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Impact of including boys in the national school-based human papillomavirus vaccination programme in Singapore: A modelling-based cost-effectiveness analysis. Vaccine 2023; 41:1934-1942. [PMID: 36797100 DOI: 10.1016/j.vaccine.2023.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023]
Abstract
Globally, gender-neutral Human Papillomavirus (HPV) vaccination programmes are gaining traction. Although cervical cancer remains the most prevalent, other HPV-related cancers are increasingly recognised as important, especially among men who have sex with men. We assessed if including adolescent boys in Singapore's school-based HPV vaccination programme is cost-effective from the healthcare perspective. We adapted a World Health Organization-supported model, Papillomavirus Rapid Interface for Modelling and Economics, and modelled the cost and quality-adjusted life years (QALY) associated with vaccinating 13-year-olds with the HPV vaccine. Cancer incidence and mortality rates were obtained from local sources and adjusted based on the expected direct and indirect vaccine protection for various population subgroups at an 80 % vaccine coverage. Moving to a gender-neutral vaccination programme with a bivalent or nonavalent vaccine could avert 30 (95 % uncertainty interval [UI]: 20-44) and 34 (95 % UI: 24-49) HPV-related cancers per birth cohort, respectively. At a 3 % discount rate, a gender-neutral vaccination programme is not cost-effective. However, with a 1.5 % discount rate, which puts more value on long-term health gains from vaccination, moving to a gender-neutral vaccination programme with the bivalent vaccine is likely cost-effective, with an incremental cost-effectiveness ratio of SGD$19 007 (95 % UI: 10 164-30 633) per QALY gained. The findings suggest the need to engage experts to examine, in detail, the cost-effectiveness of gender-neutral vaccination programmes in Singapore. Issues of drug licensing, feasibility, gender equity, global vaccine supplies, and the global trend towards disease elimination/eradication should also be considered. This model provides a simplified method for resource-strapped countries to gain a preliminary estimate of the cost-effectiveness of a gender-neutral HPV vaccination programme before investing resources for further research.
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Sargazi N, Takian A, Daroudi R, Nahvijou A, Yaseri M, Ghanbari Motlagh A, Zendehdel K. Cost-Benefit Analysis of Human Papillomavirus Vaccine in Iran. JOURNAL OF PREVENTION (2022) 2022; 43:841-857. [PMID: 35916995 DOI: 10.1007/s10935-022-00697-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 12/29/2022]
Abstract
Despite increasing global attention to the national human papillomavirus (HPV) immunization program, this program is controversial in Iran. Evidence indicates that HPV vaccination is not cost-effective in Iran. Using cost-effectiveness analysis for decision-making about public health interventions such as vaccination is controversial because its potential benefits may not fit this framework. This study aimed to evaluate the economic effects of the HPV vaccination by cost-benefit analysis (CBA) using bivalent and quadrivalent in Iran in 2020. We performed a CBA from a societal perspective. We used two approaches of the vaccine's economic benefits: willingness to pay by discrete choice experiment and cost of illness. Costs only included the vaccine cost. The cost of two doses of bivalent and quadrivalent vaccines were US $29 and the US $151, respectively (US $1 = IRR 42,000). The benefits of bivalent and quadrivalent vaccines were US $ - 432, US $380 per person using the willingness to pay approach, and they were US $7375 and US $6590 thorough cost-of-illness approach. The cost-benefit ratio (CBR) of bivalent and quadrivalent vaccines was - 15.11 and 2.51 by the willingness to pay approach, and 258.12 and 43.51 by the cost of illness approach. This study confirms the benefits of the national bivalent and quadrivalent vaccination programs and provides reliable evidence for policy-makers programming HPV vaccination.
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Affiliation(s)
- Nasrin Sargazi
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Amirhossein Takian
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran. .,Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran. .,Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.
| | - Rajabali Daroudi
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Azin Nahvijou
- Cancer Research Center of Cancer Institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Ali Ghanbari Motlagh
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Mortazavi (Jorjiani) Radiation Oncology Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kazem Zendehdel
- Cancer Research Center of Cancer Institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Cancer Biology Research Center, of Cancer Institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Breast Diseases Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Owusu-Edusei K, Palmer C, Ovcinnikova O, Favato G, Daniels V. Assessing the Health and Economic Outcomes of a 9-Valent HPV Vaccination Program in the United Kingdom. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2022; 9:140-150. [PMID: 35795155 PMCID: PMC9170517 DOI: 10.36469/001c.34721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/20/2022] [Indexed: 06/15/2023]
Abstract
Background: The United Kingdom (UK) switched from using the 4-valent human papillomavirus (HPV) vaccine (Gardasil®) to the 9-valent vaccine (Gardasil 9®) in 2021. Objective: To estimate and compare the health and economic outcomes of 2 HPV vaccination programs in the UK targeting girls and boys aged 12-13 years from the perspective of the UK National Health Service. The 2 vaccination strategies were (1) universal vaccination 4-valent (UV4V), using the 4-valent HPV vaccine (4vHPV), and (2) universal vaccination 9-valent (UV9V), using the 9-valent HPV vaccine (9vHPV). Methods: A deterministic heterosexual compartmental disease transmission model was used to track health and economic outcomes over a 100-year time horizon. Outcomes were discounted at an annual rate of 3.5% and 1.5%. All costs were adjusted to 2020 British pounds (£). Health outcomes were measured in quality-adjusted life-years (QALYs), and the summary results were presented as incremental cost-effectiveness ratios (£/QALY gained) when comparing UV4V with UV9V. Results: Using the same vaccine coverage for both programs, the total cumulative cases of HPV-related health outcomes tracked over the 100-year horizon indicated that the relative number of cases averted (UV9V vs UV4V) ranged from 4% (anal male cancers and deaths) to 56% (cervical intraepithelial neoplasia [CIN1]). Assuming that 9vHPV cost £15.18 more than 4vHPV (a cost differential based on discounted list prices), the estimated incremental cost-effectiveness ratio was £8600/QALY gained when discounted at 3.5%, and £3300/QALY gained when discounted at 1.5%. The estimated incremental cost-effectiveness ratios from the sensitivity analyses remained <£28000/QALY over a wide range of parameter inputs and demonstrated that disease utilities, discount rate, and vaccine efficacy were the 3 most influential parameters. Discussion: Consistent with other published studies, the results from this study found that the 9vHPV vaccine prevented a substantial number of cases when compared with the 4vHPV vaccine and was highly cost-effective. Conclusions: These results demonstrate that replacing universal 4vHPV with 9vHPV can prevent a substantial additional number of HPV-related cases/deaths (in both women and men) and remain cost-effective over a range of 9vHPV price premiums.
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Daniels V, Saxena K, Patterson-Lomba O, Gomez-Lievano A, Saah A, Luxembourg A, Velicer C, Chen YT, Elbasha E. Modeling the health and economic implications of adopting a 1-dose 9-valent human papillomavirus vaccination regimen in a high-income country setting: An analysis in the United Kingdom. Vaccine 2022; 40:2173-2183. [PMID: 35232593 DOI: 10.1016/j.vaccine.2022.02.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/19/2021] [Accepted: 02/18/2022] [Indexed: 02/07/2023]
Abstract
Although no human papillomavirus (HPV) vaccine is indicated for single-dose administration, some observational evidence suggests that a 1-dose regimen might reduce HPV infection risk to that achieved with 2 doses. This study estimated the potential health and economic outcomes associated with switching from a 2-dose HPV vaccination program for girls and boys aged 13-14 years to an off-label 9-valent (9vHPV), 1-dose regimen, accounting for the uncertainty of the effectiveness and durability of a single dose. A dynamic HPV transmission infection and disease model was adapted to the United Kingdom and included a probabilistic sensitivity analysis using estimated distributions for duration of protection of 1-dose and degree of protection of 1 relative to 2 doses. One-way sensitivity analyses of key inputs were performed. Outcomes included additional cancer and disease cases and the difference in net monetary benefit (NMB). The 1-dose program was predicted to result in 81,738 additional HPV-related cancer cases in males and females over 100 years compared to the 2-dose program, ranging from 36,673 to 134,347 additional cases (2.5% and 97.5% quantiles, respectively), and had a 7.8% probability of being cost-effective at the £20,000/quality-adjusted life years willingness-to-pay (WTP) threshold. In one-way sensitivity analyses, the number of additional cancer cases was sensitive to the median of the duration of protection distribution and coverage rates. The differences in NMBs were sensitive to the median of the duration of protection distribution, dose price and discount rate, but not coverage variations. Across sensitivity analyses, the probability of 1 dose being cost-effective vs 2 doses was < 50% at the standard WTP threshold. Adoption of a 1-dose 9vHPV vaccination program resulted in more vaccine-preventable HPV-related cancer and disease cases in males and females, introduced substantial uncertainty in health and economic outcomes, and had a low probability of being cost-effective compared to the 2-dose program.
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Affiliation(s)
- Vincent Daniels
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA.
| | - Kunal Saxena
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA.
| | | | | | - Alfred Saah
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA.
| | - Alain Luxembourg
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA.
| | - Christine Velicer
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA.
| | - Ya-Ting Chen
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA.
| | - Elamin Elbasha
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA.
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Sandmann F, Ramsay M, Edmunds WJ, Choi YH, Jit M. How to Prevent Vaccines Falling Victim to Their Own Success: Intertemporal Dependency of Incidence Levels on Indirect Effects in Economic Reevaluations. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1391-1399. [PMID: 34593161 PMCID: PMC9525135 DOI: 10.1016/j.jval.2021.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/03/2021] [Accepted: 03/17/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Incremental cost-effectiveness analyses may inform the optimal choice of healthcare interventions. Nevertheless, for many vaccines, benefits fluctuate with incidence levels over time. Reevaluating a vaccine after it has successfully decreased incidences may eventually cause a disease resurgence if switching to a vaccine with lower indirect benefits. Decisions may successively alternate between vaccines alongside repeated rises and falls in incidence and when indirect effects from historic use are ignored. Our suggested proposal aims to prevent suboptimal decision making. METHODS We used a conceptual model of demand to illustrate alternating decisions between vaccines because of time-varying levels of indirect effects. Similar to the concept of subsidies, we propose internalizing the indirect effects achievable with vaccines. In a case study over 60 years, we simulated a hypothetical 10-year reevaluation of 2 oncogenic human papillomavirus vaccines, of which only 1 protects additionally against anogenital warts. RESULTS Our case study showed that the vaccine with additional warts protection is initially valued higher than the vaccine without additional warts protection. After 10 years, this differential decreases because of declines in warts incidence, which supports switching to the nonwarts vaccine that causes a warts resurgence eventually. Instead, pricing the indirect effects separately supports continuing with the warts vaccine. CONCLUSIONS Ignoring how the observed incidences depend on the indirect effects achieved with a particular vaccine may lead to repeated changes in vaccines at successive reevaluations, with unintended resurgences, economic inefficiencies, and eroding vaccine confidence. We propose internalizing indirect effects to prevent vaccines falling victim to their own success.
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Affiliation(s)
- Frank Sandmann
- Statistics, Modelling, and Economics Department, National Infection Service, Public Health England, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - Mary Ramsay
- Immunisation and Countermeasures Department, National Infection Service, Public Health England, London, UK
| | - W John Edmunds
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Yoon H Choi
- Statistics, Modelling, and Economics Department, National Infection Service, Public Health England, London, UK
| | - Mark Jit
- Statistics, Modelling, and Economics Department, National Infection Service, Public Health England, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; School of Public Health, University of Hong Kong, Hong Kong SAR, China
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Gilson R, Nugent D, Bennett K, Doré CJ, Murray ML, Meadows J, Haddow LJ, Lacey C, Sandmann F, Jit M, Soldan K, Tetlow M, Caverly E, Nathan M, Copas AJ. Imiquimod versus podophyllotoxin, with and without human papillomavirus vaccine, for anogenital warts: the HIPvac factorial RCT. Health Technol Assess 2021; 24:1-86. [PMID: 32975189 DOI: 10.3310/hta24470] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The comparative efficacy, and cost-effectiveness, of imiquimod or podophyllotoxin cream, either alone or in combination with the quadrivalent HPV vaccine (Gardasil®, Merck Sharp & Dohme Corp., Merck & Co., Inc., Whitehouse Station, NJ, USA) in the treatment and prevention of recurrence of anogenital warts is not known. OBJECTIVE The objective was to compare the efficacy of imiquimod and podophyllotoxin creams to treat anogenital warts and to assess whether or not the addition of quadrivalent human papillomavirus vaccine increases wart clearance or prevention of recurrence. DESIGN A randomised, controlled, multicentre, partially blinded factorial trial. Participants were randomised equally to four groups, combining either topical treatment with quadrivalent human papillomavirus vaccine or placebo. Randomisation was stratified by gender, a history of previous warts and human immunodeficiency virus status. There was an accompanying economic evaluation, conducted from the provider perspective over the trial duration. SETTING The setting was 22 sexual health clinics in England and Wales. PARTICIPANTS Participants were patients with a first or repeat episode of anogenital warts who had not been treated in the previous 3 months and had not previously received quadrivalent human papillomavirus vaccine. INTERVENTIONS Participants were randomised to 5% imiquimod cream (Aldara®; Meda Pharmaceuticals, Takeley, UK) for up to 16 weeks or 0.15% podophyllotoxin cream (Warticon®; GlaxoSmithKlein plc, Brentford, UK) for 4 weeks, which was extended to up to 16 weeks if warts persisted. Participants were simultaneously randomised to quadrivalent human papillomavirus vaccine (Gardasil) or saline control at 0, 8 and 24 weeks. Cryotherapy was permitted after week 4 at the discretion of the investigator. MAIN OUTCOME MEASURES The main outcome measures were a combined primary outcome of wart clearance at week 16 and remaining wart free at week 48. Efficacy analysis was by logistic regression with multiple imputation for missing follow-up values; economic evaluation considered the costs per quality-adjusted life-year. RESULTS A total of 503 participants were enrolled and attended at least one follow-up visit. The mean age was 31 years, 66% of participants were male (24% of males were men who have sex with men), 50% had a previous history of warts and 2% were living with human immunodeficiency virus. For the primary outcome, the adjusted odds ratio for imiquimod cream versus podophyllotoxin cream was 0.81 (95% confidence interval 0.54 to 1.23), and for quadrivalent human papillomavirus vaccine versus placebo, the adjusted odds ratio was 1.46 (95% confidence interval 0.97 to 2.20). For the components of the primary outcome, the adjusted odds ratio for wart free at week 16 for imiquimod versus podophyllotoxin was 0.77 (95% confidence interval 0.52 to 1.14) and for quadrivalent human papillomavirus vaccine versus placebo was 1.30 (95% confidence interval 0.89 to 1.91). The adjusted odds ratio for remaining wart free at 48 weeks (in those who were wart free at week 16) for imiquimod versus podophyllotoxin was 0.98 (95% confidence interval 0.54 to 1.78) and for quadrivalent human papillomavirus vaccine versus placebo was 1.39 (95% confidence interval 0.73 to 2.63). Podophyllotoxin plus quadrivalent human papillomavirus vaccine had inconclusive cost-effectiveness compared with podophyllotoxin alone. LIMITATIONS Hepatitis A vaccine as control was replaced by a saline placebo in a non-identical syringe, administered by someone outside the research team, for logistical reasons. Sample size was reduced from 1000 to 500 because of slow recruitment and other delays. CONCLUSIONS A benefit of the vaccine was not demonstrated in this trial. The odds of clearance at week 16 and remaining clear at week 48 were 46% higher with vaccine, and consistent effects were seen for both wart clearance and recurrence separately, but these differences were not statistically significant. Imiquimod and podophyllotoxin creams had similar efficacy for wart clearance, but with a wide confidence interval. The trial results do not support earlier evidence of a lower recurrence with use of imiquimod than with use of podophyllotoxin. Podophyllotoxin without quadrivalent human papillomavirus vaccine is the most cost-effective strategy at the current vaccine list price. A further larger trial is needed to definitively investigate the effect of the vaccine; studies of the immune response in vaccine recipients are needed to investigate the mechanism of action. TRIAL REGISTRATION Current Controlled Trials. Current Controlled Trials ISRCTN32729817 and EudraCT 2013-002951-14. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 47. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Richard Gilson
- University College London Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK.,Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Diarmuid Nugent
- University College London Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK.,Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Kate Bennett
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Caroline J Doré
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Macey L Murray
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Jade Meadows
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Lewis J Haddow
- University College London Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK.,Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Charles Lacey
- Centre for Immunology and Infection, Hull York Medical School, University of York, York, UK
| | - Frank Sandmann
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,Statistics, Modelling and Economics Department, Public Health England, London, UK
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,Statistics, Modelling and Economics Department, Public Health England, London, UK
| | - Kate Soldan
- Statistics, Modelling and Economics Department, Public Health England, London, UK
| | - Michelle Tetlow
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Emilia Caverly
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Mayura Nathan
- Homerton Anogenital Neoplasia Service, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Andrew J Copas
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK.,Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
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Woestenberg PJ, Guevara Morel AE, Bogaards JA, Hooiveld M, Schurink-van 't Klooster TM, Hoebe CJPA, van der Sande MAB, van Benthem BHB. Partial Protective Effect of Bivalent Human Papillomavirus 16/18 Vaccination Against Anogenital Warts in a Large Cohort of Dutch Primary Care Patients. Clin Infect Dis 2021; 73:291-297. [PMID: 32421775 PMCID: PMC8516515 DOI: 10.1093/cid/ciaa582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 05/12/2020] [Indexed: 12/21/2022] Open
Abstract
Background There is ongoing debate about the possible protective effect of the bivalent human papillomavirus (2vHPV) vaccine, targeting oncogenic types HPV-16/18, against anogenital warts (AGWs), commonly attributed to HPV-6/11. We performed a retrospective registry-based open cohort study to assess the effect of 2vHPV vaccination on AGWs. Methods We linked general practice (ie, primary care) data from women born between 1993 and 2002, who had been eligible for HPV vaccination in the Netherlands, to the Dutch national immunization registry on an individual level. Women were followed until their first AGW diagnosis or end of follow-up. Adjusted incidence rate ratios (aIRRs) were estimated using Poisson regression with vaccination status as a time-dependent exposure. Results We linked data of 96 468 women with a total of 328 019 years observation time and 613 AGW diagnoses (incidence: 1.87/1000 person-years). At the end of follow-up, 61% were 2vHPV vaccinated (≥ 1 dose) of whom 91% were fully vaccinated. The AGW incidence was lower among those with ≥ 1 dose vs 0 doses (aIRR, 0.75 [95% confidence interval {CI}, .64–.88]). The effect of vaccination was stronger after full vaccination (aIRR, 0.72 [95% CI, .61–.86]) and for women who were offered vaccination at 12–13 years of age (aIRR, 0.69 [95% CI, .51–.93]) vs those at 13–16 years of age (aIRR, 0.77 [95% CI, .64–.93]). Conclusions This is the largest population-based study so far to examine the effect of 2vHPV vaccination on AGWs, with reliable individual information on AGW diagnoses and vaccination status. The results indicate that 2vHPV vaccination partially protects against AGWs, especially when administered in early adolescence.
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Affiliation(s)
- Petra J Woestenberg
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alejandra E Guevara Morel
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Johannes A Bogaards
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,Department of Epidemiology and Data Science, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | | | - Christian J P A Hoebe
- Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Sexual Health, Infectious Diseases and Environment, South Limburg Public Health Service, Heerlen, The Netherlands
| | - Marianne A B van der Sande
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Birgit H B van Benthem
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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Phua LC, Choi HCW, Wu J, Jit M, Low J, Ng K, Pearce F, Hall C, Abdul Aziz MI. Cost-effectiveness analysis of the nonavalent human papillomavirus vaccine for the prevention of cervical cancer in Singapore. Vaccine 2021; 39:2255-2263. [PMID: 33744050 DOI: 10.1016/j.vaccine.2021.03.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The nonavalent human papillomavirus (HPV) vaccine has been shown to extend protection against oncogenic HPV types 31/33/45/52/58 (HPV-OV) not covered by the bivalent and quadrivalent HPV vaccines. Besides its clinical benefit, evidence on the economic value of the nonavalent vaccine is required to inform local vaccination strategies and funding decisions. This study evaluated the cost-effectiveness of replacing the bivalent vaccine with the nonavalent vaccine in the national school-based HPV vaccination programme in Singapore. METHODS An existing age-structured dynamic transmission model coupled with stochastic individual-based simulations was adapted to project the health and economic impact of vaccinating 13-year-old girls with two doses of the nonavalent or bivalent HPV vaccines in Singapore. Direct costs (in Singapore dollars, S$) were obtained from public healthcare institutions in Singapore, while health state utilities were sourced from the literature. Incremental cost-effectiveness ratios (ICERs) were estimated over a lifetime horizon, from a healthcare system perspective. Probabilistic sensitivity analysis was performed to obtain the ICERs and corresponding variations across variable uncertainty. Particularly, this study tested the scenarios of lifelong and 20-year vaccine-induced protection, assumed 96.0% and 22.3% cross-protection against HPV-OV by nonavalent and bivalent vaccines respectively, and fixed vaccine prices per dose at S$188 for nonavalent and S$61.50 for bivalent vaccines. RESULTS Compared with the bivalent vaccine, the use of the nonavalent vaccine was associated with an ICER of S$61,629 per quality-adjusted life year gained in the base case. The result was robust across a range of plausible input values, and to assumptions regarding the duration of vaccine protection. CONCLUSION Given the high ICER, the nonavalent vaccine is unlikely to represent a cost-effective option compared with the bivalent vaccine for school-based HPV vaccination of 13-year old female students in Singapore. Substantial price reductions would be required to justify its inclusion in the school-based programme in the future.
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Affiliation(s)
- Lee Cheng Phua
- Agency for Care Effectiveness, Ministry of Health, Singapore
| | - Horace C W Choi
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Joseph Wu
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region; WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
| | - Mark Jit
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jeffrey Low
- Gynaecologic Oncology, National University Cancer Institute, National University Hospital, Singapore
| | - Kwong Ng
- Agency for Care Effectiveness, Ministry of Health, Singapore
| | - Fiona Pearce
- Agency for Care Effectiveness, Ministry of Health, Singapore
| | - Cameron Hall
- Agency for Care Effectiveness, Ministry of Health, Singapore
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10
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Chesson HW, Meites E, Ekwueme DU, Saraiya M, Markowitz LE. Cost-effectiveness of HPV vaccination for adults through age 45 years in the United States: Estimates from a simplified transmission model. Vaccine 2020; 38:8032-8039. [PMID: 33121846 PMCID: PMC10395540 DOI: 10.1016/j.vaccine.2020.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 09/30/2020] [Accepted: 10/07/2020] [Indexed: 01/28/2023]
Abstract
INTRODUCTION The objective of this study was to assess incremental costs and benefits of a human papillomavirus (HPV) vaccination program expanded to include "mid-adults" (adults aged 27 through 45 years) in the United States. METHODS We adapted a previously published, dynamic mathematical model of HPV transmission and HPV-associated disease to estimate the incremental costs and benefits of a 9-valent HPV vaccine (9vHPV) program for people aged 12 through 45 years compared to a 9vHPV program for females aged 12 through 26 years and males aged 12 through 21 years. RESULTS A 9vHPV program for females aged 12 through 26 years and males aged 12 through 21 years was estimated to cost < $10,000 quality-adjusted life year (QALY) gained, compared to no vaccination. Expanding the 9vHPV program to include mid-adults was estimated to cost $587,600 per additional QALY gained when including adults through age 30 years, and $653,300 per additional QALY gained when including adults through age 45 years. Results were most sensitive to assumptions about HPV incidence among mid-adults, current and historical vaccination coverage, vaccine price, and the impact of HPV diseases on quality of life. CONCLUSIONS Mid-adult vaccination is much less cost-effective than the comparison strategy of routine vaccination for all adolescents at ages 11 to 12 years and catch-up vaccination for women through age 26 years and men through age 21 years.
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Toppenberg MD, Christiansen TEM, Rasmussen F, Nielsen CP, Damsgaard EM. Mobile X-ray outside the hospital: a scoping review. BMC Health Serv Res 2020; 20:767. [PMID: 32814588 PMCID: PMC7439673 DOI: 10.1186/s12913-020-05564-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 07/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For several years mobile X-ray equipment has been routinely used for imaging in patients too unwell within the hospital, when transportation to the radiology department was inadvisable. Now, mobile X-ray examinations are also used outside the hospital. The literature describes that fragile patients may benefit from mobile X-ray, but we need to provide insights into the breadth, depth and gaps in a body of literature. METHODS The scoping review was performed by searching PubMed, Cinahl, Embase, EconLit and Health Technology Assessment. English-, Danish-, Norwegian-, German-, Italian-, French- and Swedish-language studies, published 1.1.2009-1.5.2020 about mobile X-ray outside the hospital were included. Participants were patients examined using mobile X-ray as the intervention. PRISMA was used when eligible to build up the review. To extract data from the selected articles, we used a structured summary table. RESULTS We included 12 studies in this scoping review. The results were divided into four topics:1. Target population 2. Population health 3. Experience of care and 4. Cost effectiveness. The main findings are that target population could be larger for instance including hospice patients for palliative care, group dwelling for people with intellectual disabilities, or psychiatric patients, population health may be improved, image quality seems to be good and mobile X-ray may be cost effective. Limitations of language, databases and grey literature may have resulted in studies being missed. CONCLUSIONS Mobile X-ray may be used outside hospital. There seems to be potential benefits to both patients and health care staff. Based on the published studies it is not possible to draw a final conclusion if mobile X-ray examination is a relevant diagnostic offer and for whom. Further studies are needed to assess the feasibility of use in fragile patients, also regarding staff, relatives and societal consequences and therefore the topic mobile X-ray needs more research.
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Affiliation(s)
- Maria Dietz Toppenberg
- The Department of Radiology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | | | - Finn Rasmussen
- The Department of Radiology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Camilla Palmhøj Nielsen
- DEFACTUM, Social and Health Services and Labour Market, Olof Palmes Allé 15, 8200, Aarhus N, Denmark
| | - Else Marie Damsgaard
- Department of Geriatrics, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
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12
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Ballestas SA, Shelly S, Soriano RM, Klein A. Trends in recurrent respiratory papillomatosis treatment. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 72:109-120. [PMID: 32312478 DOI: 10.1016/j.otorri.2019.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/23/2019] [Accepted: 11/08/2019] [Indexed: 11/27/2022]
Abstract
Recurrent respiratory papillomatosis (RRP) consist of benign tumours along the airway caused by human papillomavirus infection. Papillomas may cause changes in phonation and obstruct the airway. The purpose of this study was to evaluate the different surgical and adjuvant therapies available for the treatment of this condition reported between 2014-2018. A PubMed search was performed for RRP treatment articles published between 2014 -2018. Forty articles that encompassed 1425 patients with RRP met the criteria. Of these, 24 articles evaluate the use of adjuvant therapies such as bevacizumab, human papillomavirus vaccine and cidofovir. There has been an increase in adjuvant therapy options for RRP in the literature in recent years. An awareness of these options highlights gaps and opportunities in the care of these patients, opens the door to new protocols to control disease and increase intersurgical intervals, and guides us towards new management paradigms in the future.
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Affiliation(s)
- Samir A Ballestas
- Departamento de Otorrinolaringología y Cirugía de Cabeza y Cuello, Emory University School of Medicine, Atlanta, Estados Unidos
| | - Sandeep Shelly
- Departamento de Otorrinolaringología y Cirugía de Cabeza y Cuello, Emory University School of Medicine, Atlanta, Estados Unidos
| | - Roberto M Soriano
- Departamento de Otorrinolaringología y Cirugía de Cabeza y Cuello, Emory University School of Medicine, Atlanta, Estados Unidos
| | - Adam Klein
- Departamento de Otorrinolaringología y Cirugía de Cabeza y Cuello, Emory University School of Medicine, Atlanta, Estados Unidos.
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13
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Stephens S, Chatterjee A, Coles V, Crawford R. The costs of treating vaginal and vulval cancer in England (2009-2015). BMC Public Health 2020; 20:453. [PMID: 32252711 PMCID: PMC7137284 DOI: 10.1186/s12889-020-08545-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 03/18/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) infection is a pre-requisite for cervical cancer, which represents the third most common cancer among women worldwide. A causal relationship also exists between HPV and cancer in other areas of the female reproductive system including the vagina and vulva. Whilst the incidence of vaginal cancer in the UK has remained relatively stable over the past 25 years, vulval cancer rates are increasing. A body of literature exists on the epidemiology and aetiology of vaginal and vulval cancer, but little is known about the economic burden. The objective of this study was to quantify the costs of treating these cancers on the National Health Service (NHS) in England. METHODS Inpatient and outpatient episodes were derived from Hospital Episode Statistics (HES). Health Resource Group (HRG) tariffs and National Reference Costs were used to estimate the cost of treating pre-cancerous and invasive vaginal and vulval lesions in England. RESULTS The study showed that for the 5 years from 2009/2010 to 2014/2015 the total cost associated with pre-cancerous and invasive vaginal and vulval lesions was over £14 million per year on average (95% of which was attributed to inpatient costs). Vulval cancer accounted for the largest proportion; an estimated 60% of the total cost (£8.82 million). On average 4316 patients per year in England were admitted to hospital and 912 patients attended outpatient settings for pre-cancerous and invasive disease of the vagina and vulva. CONCLUSION The results indicate that vaginal and vulval cancer cost the English health care system over £14 million per year. Given the causal role of HPV in a proportion of these cancers, preventative measures such as the national HPV immunisation programme have the potential to reduce the economic burden. To ensure optimal use of NHS resources, it is important that future economic evaluations of such preventative measures consider the full burden of HPV related disease.
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Affiliation(s)
| | | | | | - Robin Crawford
- Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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14
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Luo Y, He H, Tang X, Wang S, Zhang J, Wu T, Chen Z. Cost-effectiveness of 2-dose human papillomavirus vaccination for 12-year-old girls in Zhejiang Province: implications for China's expanded program on immunization. Hum Vaccin Immunother 2020; 16:1623-1629. [PMID: 32186953 DOI: 10.1080/21645515.2019.1711299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The high cost and insufficient supply of HPV vaccines have substantially slowed their implementation in lower-income countries. This study aimed to assess the incremental cost-effectiveness of two doses of human papillomavirus (HPV) vaccination (bivalent 16/18 vaccine; 2vHPV) compared to a no-vaccination scenario and a three-dose scenario in one province in China. METHODS A static Markov model was used to model a lifetime cohort of 100,000 girls aged 12 years at the start of vaccination. A two-dose vaccination schedule was assumed to be non-inferior to a three-dose schedule in terms of vaccine efficacy, and both vaccination schemes were assumed to provide lifelong protection. Incremental costs, health effects and incremental cost-effectiveness ratios were used to measure the outcomes when comparing the different strategies. RESULTS Compared to no vaccination, the incremental cost-effectiveness ratio (Chinese yuan per quality-adjusted life year) of the two-dose vaccination strategy is 12,472, and the 2-dose strategy is calculated to be cost saving relative to the 3-dose vaccination strategy. CONCLUSIONS Introducing the 2vHPV vaccine would be highly cost effective at a per-dose vaccine price of CNY 500, which has implications for cervical cancer control in China and other resource-limited countries.
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Affiliation(s)
- Yan Luo
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University , Xiamen, China
| | - Hanqing He
- Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China
| | - Xuewen Tang
- Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China
| | - Shenyu Wang
- Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China
| | - Jun Zhang
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University , Xiamen, China
| | - Ting Wu
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University , Xiamen, China
| | - Zhiping Chen
- Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China
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15
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Canfell K, Kim JJ, Kulasingam S, Berkhof J, Barnabas R, Bogaards JA, Campos N, Jennett C, Sharma M, Simms KT, Smith MA, Velentzis LS, Brisson M, Jit M. HPV-FRAME: A consensus statement and quality framework for modelled evaluations of HPV-related cancer control. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2019; 8:100184. [PMID: 31505258 PMCID: PMC6804684 DOI: 10.1016/j.pvr.2019.100184] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 08/05/2019] [Accepted: 09/04/2019] [Indexed: 11/26/2022]
Abstract
Intense research activity in HPV modelling over this decade has prompted the development of additional guidelines to those for general modelling. A specific framework is required to address different policy questions and unique complexities of HPV modelling. HPV-FRAME is an initiative to develop a consensus statement and quality-based framework for epidemiologic and economic HPV models. Its development involved an established process. Reporting standards have been structured according to seven domains reflecting distinct policy questions in HPV and cancer prevention and categorised by relevance to a population or evaluation. Population-relevant domains are: 1) HPV vaccination in pre-adolescent and young adolescent individuals; 2) HPV vaccination in older individuals; 3) targeted vaccination in men who have sex with men; 4) considerations for individuals living with HIV and 5) considerations for low- and middle-income countries. Additional considerations applicable to specific evaluations are: 6) cervical screening or integrated cervical screening and HPV vaccination approaches and 7) alternative vaccine types and alternative dosing schedules. HPV-FRAME aims to promote the development of models in accordance with an explicit framework, to better enable target audiences to understand a model's strength and weaknesses in relation to a specific policy question and ultimately improve the model's contribution to informed decision-making.
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Affiliation(s)
- Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, 2011, NSW, Australia; School of Public Health, Sydney Medical School, University of Sydney, NSW, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
| | - Jane J Kim
- Department of Health Policy and Management and Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | | | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, Netherlands
| | - Ruanne Barnabas
- Department of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
| | - Johannes A Bogaards
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, Netherlands; Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Nicole Campos
- Department of Health Policy and Management and Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Chloe Jennett
- Cancer Research Division, Cancer Council NSW, Sydney, 2011, NSW, Australia
| | - Monisha Sharma
- Department of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
| | - Kate T Simms
- Cancer Research Division, Cancer Council NSW, Sydney, 2011, NSW, Australia
| | - Megan A Smith
- Cancer Research Division, Cancer Council NSW, Sydney, 2011, NSW, Australia; School of Public Health, Sydney Medical School, University of Sydney, NSW, Australia
| | - Louiza S Velentzis
- Cancer Research Division, Cancer Council NSW, Sydney, 2011, NSW, Australia; School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Marc Brisson
- Centre de Recherche du CHU de Québec, Université Laval, Axe santé des Populations et Pratiques Optimales en santé, Québec, Canada; Imperial College, Department of Infectious Disease Epidemiology, London, UK
| | - Mark Jit
- London School of Hygiene and Tropical Medicine, London, UK; Modelling and Economics Unit, Public Health England, London, UK
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16
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Silfverschiöld M, Sjövall J, Wennerberg J, Östensson E, Greiff L. Societal cost of oropharyngeal cancer by human papillomavirus status, cancer stage, and subsite. PLoS One 2019; 14:e0220534. [PMID: 31356646 PMCID: PMC6663066 DOI: 10.1371/journal.pone.0220534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/17/2019] [Indexed: 11/18/2022] Open
Abstract
Background The incidence of oropharyngeal cancer (OPC) is increasing, particularly human papillomavirus (HPV)-associated OPC. The aim of this study was to specify the total societal cost of OPC by HPV status, cancer stage, and subsite using a bottom-up cost-of-illness approach. Methods We analyzed 121 consecutive patients with OPC from the Southern Health Care Region of Sweden. We estimated the direct medical costs and indirect costs (e.g., disease-related morbidity and premature death) from 1 month prior to OPC diagnosis until 3 years after treatment completion. Results The mean total cost per patient was €103 386 for HPV-positive and €120 244 for HPV-negative OPC. Eighty-one percent of the patients analyzed were HPV-positive: Accordingly, HPV-positive OPC represented 79% of the total cost of OPC. The mean total cost of stage I, II, III, IVA, IVB, and IVC, regardless of HPV status, was €59 424, €57 000, €69 246, €115 770, €234 459, and €21 930, respectively, of which indirect costs were estimated at €22 493 (37.8%), €14 754 (25.9%), €28 681 (41.4%), €67 107 (58%), €166 280 (70.9%), and €0. Tonsillar cancer represented 64% of OPC, with a mean total cost of €117 512 per patient. Conclusion The societal cost of OPC is substantial. HPV-associated OPC comprises 79% of the total cost of this disease. The data presented in this study may be used in analytical models to aid decision makers in determining the potential value of gender-neutral HPV vaccination.
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Affiliation(s)
- Maria Silfverschiöld
- Department of Otorhinolaryngology, Head & Neck Surgery, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
- * E-mail:
| | - Johanna Sjövall
- Department of Otorhinolaryngology, Head & Neck Surgery, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Johan Wennerberg
- Department of Otorhinolaryngology, Head & Neck Surgery, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Ellinor Östensson
- Department of Medical Epidemiology & Biostatistics, Karolinska Institute, Stockholm, Sweden
- Department of Children’s & Women’s Health, Karolinska Hospital, Stockholm, Sweden
| | - Lennart Greiff
- Department of Otorhinolaryngology, Head & Neck Surgery, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
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17
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Datta S, Pink J, Medley GF, Petrou S, Staniszewska S, Underwood M, Sonnenberg P, Keeling MJ. Assessing the cost-effectiveness of HPV vaccination strategies for adolescent girls and boys in the UK. BMC Infect Dis 2019; 19:552. [PMID: 31234784 PMCID: PMC6591963 DOI: 10.1186/s12879-019-4108-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 05/17/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) is the most widespread sexually transmitted infection worldwide. It causes several health consequences, in particular accounting for the majority of cervical cancer cases in women. In the United Kingdom, a vaccination campaign targeting 12-year-old girls started in 2008; this campaign has been successful, with high uptake and reduced HPV prevalence observed in vaccinated cohorts. Recently, attention has focused on vaccinating both sexes, due to HPV-related diseases in males (particularly for high-risk men who have sex with men) and an equity argument over equalising levels of protection. METHODS We constructed an epidemiological model for HPV transmission in the UK, accounting for nine of the most common HPV strains. We complemented this with an economic model to determine the likely health outcomes (healthcare costs and quality-adjusted life years) for individuals from the epidemiological model. We then tested vaccination with the three HPV vaccines currently available, vaccinating either girls alone or both sexes. For each strategy we calculated the threshold price per vaccine dose, i.e. the maximum amount paid for the added health benefits of vaccination to be worth the cost of each vaccine dose. We calculated results at 3.5% discounting, and also 1.5%, to consider the long-term health effects of HPV infection. RESULTS At 3.5% discounting, continuing to vaccinate girls remains highly cost-effective compared to halting vaccination, with threshold dose prices of £56-£108. Vaccination of girls and boys is less cost-effective (£25-£53). Compared to vaccinating girls only, adding boys to the programme is not cost-effective, with negative threshold prices (-£6 to -£3) due to the costs of administration. All threshold prices increase when using 1.5% discounting, and adding boys becomes cost-effective (£36-£47). These results are contingent on the UK's high vaccine uptake; for lower uptake rates, adding boys (at the same uptake rate) becomes more cost effective. CONCLUSIONS Vaccinating girls is extremely cost-effective compared with no vaccination, vaccinating both sexes is less so. Adding boys to an already successful girls-only programme has a low cost-effectiveness, as males have high protection through herd immunity. If future health effects are weighted more heavily, threshold prices increase and vaccination becomes cost-effective.
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Affiliation(s)
- Samik Datta
- Zeeman Institute: SBIDER, Warwick Mathematics Institute and School of Life Sciences, The University of Warwick, Coventry, CV4 8UW, UK. .,National Institute of Water and Atmospheric Research, Wellington, 6021, New Zealand.
| | - Joshua Pink
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Coventry, CV4 8UW, UK
| | - Graham F Medley
- Department for Global Health and Development, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK
| | - Stavros Petrou
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Coventry, CV4 8UW, UK
| | - Sophie Staniszewska
- Royal College of Nursing Research Institute, Warwick Medical School, The University of Warwick, Coventry, CV4 8UW, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Coventry, CV4 8UW, UK
| | - Pam Sonnenberg
- Research Department of Infection and Population Health, University College London, London, WC1E 6JB, UK
| | - Matt J Keeling
- Zeeman Institute: SBIDER, Warwick Mathematics Institute and School of Life Sciences, The University of Warwick, Coventry, CV4 8UW, UK
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18
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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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19
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Woestenberg PJ, King AJ, van Benthem BHB, Donken R, Leussink S, van der Klis FRM, de Melker HE, van der Sande MAB, Hoebe CJPA, Bogaards JA. Bivalent Vaccine Effectiveness Against Type-Specific HPV Positivity: Evidence for Cross-Protection Against Oncogenic Types Among Dutch STI Clinic Visitors. J Infect Dis 2019; 217:213-222. [PMID: 29140439 PMCID: PMC5853250 DOI: 10.1093/infdis/jix582] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/06/2017] [Indexed: 01/11/2023] Open
Abstract
Background Observational postmarketing studies are important to assess vaccine effectiveness (VE). We estimated VE from the bivalent human papillomavirus (HPV) vaccine against HPV positivity of vaccine and nonvaccine types in a high-risk population. Methods We included all vaccine-eligible women from the PASSYON study, a biennial cross-sectional survey in Dutch sexually transmitted infection clinics. Vaginal swabs were analyzed using a polymerase chain reaction-based assay (SPF10-LiPA25) able to detect the 12 high-risk HPV (hrHPV) types 16/18/31/33/35/39/45/51/52/56/58/59. We compared hrHPV positivity between self-reported vaccinated (≥1 dose) and unvaccinated women, and estimated VE by a logistic mixed model. Results We included 1087 women of which 53% were hrHPV positive and 60% reported to be vaccinated. The adjusted pooled VE against HPV-16/18 was 89.9% (81.7%-94.4%). Moreover, we calculated significant VE against nonvaccine types HPV-45 (91%), HPV-35 (57%), HPV-31 (50%), and HPV-52 (37%). Among women who were offered vaccination 5/6 years ago, we estimated similar VE against HPV-16/18 (92%) and all hrHPV types (35%) compared to women who were offered vaccination <5 years ago (83% and 33%, respectively). Conclusion We demonstrated high VE of the bivalent vaccine against HPV-16/18 and cross-protection against HPV-45/35/31/52. Protection against HPV-16/18 was sustained up to 6 years postvaccination.
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Affiliation(s)
- Petra J Woestenberg
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Maastricht University Medical Center, Amsterdam, The Netherlands.,Care and Public Health Research Institute, Maastricht University Medical Center, Amsterdam, The Netherlands
| | - Audrey J King
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Maastricht University Medical Center, Amsterdam, The Netherlands
| | - Birgit H B van Benthem
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Maastricht University Medical Center, Amsterdam, The Netherlands
| | - Robine Donken
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Maastricht University Medical Center, Amsterdam, The Netherlands.,Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Suzan Leussink
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Maastricht University Medical Center, Amsterdam, The Netherlands
| | - Fiona R M van der Klis
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Maastricht University Medical Center, Amsterdam, The Netherlands
| | - Hester E de Melker
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Maastricht University Medical Center, Amsterdam, The Netherlands
| | - Marianne A B van der Sande
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Maastricht University Medical Center, Amsterdam, The Netherlands.,Julius Center, University Medical Center Utrecht, The Netherlands.,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Christian J P A Hoebe
- Care and Public Health Research Institute, Maastricht University Medical Center, Amsterdam, The Netherlands.,Department of Sexual Health, Infectious Diseases and Environment, South Limburg Public Health Service, Geleen
| | - Johannes A Bogaards
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Maastricht University Medical Center, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
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20
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Effect of Multiple Vaccinations with Tumor Cell-Based Vaccine with Codon-Modified GM-CSF on Tumor Growth in a Mouse Model. Cancers (Basel) 2019; 11:cancers11030368. [PMID: 30875953 PMCID: PMC6468346 DOI: 10.3390/cancers11030368] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/07/2019] [Accepted: 03/11/2019] [Indexed: 12/11/2022] Open
Abstract
Ectopic expression of codon-modified granulocyte-macrophage colony-stimulating factor (cGM-CSF) in TC-1 cells (TC-1/cGM-CSF), a model cell line for human papillomavirus (HPV)-infected cervical cancer cells, increased the expression level of GM-CSF and improved the efficacy of tumor cell-based vaccines in a cervical cancer mouse model. The number of vaccine doses required to induce a long-term immune response in a cervical cancer mouse model is poorly understood. Here, we investigated one, three, and five doses of the irradiated TC-1/cGM-CSF vaccine to determine which dose was effective in inducing a greater immune response and the suppression of tumors. Our findings showed that three doses of irradiated TC-1/cGM-CSF vaccine elicited slower tumor growth rates and enhanced survival rates compared with one dose or five doses of irradiated TC-1/cGM-CSF vaccine. Consistently, mice vaccinated with three doses of irradiated TC-1/cGM-CSF vaccine exhibited stronger interferon gamma (IFN-γ) production in HPV E7-specific CD8⁺ T cells and CD4⁺ T cells. A higher percentage of natural killer cells and interferon-producing killer dendritic cells (IKDCs) appeared in the splenocytes of the mice vaccinated with three doses of irradiated TC-1/cGM-CSF vaccine compared with those of the mice vaccinated with one dose or five doses of irradiated TC-1/cGM-CSF vaccine. Our findings demonstrate that single or multiple vaccinations, such as five doses, with irradiated TC-1/cGM-CSF vaccine suppressed the immune response, whereas three doses of irradiated TC-1/cGM-CSF vaccine elicited a greater immune response and subsequent tumor suppression.
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21
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Castañon A, Rebolj M, Sasieni P. Is a delay in the introduction of human papillomavirus-based cervical screening affordable? J Med Screen 2019; 26:44-49. [PMID: 30280637 PMCID: PMC6376595 DOI: 10.1177/0969141318800355] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 08/22/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE It often takes considerable time for sufficient evidence to accumulate to support implementation of new methods in routine screening. Where national screening programmes are already effective, switching to a more sensitive screening test may not be a priority. Although risk associated with overly rapid implementation exists, postponement is also associated with a (to date unquantified) missed opportunity to prevent deaths. This risk tends not to be addressed where effective screening methods are already in use. We here estimate the monetary value of a one-year delay in replacing cytology cervical screening with human papillomavirus testing. METHODS Using a previously validated model, we calculated the number of incident and fatal cervical cancers that would be diagnosed by 2030 in England, under the assumption that human papillomavirus testing replaces cytology in 2020 rather than 2019, and the monetary value of the quality-adjusted life years lost in preventable cases. RESULTS A one-year delay in the implementation of human papillomavirus screening would miss the opportunity to prevent 581 cases of cervical cancer, and lead to a loss of 1595 quality-adjusted life years (3.5% discount rate) with a monetary value of £32 million (at £20,000 per quality-adjusted life year). CONCLUSION This is a measurable loss and should be considered in prioritising decision-making in screening.
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Affiliation(s)
- Alejandra Castañon
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- King’s College London, School of Cancer & Pharmaceutical Sciences, Cancer Prevention Group, Innovation Hub, Guys Cancer Centre, Guys Hospital, Great Maze Pond, London, UK
| | - Matejka Rebolj
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- King’s College London, School of Cancer & Pharmaceutical Sciences, Cancer Prevention Group, Innovation Hub, Guys Cancer Centre, Guys Hospital, Great Maze Pond, London, UK
| | - Peter Sasieni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- King’s College London, School of Cancer & Pharmaceutical Sciences, Cancer Prevention Group, Innovation Hub, Guys Cancer Centre, Guys Hospital, Great Maze Pond, London, UK
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22
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Qendri V, Bogaards JA, Berkhof J. Pricing of HPV vaccines in European tender-based settings. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:271-280. [PMID: 30051152 PMCID: PMC6439217 DOI: 10.1007/s10198-018-0996-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/18/2018] [Indexed: 05/07/2023]
Abstract
BACKGROUND Vaccine price is one of the most influential parameters in economic evaluations of HPV vaccination programmes. Vaccine tendering is a cost-containment method widely used by national or regional health authorities, but information on tender-based HPV vaccine prices is scarce. METHODS Procurement notices and awards for the HPV vaccines, published from January 2007 until January 2018, were systematically retrieved from the online platform for public procurement in Europe. Information was collected from national or regional tenders organized for publicly funded preadolescent vaccination programmes against HPV. The influence of variables on the vaccine price was estimated by means of a mixed-effects model. FINDINGS Prices were collected from 178 procurements announced in 15 European countries. The average price per dose for the first-generation HPV vaccines decreased from €101.8 (95% CI 91.3-114) in 2007 to €28.4 (22.6-33.5) in 2017, whereas the average dose price of the 9-valent vaccine in 2016-2017 was €49.1 (38.0-66.8). Unit prices were, respectively, €7.5 (4.4-10.6) and €34.4 (27.4-41.4) higher for the 4-valent and 9-valent vaccines than for the 2-valent vaccine. Contract volume and duration, level of procurement (region or country), per capita GDP and number of offers received had a significant effect on vaccine price. INTERPRETATION HPV vaccine procurement is widely used across Europe. The fourfold decrease in the average tender-based prices compared to list prices confirms the potential of tendering as an efficient cost-containment strategy, thereby expanding the indications for cost-effective HPV vaccination to previously ineligible target groups.
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Affiliation(s)
- Venetia Qendri
- Department of Epidemiology and Biostatistics, VU University Medical Center, PO Box 7057, MF F-wing ST, 1007 MB, Amsterdam, The Netherlands.
| | - Johannes A Bogaards
- Department of Epidemiology and Biostatistics, VU University Medical Center, PO Box 7057, MF F-wing ST, 1007 MB, Amsterdam, The Netherlands
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, VU University Medical Center, PO Box 7057, MF F-wing ST, 1007 MB, Amsterdam, The Netherlands
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23
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Murray ML, Meadows J, Doré CJ, Copas AJ, Haddow LJ, Lacey C, Jit M, Soldan K, Bennett K, Tetlow M, Nathan M, Gilson R. Human papillomavirus infection: protocol for a randomised controlled trial of imiquimod cream (5%) versus podophyllotoxin cream (0.15%), in combination with quadrivalent human papillomavirus or control vaccination in the treatment and prevention of recurrence of anogenital warts (HIPvac trial). BMC Med Res Methodol 2018; 18:125. [PMID: 30400777 PMCID: PMC6220496 DOI: 10.1186/s12874-018-0581-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 10/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anogenital warts are the second most common sexually transmitted infection diagnosed in sexual health services in England. About 90% of genital warts are caused by human papillomavirus (HPV) types 6 or 11, and half of episodes diagnosed are recurrences. The best and most cost-effective treatment for patients with anogenital warts is unknown. The commonly used treatments are self-administered topical agents, podophyllotoxin (0.15% cream) or imiquimod (5% cream), or cryotherapy with liquid nitrogen. Quadrivalent HPV (qHPV) vaccination is effective in preventing infection, and disease, but whether it has any therapeutic effect is not known. METHODS AND DESIGN To investigate the efficacy of clearance and prevention of recurrence of external anogenital warts by topical treatments, podophyllotoxin 0.15% cream or imiquimod 5% cream, in combination with a three-dose regimen of qHPV or control vaccination. 500 adult patients presenting with external anogenital warts with either a first or subsequent episode of anogenital warts will be entered into this randomised, controlled partially blinded 2 × 2 factorial trial. DISCUSSION The trial is expected to provide the first high-quality evidence of the comparative efficacy and cost-effectiveness of the two topical treatments in current use, as well as investigate the potential benefit of HPV vaccination, in the management of anogenital warts. TRIAL REGISTRATION The trial was registered prior to starting recruitment under the following reference numbers: International Standard Randomized Controlled Trial Number (ISRCTN) Registry - ISRCTN32729817 (registered 25 July 2014); European Union Clinical Trials Register (EudraCT) - 2013-002951-14 (registered 26 June 2013).
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Affiliation(s)
- Macey L Murray
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, Gower Street, London, WC1E 6BT, UK
| | - Jade Meadows
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, Gower Street, London, WC1E 6BT, UK
| | - Caroline J Doré
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, Gower Street, London, WC1E 6BT, UK
| | - Andrew J Copas
- UCL Centre for Clinical Research in Infection and Sexual Health, The Mortimer Market Centre, Institute for Global Health, University College London, London, WC1E 6JB, UK
| | - Lewis J Haddow
- UCL Centre for Clinical Research in Infection and Sexual Health, The Mortimer Market Centre, Institute for Global Health, University College London, London, WC1E 6JB, UK
| | - Charles Lacey
- Centre for Immunology and Infection, Hull York Medical School, University of York, York, YO10 5DD, UK
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.,Public Health England, London, NW9 5EQ, UK
| | | | - Kate Bennett
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, Gower Street, London, WC1E 6BT, UK
| | - Michelle Tetlow
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, Gower Street, London, WC1E 6BT, UK
| | - Mayura Nathan
- Homerton Anal Neoplasia Service, Homerton University Hospital NHS Foundation Trust, London, E9 6SR, UK
| | - Richard Gilson
- UCL Centre for Clinical Research in Infection and Sexual Health, The Mortimer Market Centre, Institute for Global Health, University College London, London, WC1E 6JB, UK.
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24
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Chesson HW, Meites E, Ekwueme DU, Saraiya M, Markowitz LE. Cost-effectiveness of nonavalent HPV vaccination among males aged 22 through 26 years in the United States. Vaccine 2018; 36:4362-4368. [PMID: 29887325 DOI: 10.1016/j.vaccine.2018.04.071] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/02/2018] [Accepted: 04/23/2018] [Indexed: 01/06/2023]
Abstract
INTRODUCTION In the United States, routine human papillomavirus (HPV) vaccination is recommended for females and males at age 11 or 12 years; the series can be started at age 9 years. Vaccination is also recommended for females through age 26 years and males through age 21 years. The objective of this study was to assess the health impact and cost-effectiveness of harmonizing female and male vaccination recommendations by increasing the upper recommended catch-up age of HPV vaccination for males from age 21 to age 26 years. METHODS We updated a published model of the health impact and cost-effectiveness of 9-valent human papillomavirus vaccine (9vHPV). We examined the cost-effectiveness of (1) 9vHPV for females aged 12 through 26 years and males aged 12 through 21 years, and (2) an expanded program including males through age 26 years. RESULTS Compared to no vaccination, providing 9vHPV for females aged 12 through 26 years and males aged 12 through 21 years cost an estimated $16,600 (in 2016 U.S. dollars) per quality-adjusted life year (QALY) gained. The estimated cost per QALY gained by expanding male vaccination through age 26 years was $228,800 and ranged from $137,900 to $367,300 in multi-way sensitivity analyses. CONCLUSIONS The cost-effectiveness ratios we estimated are not so favorable as to make a strong economic case for recommending expanding male vaccination, yet are not so unfavorable as to preclude consideration of expanding male vaccination. The wide range of plausible results we obtained may underestimate the true degree of uncertainty, due to model limitations. For example, the cost per QALY might be less than our lower bound estimate of $137,900 had our model allowed for vaccine protection against re-infection. Models that specifically incorporate men who have sex with men (MSM) are needed to provide a more comprehensive assessment of male HPV vaccination strategies.
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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.
| | - Elissa Meites
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, 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
| | - Lauri E Markowitz
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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25
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Choi HCW, Jit M, Leung GM, Tsui KL, Wu JT. Simultaneously characterizing the comparative economics of routine female adolescent nonavalent human papillomavirus (HPV) vaccination and assortativity of sexual mixing in Hong Kong Chinese: a modeling analysis. BMC Med 2018; 16:127. [PMID: 30115065 PMCID: PMC6097427 DOI: 10.1186/s12916-018-1118-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/04/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Although routine vaccination of females before sexual debut against human papillomavirus (HPV) has been found to be cost-effective around the world, its cost-benefit has rarely been examined. We evaluate both the cost-effectiveness and cost-benefit of routine female adolescent nonavalent HPV vaccination in Hong Kong to guide its policy, and by extension that of mainland China, on HPV vaccination. One major obstacle is the lack of data on assortativity of sexual mixing. Such difficulty could be overcome by inferring sexual mixing parameters from HPV epidemiologic data. METHODS We use an age-structured transmission model coupled with stochastic individual-based simulations to estimate the health and economic impact of routine nonavalent HPV vaccination for girls at age 12 on cervical cancer burden and consider vaccine uptake at 25%, 50%, and 75% with at least 20 years of vaccine protection. Bayesian inference was employed to parameterize the model using local data on HPV prevalence and cervical cancer incidence. We use the human capital approach in the cost-benefit analysis (CBA) and GDP per capita as the indicative willingness-to-pay threshold in the cost-effectiveness analysis (CEA). Finally, we estimate the threshold vaccine cost (TVC), which is the maximum cost for fully vaccinating one girl at which routine female adolescent nonavalent HPV vaccination is cost-beneficial or cost-effective. RESULTS As vaccine uptake increased, TVC decreased (i.e., economically more stringent) in the CBA but increased in the CEA. When vaccine uptake was 75% and the vaccine provided only 20 years of protection, the TVC was US$444 ($373-506) and $689 ($646-734) in the CBA and CEA, respectively, increasing by approximately 2-4% if vaccine protection was assumed lifelong. TVC is likely to be far higher when non-cervical diseases are included. The inferred sexual mixing parameters suggest that sexual mixing in Hong Kong is highly assortative by both age and sexual activity level. CONCLUSIONS Routine HPV vaccination of 12-year-old females is highly likely to be cost-beneficial and cost-effective in Hong Kong. Inference of sexual mixing parameters from epidemiologic data of prevalent sexually transmitted diseases (i.e., HPV, chlamydia, etc.) is a potentially fruitful but largely untapped methodology for understanding sexual behaviors in the population.
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Affiliation(s)
- Horace C W Choi
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F North Wing, Patrick Manson Building, 7 Sassoon Road, Pok Fu Lam, Hong Kong.,Department of Systems Engineering and Engineering Management, City University of Hong Kong, Kowloon Tong, Hong Kong.,Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Mark Jit
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F North Wing, Patrick Manson Building, 7 Sassoon Road, Pok Fu Lam, Hong Kong.,Modelling and Economics Unit, Public Health England, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Gabriel M Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F North Wing, Patrick Manson Building, 7 Sassoon Road, Pok Fu Lam, Hong Kong
| | - Kwok-Leung Tsui
- Department of Systems Engineering and Engineering Management, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Joseph T Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F North Wing, Patrick Manson Building, 7 Sassoon Road, Pok Fu Lam, Hong Kong.
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26
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Haeussler K, den Hout AV, Baio G. A dynamic Bayesian Markov model for health economic evaluations of interventions in infectious disease. BMC Med Res Methodol 2018; 18:82. [PMID: 30068316 PMCID: PMC6090931 DOI: 10.1186/s12874-018-0541-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 07/12/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Health economic evaluations of interventions in infectious disease are commonly based on the predictions of ordinary differential equation (ODE) systems or Markov models (MMs). Standard MMs are static, whereas ODE systems are usually dynamic and account for herd immunity which is crucial to prevent overestimation of infection prevalence. Complex ODE systems including distributions on model parameters are computationally intensive. Thus, mainly ODE-based models including fixed parameter values are presented in the literature. These do not account for parameter uncertainty. As a consequence, probabilistic sensitivity analysis (PSA), a crucial component of health economic evaluations, cannot be conducted straightforwardly. METHODS We present a dynamic MM under a Bayesian framework. We extend a static MM by incorporating the force of infection into the state allocation algorithm. The corresponding output is based on dynamic changes in prevalence and thus accounts for herd immunity. In contrast to deterministic ODE-based models, PSA can be conducted straightforwardly. We introduce a case study of a fictional sexually transmitted infection and compare our dynamic Bayesian MM to a deterministic and a Bayesian ODE system. The models are calibrated to simulated time series data. RESULTS By means of the case study, we show that our methodology produces outcome which is comparable to the "gold standard" of the Bayesian ODE system. CONCLUSIONS In contrast to ODE systems in the literature, the dynamic MM includes distributions on all model parameters at manageable computational effort (including calibration). The run time of the Bayesian ODE system is 15 times longer.
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Affiliation(s)
- Katrin Haeussler
- University College London, Department of Statistical Science, Torrington Place, London, WC1E 7JE UK
- ICON plc Clinical Research Organisation, Konrad-Zuse-Platz 11, München, 81829 Germany
| | - Ardo van den Hout
- University College London, Department of Statistical Science, Torrington Place, London, WC1E 7JE UK
| | - Gianluca Baio
- University College London, Department of Statistical Science, Torrington Place, London, WC1E 7JE UK
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27
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Van Kriekinge G, Sohn WY, Aljunid SM, Soon R, Yong CM, Chen J, Lee IH. Comparative Cost-Effectiveness Analysis of Two Different Two-Dose Human Papillomavirus Vaccines in Malaysia. Asian Pac J Cancer Prev 2018; 19:933-940. [PMID: 29693347 PMCID: PMC6031794 DOI: 10.22034/apjcp.2018.19.4.933] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose: To comparatively evaluate the results of a 2-dose human papillomavirus (HPV) vaccination programme with the AS04-adjuvanted HPV16/18 vaccine (AS04-HPV-16/18v) or HPV-6/11/16/18 vaccine (4vHPVv), in addition to cervical cancer (CC) screening, in Malaysia. Methods: A lifetime Markov model replicating the natural history of HPV in 13-year-old girls was adapted to Malaysia to assess the impact of vaccination on pre-cancerous lesions, genital warts and CC cases, CC deaths, quality-adjusted life years (QALYs), and costs from the perspective of the Malaysian Ministry of Health. Vaccine effectiveness was based on efficacy and HPV type distribution. Both vaccines were assumed to have equal efficacy against vaccine-type HPV but differed for protection against non-vaccine types. Vaccine price parity was used and health and cost outcomes were discounted at 3%/annum. Sensitivity analyses tested the robustness of the results. Results: The model predicted that AS04-HPV-16/18v would result in 361 fewer CC cases and 115 fewer CC deaths than 4vHPVv, whereas 4vHPVv averted 4,241 cases of genital warts over the cohort’s lifetime. Discounted total costs showed savings of 18.50 million Malaysian Ringgits and 246 QALYs in favour of AS04-HPV-16/18v. In one-way sensitivity analyses, the discount rate was the most influential variable for costs and QALYs, but AS04-HPV-16/18v remained dominant throughout. A two-way sensitivity analysis to assess the longevity of cross-protection for both vaccines confirmed the base-case. Conclusions: In Malaysia, the use of AS04-HPV-16/18v, in addition to screening, was modelled to be dominant over 4vHPVv, with greater estimated CC benefits and lower costs.
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28
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Cordeiro MN, De Lima RDCP, Paolini F, Melo ARDS, Campos APF, Venuti A, De Freitas AC. Current research into novel therapeutic vaccines against cervical cancer. Expert Rev Anticancer Ther 2018; 18:365-376. [DOI: 10.1080/14737140.2018.1445527] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Marcelo Nazário Cordeiro
- Laboratório de Estudos Moleculares e Terapia Experimental – LEMTE, Brazil Universidade Federal de Pernambuco – UFPE, Brazil
| | - Rita de Cássia Pereira De Lima
- Laboratório de Estudos Moleculares e Terapia Experimental – LEMTE, Brazil Universidade Federal de Pernambuco – UFPE, Brazil
| | - Francesca Paolini
- HPV-Unit UOSD Immunology and Tumor Immunotherapy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alanne Rayssa da Silva Melo
- Laboratório de Estudos Moleculares e Terapia Experimental – LEMTE, Brazil Universidade Federal de Pernambuco – UFPE, Brazil
| | - Ana Paula Ferreira Campos
- Laboratório de Estudos Moleculares e Terapia Experimental – LEMTE, Brazil Universidade Federal de Pernambuco – UFPE, Brazil
| | - Aldo Venuti
- HPV-Unit UOSD Immunology and Tumor Immunotherapy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Antonio Carlos De Freitas
- Laboratório de Estudos Moleculares e Terapia Experimental – LEMTE, Brazil Universidade Federal de Pernambuco – UFPE, Brazil
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29
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Castanon A, Landy R, Pesola F, Windridge P, Sasieni P. Prediction of cervical cancer incidence in England, UK, up to 2040, under four scenarios: a modelling study. Lancet Public Health 2018; 3:e34-e43. [PMID: 29307386 PMCID: PMC5765529 DOI: 10.1016/s2468-2667(17)30222-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/07/2017] [Accepted: 11/09/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND In the next 25 years, the epidemiology of cervical cancer in England, UK, will change: human papillomavirus (HPV) screening will be the primary test for cervical cancer. Additionally, the proportion of women screened regularly is decreasing and women who received the HPV vaccine are due to attend screening for the first time. Therefore, we aimed to estimate how vaccination against HPV, changes to the screening test, and falling screening coverage will affect cervical cancer incidence in England up to 2040. METHODS We did a data modelling study that combined results from population modelling of incidence trends, observable data from the individual level with use of a generalised linear model, and microsimulation of unobservable disease states. We estimated age-specific absolute risks of cervical cancer in the absence of screening (derived from individual level data). We used an age period cohort model to estimate birth cohort effects. We multiplied the absolute risks by the age cohort effects to provide absolute risks of cervical cancer for unscreened women in different birth cohorts. We obtained relative risks (RRs) of cervical cancer by screening history (never screened, regularly screened, or lapsed attender) using data from a population-based case-control study for unvaccinated women, and using a microsimulation model for vaccinated women. RRs of primary HPV screening were relative to cytology. We used the proportion of women in each 5-year age group (25-29 years to 75-79 years) and 5-year period (2016-20 to 2036-40) who have a combination of screening and vaccination history, and weighted to estimate the population incidence. The primary outcome was the number of cases and rates per 100 000 women under four scenarios: no changes to current screening coverage or vaccine uptake and HPV primary testing from 2019 (status quo), changing the year in which HPV primary testing is introduced, introduction of the nine-valent vaccine, and changes to cervical screening coverage. FINDINGS The status quo scenario estimated that the peak age of cancer diagnosis will shift from the ages of 25-29 years in 2011-15 to 55-59 years in 2036-40. Unvaccinated women born between 1975 and 1990 were predicted to have a relatively high risk of cervical cancer throughout their lives. Introduction of primary HPV screening from 2019 could reduce age-standardised rates of cervical cancer at ages 25-64 years by 19%, from 15·1 in 2016 to 12·2 per 100 000 women as soon as 2028. Vaccination against HPV types 16 and 18 (HPV 16/18) could see cervical cancer rates in women aged 25-29 years decrease by 55% (from 20·9 in 2011-15 to 9·5 per 100 000 women by 2036-40), and introduction of nine-valent vaccination from 2019 compared with continuing vaccination against HPV 16/18 will reduce rates by a further 36% (from 9·5 to 6·1 per 100 000 women) by 2036-40. Women born before 1991 will not benefit directly from vaccination; therefore, despite vaccination and primary HPV screening with current screening coverage, European age-standardised rates of cervical cancer at ages 25-79 years will decrease by only 10% (from 12·8 in 2011-15 to 11·5 per 100 000 women in 2036-40). If screening coverage fell to 50%, European age-standardised rates could increase by 27% (from 12·8 to 16·3 per 100 000 by 2036-40). INTERPRETATION Going forward, focus should be placed on scenarios that offer less intensive screening for vaccinated women and more on increasing coverage and incorporation of new technologies to enhance current cervical screening among unvaccinated women. FUNDING Jo's Cervical Cancer Trust and Cancer Research UK.
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Affiliation(s)
- Alejandra Castanon
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
| | - Rebecca Landy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Francesca Pesola
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Peter Windridge
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Peter Sasieni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK; Bermondsey Wing, Guy's and St Thomas', Kings College London, London, UK
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30
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Keeping ST, Tempest MJ, Stephens SJ, Carroll SM, Simcock R, Jones TM, Shaw R. The cost of oropharyngeal cancer in England: A retrospective hospital data analysis. Clin Otolaryngol 2017; 43:223-229. [PMID: 28734109 DOI: 10.1111/coa.12944] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To estimate the total costs of treating head and neck cancers, specifically oropharyngeal, laryngeal and oral cavity cancer, in secondary care facilities in England during the period 2006/2007 to 2010/2011. DESIGN Patient records were extracted from an English hospital database to estimate the number of patients treated for oropharyngeal, laryngeal and oral cavity cancer in England. Identified resource use was linked to published United Kingdom cost estimates to quantify the reimbursement of treatment through the Payment by Results system. SETTING Retrospective hospital data analysis. PARTICIPANTS From the hospital data, patient records of patients treated for oropharyngeal, laryngeal and oral cavity cancer were selected. MAIN OUTCOME MEASURES Annual total costs of treatment, stratified by inpatient and outpatient setting and by male and female patients. RESULTS From 2006/2007 to 2010/2011, total costs of treatment across the three head and neck cancer sites were estimated to be approximately £309 million, with 90% attributable to inpatient care (bundled costs). Oropharyngeal cancer accounted for 37% of total costs. Costs and patient numbers increased over time, largely due to a rise in oropharyngeal cancer, where total costs increased from £17.21 million to £30.32 million, with over 1400 (52%) more inpatients treated in 2010/11 compared to 2006/07. CONCLUSIONS In 4 years, the number of patients with oropharyngeal cancer receiving some form of inpatient care increased by more than half, and associated costs increased by three quarters. This reinforces the case for prevention and early detection strategies to help contain this epidemiological and economic burden.
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Affiliation(s)
- S T Keeping
- Sanofi Pasteur MSD, Mallards Reach, Maidenhead, UK
| | | | | | - S M Carroll
- Sanofi Pasteur MSD, Mallards Reach, Maidenhead, UK
| | - R Simcock
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - T M Jones
- University of Liverpool, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - R Shaw
- University of Liverpool, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
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Setiawan D, Oktora MP, Hutubessy R, Riewpaiboon A, Postma MJ. The health-economic studies of HPV vaccination in Southeast Asian countries: a systematic review. Expert Rev Vaccines 2017; 16:933-943. [PMID: 28730914 DOI: 10.1080/14760584.2017.1357472] [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: 12/21/2022]
Abstract
INTRODUCTION The cervical cancer-related burden is an important problem in Southeast Asian (SEA) countries. However, only 3 out of 11 countries implement the comprehensive prevention program. Areas covered: This is a retrospective review from all relevant studies until 2015 from two main databases, MEDLINE/Pubmed and Embase in order to provide an evidence on the health economics of HPV vaccination in the region. Expert commentary: The implementation of HPV vaccination will generate substantial health and economic benefit in SEA countries since the number of cervical cancer cases in this region are generally high. Therefore, a clear recommendation on how HPV vaccination should be implemented in a country, for example on how many doses will be used, how much cost is required or is it a school based- or clinical based-delivery, is critically required.
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Affiliation(s)
- Didik Setiawan
- a PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy , University of Groningen , Groningen , The Netherlands.,b Faculty of Pharmacy , Universitas Muhammadiyah Purwokerto , Purwokerto , Indonesia
| | - Monika Puri Oktora
- a PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy , University of Groningen , Groningen , The Netherlands
| | - Raymond Hutubessy
- c Initiative for Vaccine Research , World Health Organization , Geneva , Switzerland
| | - Arthorn Riewpaiboon
- d Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy , Mahidol University , Thailand
| | - Maarten J Postma
- a PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy , University of Groningen , Groningen , The Netherlands.,e Institute of Science in Healthy Aging & healthcaRE (SHARE) , University Medical Center Groningen (UMCG) , Groningen , The Netherlands
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Mennini FS, Bonanni P, Bianic F, de Waure C, Baio G, Plazzotta G, Uhart M, Rinaldi A, Largeron N. Cost-effectiveness analysis of the nine-valent HPV vaccine in Italy. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2017; 15:11. [PMID: 28701899 PMCID: PMC5504713 DOI: 10.1186/s12962-017-0073-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 06/29/2017] [Indexed: 12/04/2022] Open
Abstract
Background In Italy HPV vaccination with the quadrivalent vaccine (Gardasil®) is offered actively and free of charge to girls aged 12 since 2007. A nine-valent vaccine (Gardasil 9®) received the European market authorization in 2015 to protect, with only 2 doses, against around 90% of all HPV positive cancers, over 80% of high-grade precancerous lesions and 90% of genital warts caused by HPV types 6/11. Methods A dynamic transmission model simulating the natural history of HPV-infections was calibrated to the Italian setting and used to estimate costs and QALYs associated with vaccination strategies. The analyses compared two strategies with the nine-valent vaccine (cervical cancer screening and vaccination in girls only or vaccination in boys and girls) to four alternative strategies (cervical cancer screening and vaccination with quadrialent vaccine in girls only, in both boys and girls, with bivalent vaccine in girls and screening strategy only). The National Health Service perspective was considered. Conclusion The switch to the nine-valent vaccine in Italy can further reduce the burden associated to cervical cancer and HPV-related diseases and is highly cost-effective. Results Compared to the current vaccination program with quadrivalent vaccine, the nine-valent vaccine in a programme including girls and boys shows further reductions of 17% in the incidence of cervical cancer, 35 and 14% in anal cancer for males and females, as well as over a million cases of genital warts avoided after 100 years. The new technology is associated with an ICER of 10,463€ per QALY gained in universal vaccination, decreasing to 4483€ when considering the vaccine switch for girls-only. Electronic supplementary material The online version of this article (doi:10.1186/s12962-017-0073-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Francesco Saverio Mennini
- Faculty of Economics, Centre for Economic and International Studies (CEIS)-Economic Evaluation and HTA (EEHTA), University of Rome, Rome, Italy.,Institute for Leadership and Management in Health, Kingston University, London, UK
| | - Paolo Bonanni
- Dept. of Health Sciences, University of Florence, Florence, Italy
| | | | - Chiara de Waure
- Institute of Public Health, Section of Hygiene, Catholic University of the Sacred Heart, Rome, Italy
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Suijkerbuijk AWM, Donken R, Lugnér AK, de Wit GA, Meijer CJLM, de Melker HE, Bogaards JA. The whole story: a systematic review of economic evaluations of HPV vaccination including non-cervical HPV-associated diseases. Expert Rev Vaccines 2016; 16:361-375. [PMID: 27807989 DOI: 10.1080/14760584.2017.1256778] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Many economic evaluations of HPV vaccination have been published, but most have focused on the prevention of cervical disease as a primary health outcome. The cost-effectiveness of vaccination is likely to be underestimated if not all HPV-associated diseases are taken into account. In this review, we assess the influence of non-cervical HPV-associated diseases on the incremental cost-effectiveness ratio (ICER) of preadolescent HPV vaccination. Areas covered: We systematically searched the literature and identified 18 studies that included non-cervical diseases in the estimates of cost-effectiveness of HPV-vaccination. When taking other HPV-related diseases into account compared to not including such other diseases, the mean ICERs were 2.85 times more favorable for girls only vaccination and 3.89 times for gender neutral vaccination. Expert commentary: Including non-cervical diseases in economic evaluations of HPV vaccination programs makes it more likely that the ICER falls beneath accepted cost-effectiveness thresholds and therefore increases the scope for gender neutral vaccination.
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Affiliation(s)
- Anita W M Suijkerbuijk
- a Center for Nutrition, Prevention and Health Services , National Institute for Public Health and the Environment (RIVM) , Bilthoven , The Netherlands
| | - Robine Donken
- b Center for Epidemiology and Surveillance , National Institute for Public Health and the Environment (RIVM) , Bilthoven , The Netherlands.,c Department of Pathology , VU University Medical Centre (VUmc) , Amsterdam , The Netherlands
| | - Anna K Lugnér
- b Center for Epidemiology and Surveillance , National Institute for Public Health and the Environment (RIVM) , Bilthoven , The Netherlands
| | - G Ardine de Wit
- a Center for Nutrition, Prevention and Health Services , National Institute for Public Health and the Environment (RIVM) , Bilthoven , The Netherlands.,d Julius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Chris J L M Meijer
- c Department of Pathology , VU University Medical Centre (VUmc) , Amsterdam , The Netherlands
| | - Hester E de Melker
- b Center for Epidemiology and Surveillance , National Institute for Public Health and the Environment (RIVM) , Bilthoven , The Netherlands
| | - Johannes A Bogaards
- b Center for Epidemiology and Surveillance , National Institute for Public Health and the Environment (RIVM) , Bilthoven , The Netherlands
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Skinner SR, Apter D, De Carvalho N, Harper DM, Konno R, Paavonen J, Romanowski B, Roteli-Martins C, Burlet N, Mihalyi A, Struyf F. Human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine for the prevention of cervical cancer and HPV-related diseases. Expert Rev Vaccines 2016; 15:367-87. [PMID: 26902666 DOI: 10.1586/14760584.2016.1124763] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Vaccines are available against human papillomavirus (HPV), the causal agent of cervical and other cancers. Efficacy data from the HPV-16/18 AS04-adjuvanted vaccine clinical trial program were reviewed. Six randomized, controlled phase II/III trials evaluating cervical endpoints enrolled women from diverse populations and geographical locations. The program analyzed extensively the cohorts most relevant from a public health perspective: the total vaccinated cohort (TVC), approximating a general population including those with existing or previous HPV infection, and TVC-naïve, approximating a population of young women before sexual debut. Results show that the vaccine reduces HPV-16/18 infection and associated cervical endpoints in women regardless of age, location, or sexual experience. It provides cross-protection against some non-vaccine oncogenic HPV types and types causing genital warts, and may be effective against vulvar, oral, and anal HPV infection. Early epidemiology data following its introduction suggest a decline in the prevalence of vaccine and some non-vaccine HPV types.
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Affiliation(s)
- S Rachel Skinner
- a Sydney University Discipline of Paediatrics and Child Health , The Children's Hospital at Westmead , Sydney , NSW , Australia.,b Vaccine Trials Group, Telethon Kids Institute , University of Western Australia , Perth , Australia
| | - Dan Apter
- c Family Federation of Finland , Sexual Health Clinic , Helsinki , Finland
| | - Newton De Carvalho
- d Department of Gynecology and Obstetrics, Gynecology and Obstetrics Infectious Diseases Sector , University of Parana , Curitiba , Parana , Brazil
| | - Diane M Harper
- e Department of Obstetrics and Gynecology, Geisel School of Medicine at Dartmouth , Hanover , NH , USA.,f Department of Family and Geriatric Medicine, University of Louisville School of Medicine , Louisville , KY , USA
| | - Ryo Konno
- g Department of Obstetrics and Gynaecology , Jichi Medical University Saitama Medical Center , Saitama , Japan
| | - Jorma Paavonen
- h Department of Obstetrics and Gynaecology , University of Helsinki , Helsinki , Finland
| | - Barbara Romanowski
- i Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry , University of Alberta , Edmonton , AB , Canada
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Summary and Recommendations from the National Institute of Allergy and Infectious Diseases (NIAID) Workshop "Gonorrhea Vaccines: the Way Forward". CLINICAL AND VACCINE IMMUNOLOGY : CVI 2016; 23:656-63. [PMID: 27335384 DOI: 10.1128/cvi.00230-16] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED There is an urgent need for the development of an antigonococcal vaccine due to the increasing drug resistance found in this pathogen. The U.S. Centers for Disease Control (CDC) have identified multidrug-resistant gonococci (GC) as among 3 "urgent" hazard-level threats to the U.S. POPULATION In light of this, on 29 to 30 June 2015, the National Institute for Allergy and Infectious Diseases (NIAID) sponsored a workshop entitled "Gonorrhea Vaccines: the Way Forward." The goal of the workshop was to gather leaders in the field to discuss several key questions on the current status of gonorrhea vaccine research and the path forward to a licensed gonorrhea vaccine. Representatives from academia, industry, U.S. Government agencies, and a state health department were in attendance. This review summarizes each of the 4 scientific sessions and a series of 4 breakout sessions that occurred during the one and a half days of the workshop. Topics raised as high priority for future development included (i) reinvigoration of basic research to understand gonococcal infection and immunity to allow intervention in processes essential for infection; (ii) clinical infection studies to establish parallels and distinctions between in vitro and animal infection models versus natural human genital and pharyngeal infection and to inform in silico modeling of vaccine impact; and (iii) development of an integrated pipeline for preclinical and early clinical evaluation and direct comparisons of potential vaccine antigens and adjuvants and routes of delivery.
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Brotherton JML, Jit M, Gravitt PE, Brisson M, Kreimer AR, Pai SI, Fakhry C, Monsonego J, Franceschi S. Eurogin Roadmap 2015: How has HPV knowledge changed our practice: Vaccines. Int J Cancer 2016; 139:510-7. [PMID: 26916230 PMCID: PMC7388730 DOI: 10.1002/ijc.30063] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 02/02/2016] [Accepted: 02/11/2016] [Indexed: 12/18/2022]
Abstract
This review is one of two complementary reviews that have been prepared in the framework of the Eurogin Roadmap 2015 to evaluate how knowledge about HPV is changing practices in HPV infection and disease control through vaccination and screening. In this review of HPV vaccine knowledge, we present the most significant findings of the past year which have contributed to our knowledge of the two HPV prophylactic vaccines currently in widespread use and about the recently licensed nonavalent HPV vaccine. Whereas anal cancer is dealt with in the companion mini-review on screening, we also review here the rapidly evolving evidence regarding HPV-associated head and neck cancer and priority research areas.
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Affiliation(s)
- Julia M L Brotherton
- National HPV Vaccination Program Register, VCS Registries, East Melbourne, Vic, Australia
- School of Population and Global Health, University of Melbourne, Vic, Australia
| | - Mark Jit
- Modelling and Economics Unit, Public Health England, London, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Patti E Gravitt
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Marc Brisson
- Département de Médecine Sociale et Préventive, Université Laval, Québec, QC, Canada
| | - Aimée R Kreimer
- Infections & Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD
| | - Sara I Pai
- Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Carole Fakhry
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine, Johns Hopkins Outpatient Center, Baltimore, MD
| | | | - Silvia Franceschi
- International Agency for Research on Cancer, 69372 Lyon cedex 08, France
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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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Jit M, Hutubessy R. Methodological Challenges to Economic Evaluations of Vaccines: Is a Common Approach Still Possible? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2016; 14:245-52. [PMID: 26832145 PMCID: PMC4871927 DOI: 10.1007/s40258-016-0224-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Economic evaluation of vaccination is a key tool to inform effective spending on vaccines. However, many evaluations have been criticised for failing to capture features of vaccines which are relevant to decision makers. These include broader societal benefits (such as improved educational achievement, economic growth and political stability), reduced health disparities, medical innovation, reduced hospital beds pressures, greater peace of mind and synergies in economic benefits with non-vaccine interventions. Also, the fiscal implications of vaccination programmes are not always made explicit. Alternative methodological frameworks have been proposed to better capture these benefits. However, any broadening of the methodology for economic evaluation must also involve evaluations of non-vaccine interventions, and hence may not always benefit vaccines given a fixed health-care budget. The scope of an economic evaluation must consider the budget from which vaccines are funded, and the decision-maker's stated aims for that spending to achieve.
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Affiliation(s)
- Mark Jit
- Modelling and Economics Unit, Public Health England, 61 Colindale Avenue, London, NW9 6BT, UK.
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Raymond Hutubessy
- Initiative for Vaccine Research, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland
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Gibson E, Begum N, Sigmundsson B, Sackeyfio A, Hackett J, Rajaram S. Economic evaluation of pediatric influenza immunization program compared with other pediatric immunization programs: A systematic review. Hum Vaccin Immunother 2016; 12:1202-16. [PMID: 26837602 PMCID: PMC4963059 DOI: 10.1080/21645515.2015.1131369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 11/23/2015] [Accepted: 12/08/2015] [Indexed: 01/07/2023] Open
Abstract
This study compared the economic value of pediatric immunisation programmes for influenza to those for rotavirus (RV), meningococcal disease (MD), pneumococcal disease (PD), human papillomavirus (HPV), hepatitis B (Hep B), and varicella reported in recent (2000 onwards) cost-effectiveness (CE) studies identified in a systematic review of PubMed, health technology, and vaccination databases. The systematic review yielded 51 economic evaluation studies of pediatric immunisation - 10 (20%) for influenza and 41 (80%) for the other selected diseases. The quality of the eligible articles was assessed using Drummond's checklist. Although inherent challenges and limitations exist when comparing economic evaluations of immunisation programmes, an overall comparison of the included studies demonstrated cost-effectiveness/cost saving for influenza from a European-Union-Five (EU5) and United States (US) perspective; point estimates for cost/quality-adjusted life-years (QALY) from dominance (cost-saving with more effect) to ≤45,444 were reported. The economic value of influenza programmes was comparable to the other vaccines of interest, with cost/QALY in general considerably lower than RV, Hep B, MD and PD. Independent of the perspective and type of analysis, the economic impact of a pediatric influenza immunisation program was influenced by vaccine efficacy, immunisation coverage, costs, and most significantly by herd immunity. This review suggests that pediatric influenza immunisation may offer a cost effective strategy when compared with HPV and varicella and possibly more value compared with other childhood vaccines (RV, Hep B, MD and PD).
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Boiron L, Joura E, Largeron N, Prager B, Uhart M. Estimating the cost-effectiveness profile of a universal vaccination programme with a nine-valent HPV vaccine in Austria. BMC Infect Dis 2016; 16:153. [PMID: 27084683 PMCID: PMC4833954 DOI: 10.1186/s12879-016-1483-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 03/25/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND HPV is a major cancer-causing factor in both sexes in the cervix, vulva, vagina, anus, penis, oropharynx as well as the causal factor in other diseases such as genital warts and recurrent respiratory papillomatis. In the context of the arrival of a nonavalent HPV vaccine (6/11/16/18/31/33/45/52/58), this analysis aims to estimate the public health impact and the incremental cost-effectiveness of a universal (girls and boys) vaccination program with a nonavalent HPV vaccine as compared to the current universal vaccination program with a quadrivalent HPV vaccine (6/11/16/18), in Austria. METHOD A dynamic transmission model including a wide range of health and cost outcomes related to cervical, anal, vulvar, vaginal diseases and genital warts was calibrated to Austrian epidemiological data. The clinical impact due to the 5 new types was included for cervical and anal diseases outcomes only. In the base case, a two-dose schedule, lifelong vaccine type-specific protection and a vaccination coverage rate of 60% and 40% for girls and boys respectively for the 9-year old cohorts were assumed. A cost-effectiveness threshold of €30,000/QALY-gained was considered. RESULTS Universal vaccination with the nonavalent vaccine was shown to reduce the incidence of HPV16/18/31/33/45/52/58 -related cervical cancer by 92%, the related CIN2/3 cases by 96% and anal cancer by 83% and 76% respectively in females and males after 100 years, relative to 75%, 76%, 80% and 74% with the quadrivalent vaccine, respectively. Furthermore, the nonavalent vaccine was projected to prevent an additional 14,893 cases of CIN2/3 and 2544 cases of cervical cancer, over 100 years. Depending on the vaccine price, the strategy was shown to be from cost-saving to cost-effective. CONCLUSION The present evaluation showed that vaccinating 60% of girls and 40% of boys aged 9 in Austria with a 9-valent vaccine will substantially reduce the incidence of cervical cancer, CIN and anal cancer compared to the existing strategy. The vaccination strategies performed with the 9-valent vaccine in the current study were all found to be cost-effective compared to the current quadrivalent vaccination strategy by considering a cost-effectiveness threshold of 30,000€/QALY gained.
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Affiliation(s)
- L. Boiron
- />Sanofi Pasteur MSD, 162 avenue Jean Jaurès CS 50712 69367, Lyon, Cedex 07 France
| | - E. Joura
- />Department of Gynecology and Obstetrics, Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
| | - N. Largeron
- />Sanofi Pasteur MSD, 162 avenue Jean Jaurès CS 50712 69367, Lyon, Cedex 07 France
| | - B. Prager
- />Sanofi Pasteur MSD, Campus 21, Europarin F11/402, Brunn am Gebirge, A-2345 Austria
| | - M. Uhart
- />Sanofi Pasteur MSD, 162 avenue Jean Jaurès CS 50712 69367, Lyon, Cedex 07 France
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Herdman M, Cole A, Hoyle CK, Coles V, Carroll S, Devlin N. Sources and Characteristics of Utility Weights for Economic Evaluation of Pediatric Vaccines: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:255-266. [PMID: 27021761 DOI: 10.1016/j.jval.2015.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 07/31/2015] [Accepted: 11/04/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Cost-effectiveness analysis of pediatric vaccines for infectious diseases often requires quality-of-life (utility) weights. OBJECTIVE To investigate how utility weights have been elicited and used in this context. METHODS A systematic review was conducted of studies published between January 1990 and July 2013 that elicited or used utility weights in cost-effectiveness analyses of vaccines for pediatric populations. The review focused on vaccines for 17 infectious diseases and is presented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. RESULTS A total of 6410 titles and abstracts and 225 full-text articles were reviewed. Of those selected for inclusion (n = 101), 15 articles described the elicitation of utility weights and 86 described economic modeling studies using utilities. Various methods were used to generate utilities, including time trade-off, contingent valuation, and willingness to pay, as well as a preference-based measure with associated value sets, such as the EuroQol five-dimensional questionnaire or the Health Utilities Index. In modeling studies, the source of utilities used was often unclear, poorly reported, or based on weak underlying evidence. We found no articles that reported on the elicitation or use of utilities in diphtheria, polio, or tetanus. CONCLUSIONS The scarcity of appropriate utility weights for vaccine-preventable infectious diseases in children and a lack of standardization in their use in economic assessments limit the ability to accurately assess the benefits associated with interventions to prevent infectious diseases. This is an issue that should be of concern to those making decisions regarding the prevention and treatment of infectious childhood illnesses.
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Response letter regarding the letter to the editors by Butt et al. Does it matter Discounting and its role in the cost-effectiveness of preventative interventions. The case of HPV vaccination. Public Health 2016; 132:110-2. [PMID: 26804476 DOI: 10.1016/j.puhe.2015.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 11/27/2015] [Indexed: 11/20/2022]
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Marcelon L, Verstraeten T, Dominiak-Felden G, Simondon F. Quantitative benefit–risk assessment by MCDA of the quadrivalent HPV vaccine for preventing anal cancer in males. Expert Rev Vaccines 2015; 15:139-48. [DOI: 10.1586/14760584.2016.1107480] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Bonanni P, Gabutti G, Demarteau N, Boccalini S, La Torre G. Vaccination of boys or catch-up of girls above 11 years of age with the HPV-16/18 AS04-adjuvanted vaccine: where is the greatest benefit for cervical cancer prevention in Italy? BMC Infect Dis 2015; 15:377. [PMID: 26381489 PMCID: PMC4574450 DOI: 10.1186/s12879-015-1067-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 07/28/2015] [Indexed: 12/02/2022] Open
Abstract
Background Since 2007, a Human Papillomavirus (HPV) vaccination programme against cervical cancer (CC) is implemented in Italy in 11-year-old girls. The extension of HPV vaccination to young adult women, or to 11-year-old boys could further reduce the CC burden, in the latter case from indirect effect on HPV transmission. The objective of the study was to compare the potential CC cases prevention from HPV-16/18 AS04-adjuvanted vaccination of adding catch-up targeting 15- or 25-year-old girls to the addition of boys vaccination in Italy. The models assessing the impact of these alternative vaccination strategies are usually dynamic models requiring numerous input data. Simpler models could however provide some insight into this question, as reported in the current study. Methods A published cohort model adapted to the Italian setting was used to estimate the potential CC reduction following different HPV vaccination strategies with a HPV-16/18 AS04-adjuvanted vaccine: vaccination of 11-year-old girls, female aged 15 or 25 years. The model assumed that the maximum benefit obtained from vaccinating boys equals the CC reduction that would result from immunisation of all non-vaccinated girls of the same age. Each cohort of 11-year-olds (either girls or boys) was assumed to include 281,000 individuals and a 70 % vaccination coverage was applied. Sensitivity analysis was performed by varying the vaccination coverage and the overlap in potential sexual contacts between vaccinated boys and girls of the same age-group. Results Under base case, compared with the screening-only scenario, HPV vaccination of 11-year-old girls, 15-year-old females, 25-year-old females or 11-year-old boys, would prevent 1,146, 1,082, 788 or 491 CC cases respectively. HPV vaccination of boys could result in more CC cases prevented than adding a female catch-up only in scenarios with low vaccination coverage in the primary target cohort and when combined with small overlap between vaccinated boys and girls of the same age cohort. Conclusions For a fixed limited additional budget allowing the inclusion of a single catch-up cohort, the extension of HPV vaccination to girls or young women instead of boys was estimated to maximise the number of CC cases prevented.
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Affiliation(s)
- Paolo Bonanni
- Department of Health Sciences, University of Florence, Viale Morgagni 48, 50134, Florence, Italy.
| | - Giovanni Gabutti
- Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/b, 44121, Ferrara, Italy.
| | - Nadia Demarteau
- Health Economics, GSK Vaccines, Avenue Fleming 20, 1300, Wavre, Belgium.
| | - Sara Boccalini
- Department of Health Sciences, University of Florence, Viale Morgagni 48, 50134, Florence, Italy.
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
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Di Mario S, Basevi V, Lopalco PL, Balduzzi S, D'Amico R, Magrini N. Are the Two Human Papillomavirus Vaccines Really Similar? A Systematic Review of Available Evidence: Efficacy of the Two Vaccines against HPV. J Immunol Res 2015; 2015:435141. [PMID: 26380321 PMCID: PMC4562171 DOI: 10.1155/2015/435141] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/30/2015] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND When the bivalent and the quadrivalent HPV vaccines were marketed they were presented as having comparable efficacy against cervical cancer. Differences between the vaccines are HPV types included and formulation of the adjuvant. METHOD A systematic review was conducted to assess the efficacy of the two vaccines against cervical cancer. Outcomes considered were CIN2+, CIN3+, and AIS. RESULTS Nine reports (38,419 women) were included. At enrollment mean age of women was 20 years, 90% had negative cytology, and 80% were seronegative and/or DNA negative for HPV 16 or 18 (naïve women). In the TVC-naïve, VE against CIN2+ was 58% (95% CI: 35, 72); heterogeneity was detected, VE being 65% (95% CI: 54, 74) for the bivalent and 43% (95% CI: 23, 57) for the quadrivalent. VE against CIN3+ was 78% (95% CI: <0, 97); heterogeneity was substantial, VE being 93% (95% CI: 77, 98) for the bivalent and 43% (95% CI: 12, 63) for the quadrivalent. VE in the TVC was much lower. No sufficient data were available on AIS. CONCLUSIONS In naïve girls bivalent vaccine shows higher efficacy, even if the number of events detected is low. In women already infected the benefit of the vaccination seems negligible.
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Affiliation(s)
- Simona Di Mario
- SaPeRiDoc Unit, Department of Primary Health Care, Regional Health Authority of Emilia-Romagna, Viale Aldo Moro 21, 40127 Bologna, Italy
| | - Vittorio Basevi
- SaPeRiDoc Unit, Department of Primary Health Care, Regional Health Authority of Emilia-Romagna, Viale Aldo Moro 21, 40127 Bologna, Italy
| | - Pier Luigi Lopalco
- Office of Chief Scientist, European Centre for Disease Prevention and Control (ECDC), 171 83 Stockholm, Sweden
| | - Sara Balduzzi
- Statistics Unit, Department of Diagnostic and Clinical Medicine and Public Health, University of Modena & Reggio Emilia, Via del Pozzo 71, 41100 Modena, Italy
| | - Roberto D'Amico
- Statistics Unit, Department of Diagnostic and Clinical Medicine and Public Health, University of Modena & Reggio Emilia, Via del Pozzo 71, 41100 Modena, Italy
| | - Nicola Magrini
- Drug Evaluation Unit, WHO Collaborating Centre for Evidence Based Research Synthesis and Guidelines Development, Regional Health and Social Agency of Emilia-Romagna, Viale Aldo Moro 21, 40127 Bologna, Italy
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Audisio RA, Icardi G, Isidori AM, Liverani CA, Lombardi A, Mariani L, Mennini FS, Mitchell DA, Peracino A, Pecorelli S, Rezza G, Signorelli C, Rosati GV, Zuccotti GV. Public health value of universal HPV vaccination. Crit Rev Oncol Hematol 2015; 97:157-67. [PMID: 26346895 DOI: 10.1016/j.critrevonc.2015.07.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 07/28/2015] [Accepted: 07/29/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The story of Human Papillomavirus vaccination demands reflection not only for its public health impact on the prophylactic management of HPV disease, but also for its relevant economic and social outcomes. Greater than ever data confirm the efficacy and support the urge for effective vaccination plans for both genders before sexual debut. METHODS A review of previous experience in gender-restricted vaccination programs has demonstrated a lower effectiveness. Limiting vaccination to women might increase the psychological burden on women by confirming a perceived inequality between genders; and even if all women were immunized, the HPV chain of transmission would still be maintained through men. RESULTS The cost-effectiveness of including boys into HPV vaccination programs should be re-assessed in view of the progressive drop of the economic burden of HPV-related diseases in men and women due to universal vaccination. The cost of the remarkable increase in anal and oropharyngeal HPV driven cancers in both sexes has been grossly underestimated or ignored. CONCLUSIONS Steps must be taken by relevant bodies to achieve the target of universal vaccination. The analysis of HPV vaccination's clinical effectiveness vs. economic efficacy are supportive of the economic sustainability of vaccination programs both in women and men. In Europe, these achievements demand urgent attention to the social equity for both genders in healthcare. There is sufficient ethical, scientific, strategic and economic evidence to urge the European Community to develop and implement a coordinated and comprehensive strategy aimed at both genders and geographically balanced, to eradicate cervical cancer and other diseases caused by HPV in Europe. Policymakers must take into consideration effective vaccination programs in the prevention of cancers.
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Affiliation(s)
| | - Giancarlo Icardi
- Department of Health Sciences, Hygiene Unit, IRCCS AOU San Martino, IST University of Genoa, Genoa, Italy.
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
| | - Carlo A Liverani
- Department of Mother and Infant Sciences, Gynecologic Oncology Unit, University of Milan, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Alberto Lombardi
- Scientific and Medical Consultant, Fondazione Giovanni Lorenzini, Milan, Italy and Houston, TX, USA.
| | - Luciano Mariani
- Department of Gynecologic Oncology, HPV Unit, "Regina Elena" National Cancer Institute, Rome, Italy.
| | - Francesco Saverio Mennini
- Faculty of Economics, University of Rome Tor Vergata, Faculty of Statistics, University of Rome La Sapienza, Kingston University, London, UK.
| | - David A Mitchell
- Bradford Teaching Hospitals NHS Foundation Trust, St. Lukes Hospital, Bradford, UK.
| | - Andrea Peracino
- Fondazione Giovanni Lorenzini Medical Science Foundation, Milan, Italy and Houston, TX, USA.
| | | | - Giovanni Rezza
- Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
| | - Carlo Signorelli
- Department S.Bi.Bi.T., Unit of Public Health, University of Parma, Parma, Italy.
| | | | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Biomedical and Clinical Science Department, University of Milan, Milan, Italy.
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McCormack PL. Quadrivalent human papillomavirus (types 6, 11, 16, 18) recombinant vaccine (gardasil(®)): a review of its use in the prevention of premalignant anogenital lesions, cervical and anal cancers, and genital warts. Drugs 2015; 74:1253-83. [PMID: 25022951 DOI: 10.1007/s40265-014-0255-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Quadrivalent human papillomavirus (HPV) [types 6, 11, 16, 18] recombinant vaccine (Gardasil(®); Silgard(®)) is composed of virus-like particles formed by self-assembly of recombinant L1 capsid protein from each of HPV types 6, 11, 16 and 18. It is indicated for use from the age of 9 years as a two- or three-dose vaccination course over 6 months for the prevention of premalignant anogenital lesions, cervical and anal cancers, and genital warts caused by the vaccine HPV types. In placebo-controlled trials, quadrivalent HPV vaccine provided high-level protection against infection or disease caused by the vaccine HPV types over 2-4 years in females aged 15-45 years who were negative for the vaccine HPV types, and provided a degree of cross-protection against certain non-vaccine HPV types. The vaccine also provided high-level protection against persistent infection, anogenital precancerous lesions and genital warts caused by the vaccine HPV types over 3 years in susceptible males aged 16-26 years. Protection has been demonstrated for up to 8 years. In subjects who were negative for the vaccine HPV types, high seroconversion rates and high levels of anti-HPV antibodies were observed in females of all age ranges from 9 to 45 years and in males aged 9-26 years. The vaccine was generally well tolerated and was usually predicted to be cost effective in girls and young women. Therefore, quadrivalent HPV vaccine offers an effective means to substantially reduce the burden of HPV-related anogenital disease in females and males, particularly cervical cancer and genital warts.
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Affiliation(s)
- Paul L McCormack
- Adis, Level 1, 5 The Warehouse Way, Northcote 0627; Private Bag 65901, Mairangi Bay 0754, Auckland, New Zealand,
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Olsen J, Jørgensen TR. Revisiting the cost-effectiveness of universal HPV-vaccination in Denmark accounting for all potentially vaccine preventable HPV-related diseases in males and females. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2015; 13:4. [PMID: 25694771 PMCID: PMC4331443 DOI: 10.1186/s12962-015-0029-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 01/05/2015] [Indexed: 11/29/2022] Open
Abstract
Objective The purpose of this study was to assess the consequences of a national immunization program with HPV vaccine for both boys and girls in Denmark, including the prophylactic effects on all potentially vaccine preventable HPV-associated diseases in male and female. Methods The study focussed on the quadrivalent vaccine which protects against HPV type 6, 11, 16 and 18, and the vaccine’s protection against genital warts, cervical intraepithelial neoplasia, cervical cancer, anogenital cancer (anal, penile, vaginal and vulvar cancer) and head and neck cancer (oral cavity, oropharyngeal, hypopharyngeal and laryngeal cancer) were included in the analyses. In general, the analysis was performed in two phases. First, an agent-based transmission model that described the HPV transmission without and with HPV vaccination was applied. Second, an analysis of the incremental costs and effects was performed. The model did not include naturally-acquired immunity to HPV in the simulations. Results In the base case result (i.e. vaccination of girls only, 85% vaccination rate, private market price at € 123 per dose ex. VAT) an ICER of 3583 €/QALY (3-dose regime) is estimated when all HPV-related diseases are taken into account. Vaccination of girls & boys vs. vaccination of girls only an ICER of 28,031 €/QALY (2-dose regime) and 41,636 €/QALY (3-dose regime) is estimated. Conclusions Extension of the current HPV programme in Denmark to include boys and girls is a cost effective preventive intervention that would lead to a faster prevention of cancers, cancer precursors and genital warts in men and women.
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Affiliation(s)
- Jens Olsen
- Centre for Applied Health Services Research and Technology Assessment (CAST), University of Southern Denmark, 5000 Odense C, Denmark ; Incentive, 2840 Holte, Denmark
| | - Tine Rikke Jørgensen
- Sanofi Pasteur MSD ApS, 2800 Kgs, Lyngby, Denmark ; Medivir, 2800 Kgs, Lyngby, Denmark
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Jit M, Brisson M, Laprise JF, Choi YH. Comparison of two dose and three dose human papillomavirus vaccine schedules: cost effectiveness analysis based on transmission model. BMJ 2015; 350:g7584. [PMID: 25567037 PMCID: PMC4285892 DOI: 10.1136/bmj.g7584] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To investigate the incremental cost effectiveness of two dose human papillomavirus vaccination and of additionally giving a third dose. DESIGN Cost effectiveness study based on a transmission dynamic model of human papillomavirus vaccination. Two dose schedules for bivalent or quadrivalent human papillomavirus vaccines were assumed to provide 10, 20, or 30 years' vaccine type protection and cross protection or lifelong vaccine type protection without cross protection. Three dose schedules were assumed to give lifelong vaccine type and cross protection. SETTING United Kingdom. POPULATION Males and females aged 12-74 years. INTERVENTIONS No, two, or three doses of human papillomavirus vaccine given routinely to 12 year old girls, with an initial catch-up campaign to 18 years. MAIN OUTCOME MEASURE Costs (from the healthcare provider's perspective), health related utilities, and incremental cost effectiveness ratios. RESULTS Giving at least two doses of vaccine seems to be highly cost effective across the entire range of scenarios considered at the quadrivalent vaccine list price of £86.50 (€109.23; $136.00) per dose. If two doses give only 10 years' protection but adding a third dose extends this to lifetime protection, then the third dose also seems to be cost effective at £86.50 per dose (median incremental cost effectiveness ratio £17,000, interquartile range £11,700-£25,800). If two doses protect for more than 20 years, then the third dose will have to be priced substantially lower (median threshold price £31, interquartile range £28-£35) to be cost effective. Results are similar for a bivalent vaccine priced at £80.50 per dose and when the same scenarios are explored by parameterising a Canadian model (HPV-ADVISE) with economic data from the United Kingdom. CONCLUSIONS Two dose human papillomavirus vaccine schedules are likely to be the most cost effective option provided protection lasts for at least 20 years. As the precise duration of two dose schedules may not be known for decades, cohorts given two doses should be closely monitored.
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Affiliation(s)
- Mark Jit
- Modelling and Economics Unit, Public Health England, London NW9 5EQ, UK Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London
| | - Marc Brisson
- SP-POS, Centre de recherche du CHU de Québec, 1050 Chemin Sainte-Foy, Québec, Canada Department of Infectious Disease Epidemiology, Imperial College, London Département de médecine sociale et préventive, Université Laval, Québec
| | - Jean-François Laprise
- SP-POS, Centre de recherche du CHU de Québec, 1050 Chemin Sainte-Foy, Québec, Canada
| | - Yoon Hong Choi
- Modelling and Economics Unit, Public Health England, London NW9 5EQ, UK Immunisation, Hepatitis and Blood Safety Department, Public Health England, London
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Abogunrin S, Di Tanna GL, Keeping S, Carroll S, Iheanacho I. Prevalence of human papillomavirus in head and neck cancers in European populations: a meta-analysis. BMC Cancer 2014; 14:968. [PMID: 25515630 PMCID: PMC4320477 DOI: 10.1186/1471-2407-14-968] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 12/11/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Infection with human papillomavirus (HPV) is necessary for the development of cervical carcinoma. By contrast, the role of HPV in the pathogenesis of other malignancies, such as head and neck cancers, is less well characterised. This study aimed to address key information gaps by conducting a systematic review and meta-analysis of the prevalence of HPV infection in head and neck cancers, focusing on data for European populations. METHODS MEDLINE, Embase and grey literature sources were systematically searched for primary studies that were published in English between July 2002 and July 2012, and which reported on the prevalence of HPV infection in head and neck cancers in European populations. Studies on non-European populations, those not published in English, and those assessing patients co-infected with human immunodeficiency virus were excluded. Eligible studies were combined in a meta-analysis. In addition, the potential statistical association between the head and neck cancers and certain HPV types was investigated. RESULTS Thirty-nine publications met the inclusion criteria. The prevalence of HPV of any type in 3,649 patients with head and neck cancers was 40.0% (95% confidence interval, 34.6% to 45.5%), and was highest in tonsillar cancer (66.4%) and lowest in pharyngeal (15.3%) and tongue (25.7%) cancers. There were no statistically significant associations between the HPV types analysed and the geographical setting, type of sample analysed or type of primer used to analyse samples in head and neck cancers. CONCLUSIONS The prevalence of HPV infection in European patients with head and neck cancers is high but varies between the different anatomical sites of these malignancies. There appears to be no association between HPV type and geographical setting, type of samples analysed or type of primer used to analyse samples in such cancers.
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Affiliation(s)
- Seye Abogunrin
- />Evidera Inc., Metro Building, 6th Floor, 1 Butterwick, London, W6 8DL UK
| | - Gian Luca Di Tanna
- />Statistical Advisor to Evidera Inc., Metro Building, 6th Floor, 1 Butterwick, London, W6 8DL UK
| | - Sam Keeping
- />Sanofi Pasteur MSD, Mallards Reach, Bridge Avenue, Maidenhead, SL6 1QP UK
| | - Stuart Carroll
- />Sanofi Pasteur MSD, Mallards Reach, Bridge Avenue, Maidenhead, SL6 1QP UK
| | - Ike Iheanacho
- />Evidera Inc., Metro Building, 6th Floor, 1 Butterwick, London, W6 8DL UK
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