1
|
Petrie K, Wells A, Eckert LO. Human Papillomavirus Vaccine. Obstet Gynecol Clin North Am 2023; 50:339-348. [PMID: 37149314 DOI: 10.1016/j.ogc.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Cervical cancer is the fourth most common cancer in women worldwide with immense associated morbidity and mortality. Although most of the cervical cancer cases are caused by the human papillomavirus (HPV) and can effectively be prevented by HPV vaccination, vaccination unfortunately remains underused on a global scale with vast inequities in distribution. A vaccine as a tool to prevent cancer, cervical and others, is largely unprecedented. Then why do HPV vaccination rates globally remain so low? This article explores the burden of disease, development of the vaccine and its subsequent uptake, cost-effectiveness, and associated equity issues.
Collapse
|
2
|
Kostaras D, Karampli E, Athanasakis K. Vaccination against HPV virus: a systematic review of economic evaluation studies for developed countries. Expert Rev Pharmacoecon Outcomes Res 2018; 19:147-158. [PMID: 30501434 DOI: 10.1080/14737167.2019.1555039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION During the last years, a significant number economic evaluations of HPV vaccination has been published. Given that cost-effectiveness constitutes an essential part of decision-making with regards to the reimbursement of a health technology, the purpose of this study is to provide a supportive tool to decision-makers regarding the economic efficiency of the introduction of HPV vaccination to national immunization programs. AREAS COVERED The PubMed database was searched in order to identify cost-effectiveness studies for HPV vaccination. A total of 42 articles were finally retrieved. All retrieved cost-effectiveness ratios (ICERs) were converted in the same currency unit (I$) and then inflated to the same year (2015) in order to facilitate cross-country comparisons. RESULTS Overall, vaccination against HPV 6,11,16,18 types appears to have a ICER with mean value of I$25132/QALY, whereas the mean ICER of vaccination against oncogenic HPV 16,18 types is estimated at I$38,253/QALY. EXPERT COMMENTARY HPV vaccination would be a cost-effective intervention in the setting of high-income countries and could reduce the incidence of HPV-related diseases.
Collapse
Affiliation(s)
- Dimitris Kostaras
- a Department of Health Economics , National School of Public Health , Athens , Greece.,b Vaccines Department , Athens , MSD Greece
| | - Eleftheria Karampli
- a Department of Health Economics , National School of Public Health , Athens , Greece
| | - Kostas Athanasakis
- a Department of Health Economics , National School of Public Health , Athens , Greece
| |
Collapse
|
3
|
Nymark LS, Sharma T, Miller A, Enemark U, Griffiths UK. Inclusion of the value of herd immunity in economic evaluations of vaccines. A systematic review of methods used. Vaccine 2017; 35:6828-6841. [PMID: 29146380 DOI: 10.1016/j.vaccine.2017.10.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 10/04/2017] [Accepted: 10/12/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objectives of this review were to identify vaccine economic evaluations that include herd immunity and describe the methodological approaches used. METHODS We used Kim and Goldie's search strategy from a systematic review (1976-2007) of modelling approaches used in vaccine economic evaluations and additionally searched PubMed/MEDLINE and Embase for 2007-2015. Studies were classified according to modelling approach used. Methods for estimating herd immunity effects were described, in particular for the static models. RESULTS We identified 625 economic evaluations of vaccines against human-transmissible diseases from 1976 to 2015. Of these, 172 (28%) included herd immunity. While 4% of studies included herd immunity in 2001, 53% of those published in 2015 did this. Pneumococcal, human papilloma and rotavirus vaccines represented the majority of studies (63%) considering herd immunity. Ninety-five of the 172 studies utilised a static model, 59 applied a dynamic model, eight a hybrid model and ten did not clearly state which method was used. Relatively crude methods and assumptions were used in the majority of the static model studies. CONCLUSION The proportion of economic evaluations using a dynamic model has increased in recent years. However, 55% of the included studies used a static model for estimating herd immunity. Values from a static model can only be considered reliable if high quality surveillance data are incorporated into the analysis. Without this, the results are questionable and they should only be included in sensitivity analysis.
Collapse
Affiliation(s)
- Liv S Nymark
- Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark; Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serums Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Tarang Sharma
- Nordic Cochrane Centre, Rigshospitalet, Blegdamsvej 9, DK- 2100 Copenhagen Ø, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200 København N, Denmark
| | | | - Ulrika Enemark
- Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark; Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serums Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark
| | - Ulla Kou Griffiths
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK; UNICEF, 3 UN Plaza, New York, NY 10007, USA
| |
Collapse
|
4
|
Rafferty ERS, Gagnon HL, Farag M, Waldner CL. Economic evaluations of vaccines in Canada: a scoping review. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2017; 15:7. [PMID: 28484344 PMCID: PMC5420143 DOI: 10.1186/s12962-017-0069-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 04/28/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND This study aims to summarise and describe the evolution of published economic evaluations of vaccines in Canada, thereby outlining the current state of this expanding and meaningful research. METHODS Using Arksey and O'Malley's scoping review framework we assembled relevant research from both academic and grey literature. Following abstract and full-text review we identified 60 articles to be included in the final analysis. RESULTS We found that since 1988 there has been a steady increase in the number of economic evaluations on vaccines in Canada. Many of these studies focus on the more recently licensed vaccines, such as influenza (16.7%), human papillomavirus (15.0%) and pneumococcal disease (15.0%). Since 2010 economic evaluations of vaccines have shown increased adherence to economic evaluation guidelines (OR = 4.6, CI 1.33, 18.7), suggesting there has been improvement in the consistency and transparency of these studies. However, there remains room for improvement, for instance, we found evidence that studies who stated a conflict of interest are more likely to assert the vaccine of interest was cost-effective (OR = 7.4; CI 1.04, 17.8). Furthermore, most reports use static models that do not consider herd immunity, and only a few evaluate vaccines post-implementation (ex-post) and traveller's vaccinations. CONCLUSION Researchers should examine identified research gaps and continue to improve standardization and transparency when reporting to ensure economic evaluations of vaccines best meet the needs of policy-makers, other researchers and the public.
Collapse
Affiliation(s)
- Ellen R S Rafferty
- School of Public Health, University of Saskatchewan, Saskatoon, SK S7N 5A2 Canada
| | | | - Marwa Farag
- School of Public Health, University of Saskatchewan, Saskatoon, SK S7N 5A2 Canada
| | - Cheryl L Waldner
- School of Public Health, University of Saskatchewan, Saskatoon, SK S7N 5A2 Canada
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK S7N 5A2 Canada
| |
Collapse
|
5
|
Bardach AE, Garay OU, Calderón M, Pichón-Riviére A, Augustovski F, Martí SG, Cortiñas P, Gonzalez M, Naranjo LT, Gomez JA, Caporale JE. Health economic evaluation of Human Papillomavirus vaccines in women from Venezuela by a lifetime Markov cohort model. BMC Public Health 2017; 17:152. [PMID: 28148228 PMCID: PMC5289055 DOI: 10.1186/s12889-017-4064-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 01/24/2017] [Indexed: 12/16/2022] Open
Abstract
Background Cervical cancer (CC) and genital warts (GW) are a significant public health issue in Venezuela. Our objective was to assess the cost-effectiveness of the two available vaccines, bivalent and quadrivalent, against Human Papillomavirus (HPV) in Venezuelan girls in order to inform decision-makers. Methods A previously published Markov cohort model, informed by the best available evidence, was adapted to the Venezuelan context to evaluate the effects of vaccination on health and healthcare costs from the perspective of the healthcare payer in an 11-year-old girls cohort of 264,489. Costs and quality-adjusted life years (QALYs) were discounted at 5%. Eight scenarios were analyzed to depict the cost-effectiveness under alternative vaccine prices, exchange rates and dosing schemes. Deterministic and probabilistic sensitivity analyses were performed. Results Compared to screening only, the bivalent and quadrivalent vaccines were cost-saving in all scenarios, avoiding 2,310 and 2,143 deaths, 4,781 and 4,431 CCs up to 18,459 GW for the quadrivalent vaccine and gaining 4,486 and 4,395 discounted QALYs respectively. For both vaccines, the main determinants of variations in the incremental costs-effectiveness ratio after running deterministic and probabilistic sensitivity analyses were transition probabilities, vaccine and cancer-treatment costs and HPV 16 and 18 distribution in CC cases. When comparing vaccines, none of them was consistently more cost-effective than the other. In sensitivity analyses, for these comparisons, the main determinants were GW incidence, the level of cross-protection and, for some scenarios, vaccines costs. Conclusions Immunization with the bivalent or quadrivalent HPV vaccines showed to be cost-saving or cost-effective in Venezuela, falling below the threshold of one Gross Domestic Product (GDP) per capita (104,404 VEF) per QALY gained. Deterministic and probabilistic sensitivity analyses confirmed the robustness of these results. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4064-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ariel Esteban Bardach
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina.
| | - Osvaldo Ulises Garay
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina
| | - María Calderón
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina
| | - Andrés Pichón-Riviére
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina
| | - Federico Augustovski
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina
| | - Sebastián García Martí
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina
| | - Paula Cortiñas
- Salud Chacao, Final Av. Ávila, Edif. Salud Chacao. Urb. Bello Campo. Chacao, 1060, Caracas, D.C, Venezuela
| | - Marino Gonzalez
- Unit of Public Policy, Simon Bolivar University, Edificio Física y Electrónica I, Planta Baja. Valle de Sartenejas, Estado Miranda, Caracas, Venezuela
| | - Laura T Naranjo
- GlaxoSmithKline Biologicals, Clayton, Ciudad del Saber Edificio 230, Panama City, Panama
| | - Jorge Alberto Gomez
- GSK Vaccines Latin America, Carlos Casares 3690, B1644 BCD, Victoria, Buenos Aires, Argentina
| | - Joaquín Enzo Caporale
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina
| |
Collapse
|
6
|
Chit A, Lee JKH, Shim M, Nguyen VH, Grootendorst P, Wu J, Van Exan R, Langley JM. Economic evaluation of vaccines in Canada: A systematic review. Hum Vaccin Immunother 2016; 12:1257-64. [PMID: 26890128 PMCID: PMC4963050 DOI: 10.1080/21645515.2015.1137405] [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: 10/26/2015] [Revised: 12/14/2015] [Accepted: 12/25/2015] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Economic evaluations should form part of the basis for public health decision making on new vaccine programs. While Canada's national immunization advisory committee does not systematically include economic evaluations in immunization decision making, there is increasing interest in adopting them. We therefore sought to examine the extent and quality of economic evaluations of vaccines in Canada. OBJECTIVE We conducted a systematic review of economic evaluations of vaccines in Canada to determine and summarize: comprehensiveness across jurisdictions, studied vaccines, funding sources, study designs, research quality, and changes over time. METHODS Searches in multiple databases were conducted using the terms "vaccine," "economics" and "Canada." Descriptive data from eligible manuscripts was abstracted and three authors independently evaluated manuscript quality using a 7-point Likert-type scale scoring tool based on criteria from the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). RESULTS 42/175 articles met the search criteria. Of these, Canada-wide studies were most common (25/42), while provincial studies largely focused on the three populous provinces of Ontario, Quebec and British Columbia. The most common funding source was industry (17/42), followed by government (7/42). 38 studies used mathematical models estimating expected economic benefit while 4 studies examined post-hoc data on established programs. Studies covered 10 diseases, with 28/42 addressing pediatric vaccines. Many studies considered cost-utility (22/42) and the majority of these studies reported favorable economic results (16/22). The mean quality score was 5.9/7 and was consistent over publication date, funding sources, and disease areas. CONCLUSIONS We observed diverse approaches to evaluate vaccine economics in Canada. Given the increased complexity of economic studies evaluating vaccines and the impact of results on public health practice, Canada needs improved, transparent and consistent processes to review and assess the findings of the economic evaluations of vaccines.
Collapse
Affiliation(s)
- Ayman Chit
- Sanofi Pasteur, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Jason K. H. Lee
- Sanofi Pasteur, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Minsup Shim
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Van Hai Nguyen
- Health Services and Systems Research Program, Duke-NUS Graduate Medical School Singapore, Singapore
| | - Paul Grootendorst
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Department of Economics, McMaster University, Hamilton, Ontario, Canada
| | - Jianhong Wu
- Center for Disease Modeling, York Institute for Health Research, York University, Toronto, Ontario, Canada
| | | | - Joanne M. Langley
- Canadian Center for Vaccinology and the Departments of Pediatrics and Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
7
|
Cheikh A, El Majjaoui S, Ismaili N, Cheikh Z, Bouajaj J, Nejjari C, El Hassani A, Cherrah Y, Benjaafar N. Evaluation of the cost of cervical cancer at the National Institute of Oncology, Rabat. Pan Afr Med J 2016; 23:209. [PMID: 27347298 PMCID: PMC4907759 DOI: 10.11604/pamj.2016.23.209.7750] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 03/07/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction The Cervical Cancer (CC) is one of the heavy and costly diseases for the population and the health system. We want to know through this study, the first in Morocco, the annual cost of the treatment of this disease at the National Institute of Oncology (NIO) in Rabat, we also want to explore the possibility of flat-rate management of this disease in order to standardize medical practices and improve reimbursement by health insurance funds. Methods 550 patients were treated for their cervical cancer in the Rabat's NIO. Data of all of medical and surgical services offered to patients were collected from the NIO registry. The cost of care was assessed using the method of micro-costing. We will focus to the total direct cost of all the services lavished to patients in NIO. Results The global cost was about US$ 1,429,673 with an average estimated at US$ 2,599 ± US$ 839. Radiotherapy accounts for 55% of total costs, followed by brachytherapy (27%) and surgery (7%). This three services plus chemotherapy influence the overall cost of care (p <0.001). Other services (radiology, laboratory tests and consultations) represent only 10%. The overall cost is influenced by the stage of the disease, this cost decreased significantly evolving in the stage of CC (p <0.001). Conclusion The standardization of medical practices is essential to the equity and efficiency in access to care. The flat-rate or lump sum by stage of disease is possible and interesting for standardizing medical practices and improving the services of the health insurance plan.
Collapse
Affiliation(s)
- Amine Cheikh
- Team of Pharmacoepidemiology and Pharmacoeconomics, Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco; Department of pharmacy, International Hospital Cheikh Zaid, Rabat, Morocco; Faculty of Medicine, Abulcasis University, Rabat, Morocco
| | - Sanaa El Majjaoui
- Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Nabil Ismaili
- Department of oncology, Regional Cancer Centre, Marrakech, Morocco
| | - Zakia Cheikh
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Jamal Bouajaj
- Department of Radiotherapy, International Hospital Cheikh Zaid, Rabat, Morocco
| | - Chakib Nejjari
- National Institute of Public Health, Rabat, Morocco; Department of Epidemiology, Faculty of Medicine and Pharmacy, Hassan II University, Fes, Morocco
| | - Amine El Hassani
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco; Head of Hospital, International Hospital Cheikh Zaid, Rabat, Morocco
| | - Yahya Cherrah
- Team of Pharmacoepidemiology and Pharmacoeconomics, Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Noureddine Benjaafar
- Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| |
Collapse
|
8
|
Gomez JA, Lepetic A, Demarteau N. Health economic analysis of human papillomavirus vaccines in women of Chile: perspective of the health care payer using a Markov model. BMC Public Health 2014; 14:1222. [PMID: 25424716 PMCID: PMC4289178 DOI: 10.1186/1471-2458-14-1222] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 10/30/2014] [Indexed: 11/04/2022] Open
Abstract
Background In Chile, significant reductions in cervical cancer incidence and mortality have been observed due to implementation of a well-organized screening program. However, it has been suggested that the inclusion of human papillomavirus (HPV) vaccination for young adolescent women may be the best prospect to further reduce the burden of cervical cancer. This cost-effectiveness study comparing two available HPV vaccines in Chile was performed to support decision making on the implementation of universal HPV vaccination. Methods The present analysis used an existing static Markov model to assess the effect of screening and vaccination. This analysis includes the epidemiology of low-risk HPV types allowing for the comparison between the two vaccines (HPV-16/18 AS04-adjuvanted vaccine and the HPV-6/11/16/18 vaccine), latest cross-protection data on HPV vaccines, treatment costs for cervical cancer, vaccine costs and 6% discounting per the health economic guideline for Chile. Results Projected incremental cost-utility ratio (ICUR) and incremental cost-effectiveness ratio (ICERs) for the HPV-16/18 AS04-adjuvanted vaccine was 116 United States (US) dollars per quality-adjusted life years (QALY) gained or 147 US dollars per life-years (LY) saved, while the projected ICUR/ICER for the HPV-6/11/16/18 vaccine was 541 US dollars per QALY gained or 726 US dollars per LY saved. Introduction of any HPV vaccine to the present cervical cancer prevention program of Chile is estimated to be highly cost-effective (below 1X gross domestic product [GDP] per capita, 14278 US dollars). In Chile, the addition of HPV-16/18 AS04-adjuvanted vaccine to the existing screening program dominated the addition of HPV-6/11/16/18 vaccine. In the probabilistic sensitivity analysis results show that the HPV-16/18 AS04-adjuvanted vaccine is expected to be dominant and cost-saving in 69.3% and 77.6% of the replicates respectively. Conclusions The findings indicate that the addition of any HPV vaccine to the current cervical screening program of Chile will be advantageous. However, this cost-effectiveness model shows that the HPV-16/18 AS04-adjuvanted vaccine dominated the HPV-6/11/16/18 vaccine. Beyond the context of Chile, the data from this modelling exercise may support healthcare policy and decision-making pertaining to introduction of HPV vaccination in similar resource settings in the region. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-1222) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
| | - Alejandro Lepetic
- GSK Vaccines Latin America, Carlos Casares, 3690, B1644CD Victoria, Buenos Aires, Argentina.
| | | |
Collapse
|
9
|
Abstract
This article explores the implications of the relation between quality of life (QoL) and time to death (TTD) for economic evaluations of preventive interventions. By using health survey data on QoL for the general Dutch population linked to the mortality registry, we quantify the magnitude of this relationship. For addressing specific features of the nonstandard QoL distribution such as boundness, skewness, and heteroscedasticity, we modeled QoL using a generalized additive model for location, scale, and shape (GAMLSS) with a β inflated outcome distribution. Our empirical results indicate that QoL decreases when approaching death, suggesting that there is a strong relationship between TTD and QoL. Predictions of different regression models revealed that ignoring this relationship results in an underestimation of the quality-adjusted life year (QALY) gains for preventive interventions. The underestimation ranged between 3% and 7% and depended on age, the number of years gained from the intervention, and the discount rate used.
Collapse
Affiliation(s)
- Maria Gheorghe
- Institute of Health Policy and Management/Institute of Health Technology Assessment Erasmus University Rotterdam, the Netherlands
| | - Werner B. F. Brouwer
- Institute of Health Policy and Management/Institute of Health Technology Assessment Erasmus University Rotterdam, the Netherlands
| | - Pieter H. M. van Baal
- Institute of Health Policy and Management/Institute of Health Technology Assessment Erasmus University Rotterdam, the Netherlands
| |
Collapse
|
10
|
Chatterjee A. The next generation of HPV vaccines: nonavalent vaccine V503 on the horizon. Expert Rev Vaccines 2014; 13:1279-90. [DOI: 10.1586/14760584.2014.963561] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
11
|
Simonella L, Canfell K. Development of a quality framework for models of cervical screening and its application to evaluations of the cost-effectiveness of HPV vaccination in developed countries. Vaccine 2014; 33:34-51. [PMID: 25171843 DOI: 10.1016/j.vaccine.2014.08.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 07/01/2014] [Accepted: 08/15/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND HPV vaccination has now been introduced in most developed countries, but this has occurred in the context of established cervical cancer screening mechanisms which provide population-level protection against the most common HPV-related cancer. Therefore, estimating the cost-effectiveness of HPV vaccination to further reduce HPV-related disease depends in large part on the estimation of the effectiveness of the cervical screening 'background'. The aim of this study was to systematically review and assess methods for simulating cervical screening in decision analytic models used for evaluation of HPV vaccination. METHODS Existing quality frameworks for economic models were extended to develop a specific quality framework for models of cervical screening. This involved domains for model structure, parameterisation (data sources) and validation (consistency). A systematic review of economic evaluations of HPV vaccination was then conducted, and assessment of cervical screening model components was then performed via application of the new quality framework. RESULTS Generally, models took into account population-level cervical screening participation, but were inconsistent in their approach to modelling abnormal smear management, diagnostic evaluation and treatment of precancerous disease. There was also considerable variability in the accuracy of modelling clinical pathways and the scope of validation performed for screening-related outcomes, with focus directed towards cervical cancer targets. Only a few models comprehensively validated against observed pre-cancerous abnormalities. CONCLUSION Models of HPV vaccination in developed countries can be improved by further attention to the 'background' modelling of secondary protection via cervical screening. The quality framework developed for this review can be used to inform future HPV vaccination evaluations, including evaluations of the cost-effectiveness of male vaccination and next generation HPV vaccines, and to assess models used to evaluate new cervical screening technologies and recommendations.
Collapse
Affiliation(s)
- Leonardo Simonella
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Karen Canfell
- Lowy Cancer Research Centre, Prince of Wales Clinical School, The University of NSW, Sydney, Australia.
| |
Collapse
|
12
|
Laprise JF, Drolet M, Boily MC, Jit M, Sauvageau C, Franco EL, Lemieux-Mellouki P, Malagón T, Brisson M. Comparing the cost-effectiveness of two- and three-dose schedules of human papillomavirus vaccination: a transmission-dynamic modelling study. Vaccine 2014; 32:5845-53. [PMID: 25131743 DOI: 10.1016/j.vaccine.2014.07.099] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/15/2014] [Accepted: 07/30/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Recent evidence suggests that two doses of HPV vaccines may be as protective as three doses in the short-term. We estimated the incremental cost-effectiveness of two- and three-dose schedules of girls-only and girls & boys HPV vaccination programmes in Canada. METHODS We used HPV-ADVISE, an individual-based transmission-dynamic model of multi-type HPV infection and diseases (anogenital warts, and cancers of the cervix, vulva, vagina, anus, penis and oropharynx). We conducted the analysis from the health payer perspective, with a 70-year time horizon and 3% discount rate, and performed extensive sensitivity analyses, including duration of vaccine protection and vaccine cost. FINDINGS Assuming 80% coverage and a vaccine cost per dose of $85, two-dose girls-only vaccination (vs. no vaccination) produced cost/quality-adjusted life-year (QALY)-gained varying between $7900-24,300. The incremental cost-effectiveness ratio of giving the third dose to girls (vs. two doses) was below $40,000/QALY-gained when: (i) three doses provide longer protection than two doses and (ii) two-dose protection was shorter than 30 years. Vaccinating boys (with two or three doses) was not cost-effective (vs. girls-only vaccination) under most scenarios investigated. INTERPRETATION Two-dose HPV vaccination is likely to be cost-effective if its duration of protection is at least 10 years. A third dose of HPV vaccine is unlikely to be cost-effective if two-dose duration of protection is longer than 30 years. Finally, two-dose girls & boys HPV vaccination is unlikely to be cost-effective unless the cost per dose for boys is substantially lower than the cost for girls.
Collapse
Affiliation(s)
| | - Mélanie Drolet
- Centre de recherche du CHU de Québec, Québec, Canada; Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College, London, United Kingdom
| | - Mark Jit
- Modelling and Economics Unit, Public Health England, United Kingdom; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
| | - Philippe Lemieux-Mellouki
- Centre de recherche du CHU de Québec, Québec, Canada; Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | - Talía Malagón
- Centre de recherche du CHU de Québec, Québec, Canada; Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | - Marc Brisson
- Centre de recherche du CHU de Québec, Québec, Canada; Département de médecine sociale et préventive, Université Laval, Québec, Canada; Department of Infectious Disease Epidemiology, Imperial College, London, United Kingdom.
| |
Collapse
|
13
|
Estimation of the potential overall impact of human papillomavirus vaccination on cervical cancer cases and deaths. Vaccine 2013; 32:733-9. [PMID: 24291200 DOI: 10.1016/j.vaccine.2013.11.049] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 10/30/2013] [Accepted: 11/17/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) vaccination offers potential for primary prevention of HPV-related pre-cancers and cancers as demonstrated in clinical trials. Mathematical models have estimated the potential real-life impact of vaccination on the burden of cervical cancer (CC). However, these are restricted to evaluations in a limited number of countries. METHODS Potential decline in CC cases and deaths with the AS04-adjuvanted HPV-16/18 vaccine of young girls naïve to HPV, was estimated at steady-state (vaccine coverage: 0-100%) based on clinical trial and country-specific incidence data. Data on vaccine efficacy were taken from the end of study PATRICIA trial of the AS04-adjuvanted HPV-16/18 vaccine. The numbers of cases and deaths due to HPV-16/18 were estimated and compared with those due to any HPV type to estimate the additional cases prevented. This difference estimates CC cases and deaths avoided due to protection against non-vaccine HPV types. Cost-offsets due to reductions in CC treatment were estimated for five countries (Brazil, Canada, Italy, Malaysia and South African Republic) using country-specific unit cost data. Additionally, cervical intraepithelial neoplasia grade 2 or 3 (CIN2/3)-related burden (cases and treatment costs) prevented by vaccination were estimated for two countries (Italy and Malaysia). RESULTS HPV vaccination could prevent a substantial number of CC cases and deaths in countries worldwide, with associated cost-offsets due to reduced CC treatment. Cross-protection increased the estimated potential number of CC cases and deaths prevented by 34 and 18% in Africa and Oceania, respectively. Moreover, vaccination could result in a substantial reduction in the number of CIN2/3 lesions and associated costs. CONCLUSION HPV vaccination could reduce the burden of CC and precancerous lesions in countries worldwide, part of disease burden reduction being related to protection against non HPV-16/18 related types.
Collapse
|
14
|
Brisson M, Laprise JF, Drolet M, Van de Velde N, Franco EL, Kliewer EV, Ogilvie G, Deeks SL, Boily MC. Comparative cost-effectiveness of the quadrivalent and bivalent human papillomavirus vaccines: a transmission-dynamic modeling study. Vaccine 2013; 31:3863-71. [PMID: 23830974 DOI: 10.1016/j.vaccine.2013.06.064] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 06/05/2013] [Accepted: 06/19/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The quadrivalent and bivalent human papillomavirus (HPV) vaccines are now licensed in several countries. We compared the cost-effectiveness of the HPV vaccines to provide evidence for policy decisions. METHODS We developed HPV-ADVISE, a multi-type individual-based transmission-dynamic model of HPV infection and disease (anogenital warts, and cervical, anogenital and oropharyngeal cancers). We calibrated the model to sexual behavior and epidemiologic data from Canada, and estimated quality-adjusted life-years (QALYs) lost and costs ($CAN 2010) from the literature. Vaccine-type efficacy was based on a systematic literature review. The analysis was performed from the healthcare provider perspective, and costs and benefits were discounted at 3%. Predictions are presented using the median [10th;90th percentiles] of simulations. RESULTS Under base-case assumptions (vaccinating 10-year-old girls, 80% coverage, $95/dose), using the quadrivalent and bivalent vaccines is estimated to cost $15,528 [12,056;19,140] and $20,182 [15,531;25,240] per QALY-gained, respectively. At equal price, the quadrivalent vaccine is more cost-effective than bivalent under all scenarios investigated, except when assuming longer duration of protection for the bivalent and minimal anogenital warts burden. Under base-case assumptions, the maximum additional cost per dose for the quadrivalent vaccine to remain more cost-effective than the bivalent is $32 [17;46] (using a $40,000/QALY-gained threshold). Results were most sensitive to discounting, time-horizon, differences in durations of protection and anogenital warts burden. CONCLUSIONS Vaccinating pre-adolescent girls against HPV is predicted to be highly cost-effective. If equally priced, the quadrivalent is the most economically desirable vaccine. However, ultimately, the most cost-effective HPV vaccine will be determined by their relative price.
Collapse
Affiliation(s)
- Marc Brisson
- SP-POS, Centre de recherche du CHU de Québec, Québec, Canada.
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Yong JHE, Kerner J, Hoch JS. The need for economic evaluation in primary prevention of cancer. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2012; 103:e395-e396. [PMID: 23617996 PMCID: PMC6973585 DOI: 10.1007/bf03404449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 11/06/2012] [Accepted: 04/28/2012] [Indexed: 06/02/2023]
Affiliation(s)
- Jean H. E. Yong
- Pharmacoeconomics Research Unit, Cancer Care Ontario, 620 University Ave, Toronto, ON M5G 2L7 Canada
- Canadian Centre for Applied Research in Cancer Control (ARCC), Toronto, ON Canada
| | - Jon Kerner
- Canadian Partnership Against Cancer, Toronto, ON Canada
| | - Jeffrey S. Hoch
- Pharmacoeconomics Research Unit, Cancer Care Ontario, 620 University Ave, Toronto, ON M5G 2L7 Canada
- Canadian Centre for Applied Research in Cancer Control (ARCC), Toronto, ON Canada
- Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| |
Collapse
|
16
|
Kohli M, Lawrence D, Haig J, Anonychuk A, Demarteau N. Modeling the impact of the difference in cross-protection data between a human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine and a human papillomavirus (HPV)-6/11/16/18 vaccine in Canada. BMC Public Health 2012; 12:872. [PMID: 23061913 PMCID: PMC3503751 DOI: 10.1186/1471-2458-12-872] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 10/08/2012] [Indexed: 11/10/2022] Open
Abstract
Background In Canada, two vaccines that have demonstrated high efficacy against infection with human papillomavirus (HPV) types −16 and −18 are available. The HPV-6/11/16/18 vaccine provides protection against genital warts (GW) while the HPV-16/18 vaccine may provide better protection against other oncogenic HPV types. In this analysis, the estimated clinical and economic benefit of each of these vaccines was compared in the Canadian setting. Methods A Markov model of the natural history of HPV infection among women, cervical cancer (CC) and GW was used to estimate the impact of vaccinating a cohort of 100,000 12-year-old females on lifetime outcomes and healthcare system costs (no indirect benefit in males included). A budget impact model was used to estimate the impact of each vaccine by province. Results In the base case, vaccination with the HPV-16/18 vaccine was predicted to prevent 48 additional CC cases, and 16 additional CC deaths, while vaccination with the HPV-6/11/16/18 vaccine was predicted to prevent 6,933 additional GW cases. Vaccination with the HPV-16/18 vaccine was estimated to save 1 additional discounted quality adjusted life year (QALY) at an overall lower lifetime cost to the healthcare system compared to the HPV-6/11/16/18 vaccine (assuming vaccine price parity). In sensitivity analyses, the HPV-6/11/16/18 vaccine was associated with greater QALYs saved when the cross-protection efficacy of the HPV-16/18 vaccine was reduced, or the burden of GW due to HPV-6/11 was increased. In most scenarios with price parity, the lifetime healthcare cost of the strategy with the HPV-16/18 vaccine was predicted to be lower than the HPV-6/11/16/18 vaccine. In the probabilistic sensitivity analyses, the HPV-16/18 vaccine provided more QALY benefit than the HPV-6/11/16/18 vaccine in 49.2% of scenarios, with lower relative lifetime costs in 83.5% of scenarios. Conclusions Overall, the predicted lifetime healthcare costs and QALYs saved by implementing each of the vaccines are similar. Vaccination with the HPV-16/18 vaccine is expected to be associated with reduced CC disease morbidity and mortality compared to vaccination with the HPV-6/11/16/18 vaccine. Differences in these outcomes depend on the extent of cervical disease prevented by cross-protection and the burden of GW caused by HPV-6/11.
Collapse
Affiliation(s)
- Michele Kohli
- OptumInsight, Health Economics and Outcomes Research, 5500 North Service Rd, Burlington, ON L7L 6W6, Canada.
| | | | | | | | | |
Collapse
|
17
|
Walker R, Nickson C, Lew JB, Smith M, Canfell K. A revision of sexual mixing matrices in models of sexually transmitted infection. Stat Med 2012; 31:3419-32. [PMID: 22847789 DOI: 10.1002/sim.5545] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 06/15/2012] [Accepted: 07/03/2012] [Indexed: 11/07/2022]
Abstract
Two sexual mixing matrices previously used in models of sexually transmitted infections (STIs) are intended to calculate the probability of sexual interaction between age groups and sexual behaviour subgroups. When these matrices are used to specify multiple criteria for how people select sexual partners (such as age group and sexual behaviour class), their conditional probability structure means that they have in practice been prone to misuse. We constructed revised mixing matrices that incorporate a corrected conditional probability structure and then used one of them to examine the effect of this revision on population modelling of STIs. Using a dynamic model of human papillomavirus (HPV) transmission as an example, we examined changes to estimates of HPV prevalence and the relative reduction in age-standardised HPV incidence after the commencement of publicly funded HPV vaccination in Australia. When all other model specifications were left unchanged, the revised mixing matrix initially led to estimates of age-specific oncogenic HPV prevalence that were up to 11% higher than our previous models at certain ages. After re-calibrating the model by modifying unobservable parameters characterising HPV natural history, the revised mixing matrix yielded similar estimates to our previous models, predicting that vaccination would lead to relative HPV incidence reductions of 43% and 85% by 2010 and 2050, respectively, compared with 43% and 86% using the unrevised mixing matrix formulation. Our revised mixing matrix offers a rigorous alternative to commonly used mixing matrices, which can be used to reliably and explicitly accommodate conditional probabilities, with appropriate re-calibration of unobservable model parameters.
Collapse
Affiliation(s)
- Robert Walker
- Cancer Research Division, Cancer Council New South Wales, Sydney, NSW, Australia
| | | | | | | | | |
Collapse
|
18
|
Demarteau N, Tang CH, Chen HC, Chen CJ, Van Kriekinge G. Cost-effectiveness analysis of the bivalent compared with the quadrivalent human papillomavirus vaccines in Taiwan. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2012; 15:622-631. [PMID: 22867770 DOI: 10.1016/j.jval.2012.02.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 01/14/2012] [Accepted: 02/18/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To compare the epidemiological and economic impact of additional cross-protection against oncogenic human papillomavirus (HPV) types beyond 16/18 of the bivalent vaccine (BV) versus protection against nononcogenic HPV types 6/11 of the quadrivalent vaccine (QV) in Taiwan. METHODS A lifetime Markov model calibrated to the Taiwanese setting simulated the natural history of low-risk (engendering cervical intraepithelial neoplasia [CIN] 1 and genital warts) and high-risk HPV (engendering CIN1, CIN2/3, and cervical cancer [CC]) infections, screening, and vaccination (100% coverage) for a cohort of 12-year-old girls (N = 153,000). Transition probabilities, costs, and utilities were estimated from published data and expert opinion. Vaccine efficacy was obtained from each vaccine's respective clinical trials. Price-parity and lifelong protection was assumed for both vaccines. The number of CIN lesions, CC cases, CC deaths and genital wart (GW) cases, and quality-adjusted life-years were estimated. Costs and outcomes (discounted at 3% and 1.5%, respectively) were compared from a payer's perspective. RESULTS The model estimated that the BV led to an additional, undiscounted, 11,484 CIN1, 1,779 (+34.3% vs. QV) CIN2/3, 188 (+29.0% vs. QV) CC, and 69 (+29.0% vs. QV) CC deaths prevented compared with the QV, while the QV prevented 4,150 GW (+71%). This resulted in an additional 768 quality-adjusted life-years (QALY) and 11.6 million new Taiwan dollars costs saved for the BV versus the QV after discounting. CONCLUSION Both vaccines have a different epidemiological impact with an increased number of CC-related lesions potentially prevented for the BV because of additional cross-protection. In the Taiwanese setting, HPV mass vaccination using the BV was estimated to dominate vaccination using the QV.
Collapse
|
19
|
Seto K, Marra F, Raymakers A, Marra CA. The cost effectiveness of human papillomavirus vaccines: a systematic review. Drugs 2012; 72:715-43. [PMID: 22413761 DOI: 10.2165/11599470-000000000-00000] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Human papillomavirus (HPV) is one of the world's most common sexually transmitted infections, and has been associated with a number of cervical and non-cervical diseases, including cancer. HPV vaccines have been licensed for use in females for some time, but the quadrivalent vaccine has only recently become licensed for use in males. Many countries have adopted a vaccination programme for adolescent females based on results of cost-effectiveness analyses. However, given the new indications for use of the vaccine in males, decision makers require information on the cost effectiveness of vaccinating males in order to make policy decisions on whether or not to fund such programmes. OBJECTIVE Our objective was to conduct a qualitative systematic review to update a previously conducted review of HPV vaccine studies. METHODS Articles were obtained from an extensive literature search to determine the cost effectiveness of implementing an HPV vaccination programme with routine cervical cancer screening. A total of 29 studies were included in this review. Seventeen of the included articles looked only at cervical disease outcomes, and 12 studies also included non-cervical disease outcomes. Four studies explored the economic impact of vaccinating both boys and girls. One study focused on a population of men who have sex with men (MSM). RESULTS While different model structures, input parameters and baseline assumptions were used, the consistent message in studies that focused on female-only vaccination programmes was that routine vaccination of females is cost effective compared with cervical cancer screening alone. DISCUSSION Based on the currently available literature, it appears that the addition of boys to a vaccination programme generally exceeds traditional cost-effectiveness thresholds. The MSM population represents a potential additional target for routine HPV vaccination; however, more cost-effectiveness studies are required before making such a policy change.
Collapse
Affiliation(s)
- Katherine Seto
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | | | | | | |
Collapse
|
20
|
Abstract
BACKGROUND Papanicolaou test (Pap test) is the most effective screening tool to prevent cervical cancer. In Taiwan, the National Health Insurance offers women older than 30 years free Pap test; however, the screening rate is merely 52.6%. OBJECTIVE The purposes of this study were to understand the status quo of Taiwanese women undertaking Pap test and to investigate relevant factors affecting women having Pap tests by applying Andersen's health-service utilization model. METHODS This study adopted data from the Taiwan's National Health Insurance Research Database from 2004 to 2008, in which 241,843 women having Pap tests were analyzed. RESULTS The following groups have a higher odds ratio of participating in Pap tests: indigenous women, low-income women, elderly women, women who visit obstetrics and gynecology departments more frequently, less urbanized women, women with less access to medical resources, women with severe diseases, disabled women, women with chronic illnesses, women with cancer, women with gynecological diseases, women with acute diseases who have longer length of hospital stay, and women with chronic diseases who have shorter length of hospital stay. CONCLUSION This study provides the status quo and influential factors of women undergoing Pap tests. IMPLICATIONS FOR PRACTICE The results can assist medical personnel to offer appropriate information and intervention and can be a reference for making relevant health policies to raise the screening rates of Pap tests.
Collapse
|
21
|
Tully SP, Anonychuk AM, Sanchez DM, Galvani AP, Bauch CT. Time for change? An economic evaluation of integrated cervical screening and HPV immunization programs in Canada. Vaccine 2011; 30:425-35. [PMID: 22075091 DOI: 10.1016/j.vaccine.2011.10.067] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 10/24/2011] [Accepted: 10/26/2011] [Indexed: 11/16/2022]
Abstract
Many jurisdictions have implemented universal human papillomavirus (HPV) immunization programs in preadolescent females. However, the cost-effectiveness of modified cervical screening guidelines and/or catch-up immunization in older females in Canada has not been evaluated. We conducted a cost-utility analysis of screening and immunization with the bivalent vaccine for the Canadian setting from the Ministry of Health perspective. We used a dynamic model to capture herd immunity and included cross-protection against strains not included in the vaccine. We found that adding catch-up immunization to the current program would be cost-effective, and that combining catch-up immunization with delaying the age at which screening is first initiated could result in cost savings and net health gains.
Collapse
Affiliation(s)
- Stephen P Tully
- Department of Mathematics and Statistics, University of Guelph, Canada
| | | | | | | | | |
Collapse
|
22
|
Kim SY, Sweet S, Chang J, Goldie SJ. Comparative evaluation of the potential impact of rotavirus versus HPV vaccination in GAVI-eligible countries: a preliminary analysis focused on the relative disease burden. BMC Infect Dis 2011; 11:174. [PMID: 21679420 PMCID: PMC3129299 DOI: 10.1186/1471-2334-11-174] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 06/16/2011] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Immunization policymakers at global and local levels need to establish priorities among new vaccines competing for limited resources. However, comparison of the potential impact of single vaccination programs is challenging, primarily due to the limited number of vaccine analyses as well as their differing analytic approaches and reporting formats. The purpose of this study is to provide early insight into how the comparative impact of different new vaccines could be assessed in resource-poor settings with respect to affordability, cost-effectiveness, and distributional equity. METHODS We compared the health, economic, and financial consequences of introducing the two vaccines in 72 GAVI-eligible countries using a number of different outcome measures to evaluate affordability, cost-effectiveness, and distributional equity. We use simple static models to standardize the analytic framework and improve comparability between the two new vaccines. These simple models were validated by leveraging previously developed, more complex models for rotavirus and human papillomavirus (HPV). RESULTS With 70% coverage of a single-age cohort of infants and pre-adolescent girls, the lives saved with rotavirus (~274,000) and HPV vaccines (~286,000) are similar, although the timing of averted mortality differs; rotavirus-attributable deaths occur in close proximity to infection, while HPV-related cancer deaths occur largely after age 30. Deaths averted per 1000 vaccinated are 5.2 (rotavirus) and 12.6 (HPV). Disability-adjusted life years (DALYs) averted were ~7.15 million (rotavirus) and ~1.30 million (HPV), reflecting the greater influence of discounting on the latter, given the lagtime between vaccination and averted cancer. In most countries (68 for rotavirus and 66 for HPV, at the cost of I$25 per vaccinated individual) the incremental cost per DALY averted was lower than each country's GDP per capita. Financial resources required for vaccination with rotavirus are higher than with HPV since both genders are vaccinated. CONCLUSIONS While lifesaving benefits of rotavirus and HPV vaccines will be realized at different times, the number of lives saved over each target populations' lifetimes will be similar. Model-based analyses that use a standardized analytic approach and generate comparable outputs can enrich the priority-setting dialogue. Although new vaccines may be deemed cost-effective, other factors including affordability and distributional equity need to be considered in different settings. We caution that for priority setting in an individual country, more rigorous comparisons should be performed, using more comprehensive models and considering all relevant vaccines and delivery strategies.
Collapse
Affiliation(s)
- Sun-Young Kim
- Center for Health Decision Science, Harvard School of Public Health, Boston, MA, USA
| | | | | | | |
Collapse
|
23
|
Jit M, Demarteau N, Elbasha E, Ginsberg G, Kim J, Praditsitthikorn N, Sinanovic E, Hutubessy R. Human papillomavirus vaccine introduction in low-income and middle-income countries: guidance on the use of cost-effectiveness models. BMC Med 2011; 9:54. [PMID: 21569406 PMCID: PMC3123559 DOI: 10.1186/1741-7015-9-54] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 05/12/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends that the cost effectiveness of introducing human papillomavirus (HPV) vaccination is considered before such a strategy is implemented. However, developing countries often lack the technical capacity to perform and interpret results of economic appraisals of vaccines. To provide information about the feasibility of using such models in a developing country setting, we evaluated models of HPV vaccination in terms of their capacity, requirements, limitations and comparability. METHODS A literature review identified six HPV vaccination models suitable for low-income and middle-income country use and representative of the literature in terms of provenance and model structure. Each model was adapted by its developers using standardised data sets representative of two hypothetical developing countries (a low-income country with no screening and a middle-income country with limited screening). Model predictions before and after vaccination of adolescent girls were compared in terms of HPV prevalence and cervical cancer incidence, as was the incremental cost-effectiveness ratio of vaccination under different scenarios. RESULTS None of the models perfectly reproduced the standardised data set provided to the model developers. However, they agreed that large decreases in type 16/18 HPV prevalence and cervical cancer incidence are likely to occur following vaccination. Apart from the Thai model (in which vaccine and non-vaccine HPV types were combined), vaccine-type HPV prevalence dropped by 75% to 100%, and vaccine-type cervical cancer incidence dropped by 80% to 100% across the models (averaging over age groups). The most influential factors affecting cost effectiveness were the discount rate, duration of vaccine protection, vaccine price and HPV prevalence. Demographic change, access to treatment and data resolution were found to be key issues to consider for models in developing countries. CONCLUSIONS The results indicated the usefulness of considering results from several models and sets of modelling assumptions in decision making. Modelling groups were prepared to share their models and expertise to work with stakeholders in developing countries. Please see related article: http://www.biomedcentral.com/1741-7007/9/55.
Collapse
Affiliation(s)
- Mark Jit
- Modelling and Economics Unit, Health Protection Agency, London, UK
| | | | | | | | | | | | | | | |
Collapse
|