirus (HPV) vaccination in addition to the current cervical cancer screening programme in Germany using a dynamic transmission model. METHODS Based on a mathematical model simulating the transmission dynamics and the natural history of HPV infection and associated diseases (cervical intraepithelial neoplasia, cervical cancer, and genital warts), we estimated the epidemiological and economic consequences of HPV vaccination with both the quadrivalent and bivalent vaccines. In our base case analysis, we assessed the cost-effectiveness of vaccinating 12-year-old girls with a 3-dose schedule. In sensitivity analysis, we also evaluated the use of a 2-dose schedule and assessed the impact of vaccinating boys. RESULTS From a health care payer perspective, incremental cost-effectiveness ratios (ICERs) of a 3-dose schedule were €34,249 per quality-adjusted life year (QALY) for the bivalent and €14,711 per QALY for the quadrivalent vaccine. Inclusion of indirect costs decreased ICERs by up to 40%. When adopting a health care payer perspective, ICERs of a 2-dose approach decreased to €19,450 per QALY for the bivalent and to €3645 per QALY for the quadrivalent vaccine. From a societal perspective, a 2-dose approach using the quadrivalent vaccine was a cost-saving strategy while using the bivalent vaccine resulted in an ICER of €13,248 per QALY. Irrespective of the perspective adopted, additional vaccination of boys resulted in ICERs exceeding €50,000 per QALY, except for scenarios with low coverage (20%) in girls. CONCLUSIONS Our model results suggest that routine HPV vaccination of 12-year-old girls with three doses is likely to be cost-effective in Germany. Due to the additional impact on genital warts, the quadrivalent vaccine appeared to be more cost-effective than the bivalent vaccine. A 2-dose schedule of the quadrivalent vaccine might even lead to cost savings when adopting a societal perspective. The cost-effectiveness of additional vaccination of boys was highly dependent on the coverage in girls.
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Affiliation(s)
- Oliver Damm
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615 Bielefeld, Germany
| | - Johannes Horn
- Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Rafael T. Mikolajczyk
- Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research, Braunschweig, Germany
- Hannover Medical School, Hannover, Germany
- German Centre for Infection Research, Site Hannover-Braunschweig, Hannover/Braunschweig, Germany
| | - Mirjam E. E. Kretzschmar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Centre for Infectious Disease Control, RIVM, Bilthoven, The Netherlands
| | - Andreas M. Kaufmann
- Gynecologic Tumor Immunology, Clinic for Gynecology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Ole Wichmann
- Immunisation Unit, Robert Koch Institute, Berlin, Germany
| | - Alexander Krämer
- Department of Public Health Medicine, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Wolfgang Greiner
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615 Bielefeld, Germany
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Triage for management of cervical high-grade squamous intraepithelial lesion patients with positive margin by conization: a retrospective analysis. Front Med 2017; 11:223-228. [DOI: 10.1007/s11684-017-0517-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/23/2017] [Indexed: 12/29/2022]
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Gervais F, Dunton K, Jiang Y, Largeron N. Systematic review of cost-effectiveness analyses for combinations of prevention strategies against human papillomavirus (HPV) infection: a general trend. BMC Public Health 2017; 17:283. [PMID: 28351348 PMCID: PMC5371248 DOI: 10.1186/s12889-017-4076-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 01/26/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Due to the arrival of multi-valent HPV vaccines, it is more and more important to have a better understanding of the relationship between vaccination and screening programmes. This review aimed to: (1) collect published evidence on the cost-effectiveness profile of different HPV prevention strategies and, in particular, those combining vaccination with changes in screening practices; (2) explore the cost-effectiveness of alternative preventive strategies based on screening and vaccination. METHODS A systematic literature review was conducted in order to identify the relevant studies regarding the cost-effectiveness of prevention strategies against HPV infection. Analysis comparing the modelling approaches between studies was made along with an assessment of the magnitude of impact of several factors on the cost-effectiveness of different screening strategies. RESULTS A total of 18 papers were quantitatively summarised within the narrative. A high degree of heterogeneity was found in terms of how HPV prevention strategies have been assessed in terms of their economic and epidemiological impact, with variation in screening practice and valence of HPV vaccination found to have large implications in terms of cost-effectiveness. CONCLUSIONS This review demonstrated synergies between screening and vaccination. New prevention strategies involving multi-valence vaccination, HPV DNA test screening, delayed commencement and frequency of screening could be implemented in the future. Strategies implemented in the future should be chosen with care, and informed knowledge of the potential impact of all possible prevention strategies. Highlighted in this review is the difficulty in assessing multiple strategies. Appropriate modelling techniques will need to be utilised to assess the most cost-effective strategies.
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Affiliation(s)
- Frédéric Gervais
- Amaris, The Fitzpatrick Building, 188 York Way, London, N7 9AS, UK
| | - Kyle Dunton
- Amaris, The Fitzpatrick Building, 188 York Way, London, N7 9AS, UK.
| | - Yiling Jiang
- Amaris, The Fitzpatrick Building, 188 York Way, London, N7 9AS, UK
| | - Nathalie Largeron
- Sanofi Pasteur MSD, 162 avenue Jean Jaurès, CS 50712, 69367, Lyon, Cedex 07, France
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Bardach AE, Garay OU, Calderón M, Pichón-Riviére A, Augustovski F, Martí SG, Cortiñas P, Gonzalez M, Naranjo LT, Gomez JA, Caporale JE. Health economic evaluation of Human Papillomavirus vaccines in women from Venezuela by a lifetime Markov cohort model. BMC Public Health 2017; 17:152. [PMID: 28148228 PMCID: PMC5289055 DOI: 10.1186/s12889-017-4064-7] [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: 04/02/2016] [Accepted: 01/24/2017] [Indexed: 12/16/2022] Open
Abstract
Background Cervical cancer (CC) and genital warts (GW) are a significant public health issue in Venezuela. Our objective was to assess the cost-effectiveness of the two available vaccines, bivalent and quadrivalent, against Human Papillomavirus (HPV) in Venezuelan girls in order to inform decision-makers. Methods A previously published Markov cohort model, informed by the best available evidence, was adapted to the Venezuelan context to evaluate the effects of vaccination on health and healthcare costs from the perspective of the healthcare payer in an 11-year-old girls cohort of 264,489. Costs and quality-adjusted life years (QALYs) were discounted at 5%. Eight scenarios were analyzed to depict the cost-effectiveness under alternative vaccine prices, exchange rates and dosing schemes. Deterministic and probabilistic sensitivity analyses were performed. Results Compared to screening only, the bivalent and quadrivalent vaccines were cost-saving in all scenarios, avoiding 2,310 and 2,143 deaths, 4,781 and 4,431 CCs up to 18,459 GW for the quadrivalent vaccine and gaining 4,486 and 4,395 discounted QALYs respectively. For both vaccines, the main determinants of variations in the incremental costs-effectiveness ratio after running deterministic and probabilistic sensitivity analyses were transition probabilities, vaccine and cancer-treatment costs and HPV 16 and 18 distribution in CC cases. When comparing vaccines, none of them was consistently more cost-effective than the other. In sensitivity analyses, for these comparisons, the main determinants were GW incidence, the level of cross-protection and, for some scenarios, vaccines costs. Conclusions Immunization with the bivalent or quadrivalent HPV vaccines showed to be cost-saving or cost-effective in Venezuela, falling below the threshold of one Gross Domestic Product (GDP) per capita (104,404 VEF) per QALY gained. Deterministic and probabilistic sensitivity analyses confirmed the robustness of these results. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4064-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ariel Esteban Bardach
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina.
| | - Osvaldo Ulises Garay
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina
| | - María Calderón
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina
| | - Andrés Pichón-Riviére
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina
| | - Federico Augustovski
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina
| | - Sebastián García Martí
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina
| | - Paula Cortiñas
- Salud Chacao, Final Av. Ávila, Edif. Salud Chacao. Urb. Bello Campo. Chacao, 1060, Caracas, D.C, Venezuela
| | - Marino Gonzalez
- Unit of Public Policy, Simon Bolivar University, Edificio Física y Electrónica I, Planta Baja. Valle de Sartenejas, Estado Miranda, Caracas, Venezuela
| | - Laura T Naranjo
- GlaxoSmithKline Biologicals, Clayton, Ciudad del Saber Edificio 230, Panama City, Panama
| | - Jorge Alberto Gomez
- GSK Vaccines Latin America, Carlos Casares 3690, B1644 BCD, Victoria, Buenos Aires, Argentina
| | - Joaquín Enzo Caporale
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina
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Germar MJ, Purugganan C, Bernardino MS, Cuenca B, Chen YC, Li X, Van Kriekinge G, Lee IH. Cost-effectiveness analysis of AS04-adjuvanted human papillomavirus 16/18 vaccine compared with human papillomavirus 6/11/16/18 vaccine in the Philippines, with the new 2-dose schedule. Hum Vaccin Immunother 2017; 13:1158-1166. [PMID: 28075249 PMCID: PMC5443386 DOI: 10.1080/21645515.2016.1269991] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Cervical cancer (CC) is the second leading cause of cancer death among Filipino women. Human papillomavirus (HPV) vaccination protects against CC. Two vaccines (AS04-HPV-16/18 and 4vHPV) are approved in the Philippines; they were originally developed for a 3-dose (3D) administration and have recently been approved in a 2-dose schedule (2D). This study aims to evaluate the cost-effectiveness of HPV vaccination of 13-year-old Filipino girls, in addition to current screening, in the new 2D schedule. An existing static lifetime, one-year cycle Markov cohort model was adapted to the Philippine settings to simulate the natural history of low-risk and oncogenic HPV infection, the effects of screening and vaccination of a 13-year-old girls cohort vaccinated with either the 2D-AS04-HPV-16/18 or 2D-4vHPV assuming a 100% vaccination coverage. Incremental cost, quality-adjusted life year (QALY) and cost-effectiveness were derived from these estimates. Input data were obtained from published sources and Delphi panel, using country-specific data where possible. Sensitivity analyses were performed to assess the robustness of the model. The model estimated that 2D-AS04-HPV-16/18 prevented 986 additional CC cases and 399 CC deaths (undiscounted), as well as 555 increased QALY (discounted), and save 228.1 million Philippine pesos (PHP) compared with the 2D-4vHPV. In conclusion, AS04-HPV-16/18 is shown to be dominant over 4vHPV in the Philippines, with greater estimated health benefits and lower costs.
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Affiliation(s)
- Maria Julieta Germar
- a University of the Philippines College of Medicine, Philippine General Hospital, Metro , Manila , Philippines
| | - Carrie Purugganan
- b St Martin De Porres Charity Hospital , San Juan, Mandaluyong City , Philippines
| | | | - Benjamin Cuenca
- d Jose R Reyes Memorial Medical Center , Tondo , Manila , Philippines
| | | | | | | | - I-Heng Lee
- e GSK , Singapore , Republic of Singapore
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Parsons SK, Guy GP, Peacock S, Cohen JT, Rodday AM, Kiernan EA, Feeny D. Economic Evaluation in Adolescent and Young Adult Cancer: Methodological Considerations and the State of the Science. CANCER IN ADOLESCENTS AND YOUNG ADULTS 2017. [DOI: 10.1007/978-3-319-33679-4_33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abstract
Objective: TO review the pharmacology, efficacy, safety, tolerability, and pharmacoeconomics of Cervarix and Gardasil, 2 human papillomavirus (HPV) vaccines. Data Sources: English-language articles were obtained by MEDLINE search (1966–February 2006) using the key words human papillomavirus vaccine, Cervarix, and Gardasil. Bibliographies of selected articles were used to identify additional sources. Study Selection and Data Extraction: All available published articles or abstracts reporting the results of human studies of HPV vaccines were reviewed for inclusion in this article. Additional information about ongoing clinical trials was obtained from manufacturers' Web sites. Data Synthesis: Cervarix and Gardasil are recombinant vaccines against HPV. Cervarix targets HPV-16 and -18, which are responsible for 70% of cervical cancers. Gardasil also targets HPV-16 and -18, plus the HPV-6 and -11 types responsible for more than 80% of genital warts. Both vaccines have been effective in preventing persistent infection with targeted HPV types and in preventing cervical intraepithelial lesions, while Gardasil has also been effective in preventing vulvar and vaginal neoplasia and genital warts. Both vaccines have been well tolerated, with the most common adverse effects occurring at the injection site. Phase III trials are ongoing to further evaluate vaccine efficacy. Conclusions: Cervarix and Gardasil are effective for prevention of HPV infection and cervical lesions. Issues remaining to be addressed include duration of protection, efficacy for prevention of cervical cancer, optimal age for vaccination, feasibility of application to the developing world, the ideal combination of HPV subtypes, and the most efficient combination of vaccination and cervical cancer screening.
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Ehrhardt J. What School Nurses Need to Know About Cervical Cancer, HPV, and the New Vaccine. J Sch Nurs 2016; 23:310-4. [DOI: 10.1177/10598405070230060201] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
At least 12,000 women are diagnosed with cervical cancer each year in the United States, accounting for at least 4,000 deaths. Worldwide, cervical cancer is the second most common type of cancer among women. The human papilloma virus (HPV) has been linked to at least 70% of all cervical cancer. HPV can be divided into 2 categories: (a) low risk, which is responsible for genital warts, and (b) high risk, which is responsible for cervical cancer. An effective new vaccine has been approved that will decrease the spread of infection caused by HPV, therefore decreasing the future incidence of cervical cancer and genital warts. Understanding the risks of acquiring HPV and the increased risk for cervical cancer may lead to enhanced vaccine acceptance.
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Affiliation(s)
- Jeanie Ehrhardt
- Jeanie Ehrhardt, RN, BSN, is a graduate student in the nurse practitioner program at South Florida University, Tampa, FL
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Zhang Q, Liu YJ, Hu SY, Zhao FH. Estimating long-term clinical effectiveness and cost-effectiveness of HPV 16/18 vaccine in China. BMC Cancer 2016; 16:848. [PMID: 27814703 PMCID: PMC5097411 DOI: 10.1186/s12885-016-2893-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 10/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) 16 and 18 are the two most common HPV oncogenic types that can be prevented by vaccination. This study aimed at assessing the cost-effectiveness of 3 doses of the bivalent HPV vaccine in rural and urban settings in China. METHODS A Markov model was adapted to reflect the lifetime of a modelled 100,000 12-year-old girls cohort in rural and urban settings in China. Input parameters were obtained from published literature, official reports and a two-round expert review panel. Clinical and economic outcomes of vaccination at age 12 with screening was compared to screening only. In the base case analysis, a 3 % discount rate, the vaccine cost of 247 CNY (US$ 39, PAHO vaccine cost in 2013), two rounds of screening in a life time and 70 % coverage for both screening and vaccination were used. One-way, two-way and probabilistic sensitivity analyses were performed. We used different thresholds of cost-effectiveness to reflect the diversity of economic development in China. RESULTS Vaccination in addition to screening could prevent 60 % more cervical cancer cases and deaths than screening only. The incremental cost effectiveness ratio varied largely when changing cost of vaccination and discount in one way analysis. Vaccination was very cost-effective when the vaccine cost ranged 87-630 CNY (US$ 13.8-100) in rural and 87-750 CNY (US$ 13.8-119) in urban; and remained cost-effective when the vaccine cost ranged 630-1,700 CNY (US$ 100-270) in rural and 750-1,900 CNY (US$ 119-302) in urban in two way analysis. Probabilistic sensitivity analyses showed that model results were robust. CONCLUSIONS In both rural and urban, the vaccination cost and discounting are important factors determining the cost-effectiveness of HPV vaccination; policy makers in China should take these into account when making a decision on the introduction of HPV vaccine. In areas with a high burden of cervical cancer and limited screening activities, HPV vaccination should be prioritized. However, the vaccine cost needs to be reduced in order to make it very cost-effective and affordable as well, in particular in poverty areas with high disease burden.
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Affiliation(s)
- Qian Zhang
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yi-Jun Liu
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
- Department of Preventive Medicine, School of Public Health, Zunyi Medical College, Zunyi, 563099, China
| | - Shang-Ying Hu
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Fang-Hui Zhao
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Schülein S, Taylor KJ, König J, Claus M, Blettner M, Klug SJ. Factors influencing uptake of HPV vaccination among girls in Germany. BMC Public Health 2016; 16:995. [PMID: 27645711 PMCID: PMC5028932 DOI: 10.1186/s12889-016-3663-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 09/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adequate coverage is key to the success of human papillomavirus (HPV) vaccination programmes. There is currently no organised HPV vaccination programme in Germany. The aim of this analysis was to determine HPV vaccine uptake as well as factors associated with uptake in nine to 17 year-old girls in Germany during the first year of vaccine availability. METHODS This analysis is based on data from the Healthcare Access Panel, an established population-based household panel consisting of 55 000 representative households in Germany who were contacted between September and October 2007. A total of 4 747 households included at least one girl aged nine to 17 years. After reading a description of the HPV vaccine, these girls were asked, "Would you have yourself vaccinated against HPV?" Logistic regression analyses were performed to investigate associations between vaccination status and socio-demographic characteristics of the girls and their mothers. RESULTS Of the 4 747 girls in the households who received questionnaires, 2 224 (46.9 %) participated in the study and 1 906 (40.2 %) answered the vaccination question. A total of 17.4 % of the girls were already vaccinated, 61.5 % felt positively about doing so, 4.7 % said they would not be vaccinated, and 16.3 % were not sure. The probability of a girl being vaccinated increased with each additional year of age (Odds Ratio (OR): 1.6, 95 % Confidence Interval (CI) 1.5-1.7). Among the 17 year-old girls, 38.5 % (95 % CI 32.6-44.4 %) had been vaccinated. Having a mother with high education (OR: 1.5, 95 % CI 1.0-2.3) or medium education (OR: 1.5, 95 % CI 1.1-2.1) versus basic education was a significant predictor for having been vaccinated. Similarly, medium (OR: 1.5, 95 % CI 1.0-2.4) versus low SES was significantly associated with having been vaccinated. Our analysis showed that during the first year of HPV vaccine availability in Germany, vaccination uptake was low. CONCLUSIONS Countries with organised HPV vaccination programmes showed much higher vaccination uptake, even in the first year after programme introduction. If vaccination uptake in Germany is to significantly improve in the future, an organised vaccination programme will need to be introduced.
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Affiliation(s)
- Stefanie Schülein
- Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 56 (Campus C), Munich, 80992, Germany
| | - Katherine J Taylor
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Centre, University of Mainz, Obere Zahlbacher Str. 69, Mainz, 55131, Germany
| | - Jochem König
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Centre, University of Mainz, Obere Zahlbacher Str. 69, Mainz, 55131, Germany
| | - Matthias Claus
- Institute for Teachers' Health, University Medical Centre, University of Mainz, Kupferbergterrasse 17-19, Mainz, 55116, Germany
| | - Maria Blettner
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Centre, University of Mainz, Obere Zahlbacher Str. 69, Mainz, 55131, Germany
| | - Stefanie J Klug
- Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 56 (Campus C), Munich, 80992, Germany.
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Gender-neutrality, herd effect and resilient immune response for sustainable impact of HPV vaccination. Curr Opin Obstet Gynecol 2016; 27:326-32. [PMID: 26308204 DOI: 10.1097/gco.0000000000000208] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review summarize the impact of various strategies of human papillomavirus (HPV) vaccination, such as vaccinating only girls or both girls and boys. RECENT FINDINGS Slow and inefficient implementation of HPV vaccination programmes has delayed the impact of the first human cancer vaccine. Vaccinating only girls, with a rather low coverage, has led to a limited herd effect and, thus, not full use of the HPV vaccine potential. SUMMARY Gender-neutral vaccination based on comparative effectiveness research will hopefully soon tackle the whole spectrum of HPV cancers in both sexes. The remaining challenges are how to ensure resilience of HPV vaccine-induced immunity and herd effect to guarantee population-level impact of HPV vaccination, and how to guard against HPV type replacement.
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Chesson HW, Markowitz LE, Hariri S, Ekwueme DU, Saraiya M. The impact and cost-effectiveness of nonavalent HPV vaccination in the United States: Estimates from a simplified transmission model. Hum Vaccin Immunother 2016; 12:1363-72. [PMID: 26890978 PMCID: PMC4964746 DOI: 10.1080/21645515.2016.1140288] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/16/2015] [Accepted: 01/05/2016] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The objective of this study was to assess the incremental costs and benefits of the 9-valent HPV vaccine (9vHPV) compared with the quadrivalent HPV vaccine (4vHPV). Like 4vHPV, 9vHPV protects against HPV types 6, 11, 16, and 18. 9vHPV also protects against 5 additional HPV types 31, 33, 45, 52, and 58. METHODS We adapted a previously published model of the impact and cost-effectiveness of 4vHPV to include the 5 additional HPV types in 9vHPV. The vaccine strategies we examined were (1) 4vHPV for males and females; (2) 9vHPV for females and 4vHPV for males; and (3) 9vHPV for males and females. In the base case, 9vHPV cost $13 more per dose than 4vHPV, based on available vaccine price information. RESULTS Providing 9vHPV to females compared with 4vHPV for females (assuming 4vHPV for males in both scenarios) was cost-saving regardless of whether or not cross-protection for 4vHPV was assumed. The cost per quality-adjusted life year (QALY) gained by 9vHPV for both sexes (compared with 4vHPV for both sexes) was < $0 (cost-saving) when assuming no cross-protection for 4vHPV and $8,600 when assuming cross-protection for 4vHPV. CONCLUSIONS Compared with a vaccination program of 4vHPV for both sexes, a vaccination program of 9vHPV for both sexes can improve health outcomes and can be cost-saving.
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Affiliation(s)
- Harrell W. Chesson
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lauri E. Markowitz
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan Hariri
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - 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, GA, USA
| | - Mona Saraiya
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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