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Fuady A, Setiawan D, Man I, de Kok IMCM, Baussano I. Toward a Framework to Assess the Financial and Economic Burden of Cervical Cancer in Low- and Middle-Income Countries: A Systematic Review. JCO Glob Oncol 2024; 10:e2400066. [PMID: 39116362 DOI: 10.1200/go.24.00066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/02/2024] [Accepted: 06/11/2024] [Indexed: 08/10/2024] Open
Abstract
PURPOSE To review the economic burden assessment of cervical cancer in low- and middle-income countries (LMICs) and use the findings to develop a pragmatic, standardized framework for such assessment. METHODS We first systematically reviewed articles indexed in scientific databases reporting the methodology for collecting and calculating costs related to the cervical cancer burden in LMICs. Data on study design, costing approach, cost perspective, costing period, and cost type (direct medical costs [DMC], direct nonmedical costs [DNMC], and indirect costs [IC]) were extracted. Finally, we summarized the reported limitations in the methodology and used the solutions to inform our framework. RESULTS Cervical cancer treatment costs across LMICs vary greatly and can be extremely expensive, up to 70,968 International US dollars. Economic and financial assessment methods also vary greatly across countries. Of the 28 reviewed articles, 25 studies reported DMC for cervical cancer treatment by extracting cost information from billing or insurance databases (eight studies), conducting surveys (five), and estimating the costs (12). Only 11 studies-mainly through surveys-reported DNMC and IC. The economic burden assessment framework includes health care/payer and societal perspectives (DMC, DNMC, IC, and human capital loss) across the cervical cancer screening and treatment continuum. To assess health care/payer costs, we recommend combining the predefined treatment standards with actual local treatment practices, multiplied by unit costs. To assess societal costs, we recommend conducting a cost survey in line with a standardized yet adaptable protocol. CONCLUSION Our standardized, pragmatic framework allows assessment of economic and financial burden of cervical cancer in LMICs despite the different levels of available resources across countries. This framework will facilitate global comparisons and monitoring and may also be applied to other cancers.
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Affiliation(s)
- Ahmad Fuady
- International Agency for Research on Cancer, (IARC/WHO), Early Detection, Prevention and Infections Branch, Lyon, France
- Department of Community Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Evidence-based Health Policy Center, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Didik Setiawan
- Faculty of Pharmacy, University of Muhammadiyah Purwokerto, Purwokerto, Indonesia
| | - Irene Man
- International Agency for Research on Cancer, (IARC/WHO), Early Detection, Prevention and Infections Branch, Lyon, France
| | - Inge M C M de Kok
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Iacopo Baussano
- International Agency for Research on Cancer, (IARC/WHO), Early Detection, Prevention and Infections Branch, Lyon, France
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Gupta R, Gupta S. Point-of-care tests for human papillomavirus detection in uterine cervical samples: A review of advances in resource-constrained settings. Indian J Med Res 2023; 158:509-521. [PMID: 38236008 PMCID: PMC10878492 DOI: 10.4103/ijmr.ijmr_1143_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Indexed: 01/19/2024] Open
Abstract
Incidence of cervical cancer and associated mortality are still high in resource-constrained countries due to the lack of infrastructural facilities and trained workforce. Human papillomavirus (HPV)-based screening tests offer a better sensitivity (>90%) for the detection of cervical high-grade lesions. However, these tests usually require an extensive laboratory set-up and trained technical staff. Moreover, the high cost of the currently available and approved HPV tests precludes their use in the cervical cancer screening programmes in resource-limited settings. Hence, there is a felt need for a low-cost point-of-care (POC) HPV test with good performance characteristics to help augment cervical cancer screening in such settings. A recent meta-analysis demonstrated a good sensitivity and specificity for two of the commercially available POC HPV tests. The present review discusses the merits and limitations of the current commercially available POC and near-POC devices for HPV-based cervical cancer screening. The technologies that have the potential to be developed into low-cost POC tests and newer promising modalities for HPV-based POC or near POC have also been highlighted. This review underscores the need for collaborative and coordinated research for development of POC or near-POC HPV-based tests to be used in cervical cancer screening. Efforts need to be focussed on technologies that offer ease of performance without the requirement of sophisticated equipment or extensive sample pre-processing coupled with a good sensitivity and cost-effectiveness.
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Affiliation(s)
- Ruchika Gupta
- Division of Cytopathology, ICMR-National Institute for Cancer Prevention and Research, Noida, Uttar Pradesh, India
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Trisha AT, Shakil MH, Talukdar S, Rovina K, Huda N, Zzaman W. Tea Polyphenols and Their Preventive Measures against Cancer: Current Trends and Directions. Foods 2022; 11:3349. [PMID: 36359962 PMCID: PMC9658101 DOI: 10.3390/foods11213349] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/11/2022] [Accepted: 10/13/2022] [Indexed: 07/30/2023] Open
Abstract
Cancer is exerting an immense strain on the population and health systems all over the world. Green tea because of its higher simple catechin content (up to 30% on dry weight basis) is greatly popular as an anti-cancer agent which is found to reduce the risks of cancer as well as a range of other diseases. In addition, several in vitro and in vivo studies have shown that green tea possesses copious health benefits like anti-diabetic, anti-obese, anti-inflammatory, neuro-protective, cardio-protective, etc. This review highlights the anti-carcinogenic effects of green tea catechins integrating the recent information to gain a clear concept. Special emphasis was given to the effectiveness of green tea polyphenols (GTP) in the prevention of cancer. Overall, green tea has been found to be effective to reduce the risks of breast cancer, ovarian cancer, liver cancer, colorectal cancer, skin cancer, prostate cancer, oral cancer, etc. However, sufficient information was not found to support that green tea consumption reduces the risk of lung cancer, esophageal cancer, or stomach cancer. The exciting data integrated into this article will increase interest in future researchers to garner more fruitful information on the relevant topics.
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Affiliation(s)
- Anuva Talukder Trisha
- Department of Food Engineering and Tea Technology, Shahjalal University of Science and Technology, Sylhet 3114, Bangladesh
| | - Mynul Hasan Shakil
- Department of Food Engineering and Tea Technology, Shahjalal University of Science and Technology, Sylhet 3114, Bangladesh
| | - Suvro Talukdar
- Department of Food Engineering and Tea Technology, Shahjalal University of Science and Technology, Sylhet 3114, Bangladesh
| | - Kobun Rovina
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Kota Kinabalu 88400, Sabah, Malaysia
| | - Nurul Huda
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Kota Kinabalu 88400, Sabah, Malaysia
| | - Wahidu Zzaman
- Department of Food Engineering and Tea Technology, Shahjalal University of Science and Technology, Sylhet 3114, Bangladesh
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4
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Lv H, Jin S, Zou B, Liang Y, Xie J, Wu S. Analyzing the whole-transcriptome profiles of ncRNAs and predicting the competing endogenous RNA networks in cervical cancer cell lines with cisplatin resistance. Cancer Cell Int 2021; 21:532. [PMID: 34641878 PMCID: PMC8513283 DOI: 10.1186/s12935-021-02239-6] [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: 06/24/2021] [Accepted: 09/30/2021] [Indexed: 01/07/2023] Open
Abstract
Background Cervical cancer (CC) is one of the most common malignant tumors in women. In order to identify the functional roles and the interaction between mRNA and non-coding RNA (ncRNA, including lncRNA, circRNA and miRNA) in CC cisplatin (DDP) resistance, the transcription profile analysis was performed and a RNA regulatory model of CC DDP resistance was proposed. Methods In this study, whole-transcriptome sequencing analysis was conducted to study the ncRNA and mRNA profiles of parental SiHa cells and DDP resistant SiHa/DDP cells. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) were performed for pathway analysis based on the selected genes with significant differences in expression. Subsequently, ceRNA network analyses were conducted using the drug resistance-related genes and signal-transduction pathways by Cytoscape software. Furthermore, a ceRNA regulatory pathway, namely lncRNA-AC010198.2/hsa-miR-34b-3p/STC2, was selected by RT-qPCR validation and literature searching. Further validation was done by both dual-luciferase reporter gene assays and RNA pull-down assays. Besides that, the changes in gene expression and biological function were further studied by performing si-AC010198.2 transfection and DDP resistance analyses in the SiHa and SiHa/DDP cells, respectively. Results Using bioinformatics and dual-luciferase reporter gene analyses, we found that AC010198.2/miR-34b-3p/STC2 may be a key pathway for DDP resistance in CC cells. Significant differences in both downstream gene expression and the biological function assays including colony formation, migration efficiency and cell apoptosis were identified in AC010198.2 knockdown cells. Conclusions Our study will not only provide new markers and potential mechanism models for CC DDP resistance, but also discover novel targets for attenuating it. Supplementary Information The online version contains supplementary material available at 10.1186/s12935-021-02239-6.
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Affiliation(s)
- Huimin Lv
- Department of Obstetrics and Gynecology, Third Hospital of Shanxi Medical University (Shanxi Bethune Hospital), Shanxi Academy of Medical Sciences, TaiYuan, 030032, China
| | - Shanshan Jin
- Department of Obstetrics and Gynecology, Third Hospital of Shanxi Medical University (Shanxi Bethune Hospital), Shanxi Academy of Medical Sciences, TaiYuan, 030032, China.,Shanxi Key Laboratory of Birth Defect and Cell Regeneration, Shanxi Medical University, TaiYuan, 030001, China
| | - Binbin Zou
- Department of Pathology & Shanxi Key Laboratory of Carcinogenesis and Translational Research on Esophageal Cancer, Shanxi Medical University, Taiyuan, 030001, China
| | - Yuxiang Liang
- Shanxi Key Laboratory of Birth Defect and Cell Regeneration, Shanxi Medical University, TaiYuan, 030001, China
| | - Jun Xie
- Shanxi Key Laboratory of Birth Defect and Cell Regeneration, Shanxi Medical University, TaiYuan, 030001, China.,Key Laboratory of Cellular Physiology (Shanxi Medical University), Ministry of Education, TaiYuan, 030001, China
| | - Suhui Wu
- Department of Obstetrics and Gynecology, Third Hospital of Shanxi Medical University (Shanxi Bethune Hospital), Shanxi Academy of Medical Sciences, TaiYuan, 030032, China.
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Portnoy A, Sweet S, Desalegn D, Memirie ST, Kim JJ, Verguet S. Health gains and financial protection from human papillomavirus vaccination in Ethiopia: findings from a modelling study. Health Policy Plan 2021; 36:891-899. [PMID: 33942850 PMCID: PMC8227995 DOI: 10.1093/heapol/czab052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 12/24/2022] Open
Abstract
High out-of-pocket (OOP) medical expenses for cervical cancer (CC) can lead to catastrophic health expenditures (CHEs) and medical impoverishment in many low-resource settings. There are 32 million women at risk for CC in Ethiopia, where CC screening is extremely limited. An evaluation of the population health and financial risk protection benefits, and their distributional consequences across socioeconomic groups, from human papillomavirus (HPV) vaccination will be critical to support CC prevention efforts in this setting. We used a static cohort model that captures the main features of HPV vaccines and population demographics to project health and economic outcomes associated with routine HPV vaccination in Ethiopia. Health outcomes included the number of CC cases, and costs included vaccination and operational costs in 2015 US dollars over the years 2019–2118 and CC treatment costs over the lifetimes of cohorts eligible for vaccination in Ethiopia. We estimated the household OOP medical expenditures averted (assuming 68% of direct medical expenditures were financed OOP) and cases of CHE averted. A case of CHE was defined as 40% of household consumption expenditures, and the cases of CHE averted depended on wealth quintile, disease incidence, healthcare use and OOP payments. Our analysis shows that, assuming 100% vaccine efficacy against HPV-16/18 and 50% vaccination coverage, routine HPV vaccination could avert up to 970 000 cases of CC between 2019 and 2118, which translates to ∼932 000 lives saved. Additionally, routine HPV vaccination could avert 33 900 cases of CHE. Approximately one-third of health benefits would accrue to the poorest wealth quintile, whereas 50% of financial risk protection benefits would accrue to this quintile. HPV vaccination can reduce disparities in CC incidence, mortality and household health expenditures. This understanding and our findings can help policymakers in decisions regarding targeted CC control efforts and investment in a routine HPV vaccination programme following an initial catch-up programme.
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Affiliation(s)
- Allison Portnoy
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Avenue, 2nd Floor, Boston, MA 02115, USA
| | - Steven Sweet
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Avenue, 2nd Floor, Boston, MA 02115, USA.,Vitalant Research Institute, 270 Masonic Avenue, San Francisco, CA 94118, USA
| | - Dawit Desalegn
- Department of Gynecology and Obstetrics, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Tessema Memirie
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jane J Kim
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Avenue, 2nd Floor, Boston, MA 02115, USA
| | - Stéphane Verguet
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Avenue, 2nd Floor, Boston, MA 02115, USA.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
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Devine A, Vahanian A, Sawadogo B, Zan S, Bocoum FY, Kelly H, Gilham C, Nagot N, Ong JJ, Legood R, Meda N, Miners A, Mayaud P. Costs and cost-effectiveness of cervical cancer screening strategies in women living with HIV in Burkina Faso: The HPV in Africa Research Partnership (HARP) study. PLoS One 2021; 16:e0248832. [PMID: 33765011 PMCID: PMC7993811 DOI: 10.1371/journal.pone.0248832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/05/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION This study estimated the costs and incremental cost per case detected of screening strategies for high-grade cervical intraepithelial neoplasia (CIN2+) in women living with HIV (WLHIV) attending HIV clinics in Burkina Faso. METHODS The direct healthcare provider costs of screening tests (visual inspection with acetic acid (VIA), VIA combined visual inspection with Lugol's iodine (VIA/VILI), cytology and a rapid HPV DNA test (careHPV)) and confirmatory tests (colposcopy, directed biopsy and systematic four-quadrant (4Q) biopsy) were collected alongside the HPV in Africa Research Partnership (HARP) study. A model was developed for a hypothetical cohort of 1000 WLHIV using data on CIN2+ prevalence and the sensitivity of the screening tests. Costs are reported in USD (2019). RESULTS The study enrolled 554 WLHIV with median age 36 years (inter-quartile range, 31-41) and CIN2+ prevalence of 5.8%. The average cost per screening test ranged from US$3.2 for VIA to US$24.8 for cytology. Compared to VIA alone, the incremental cost per CIN2+ case detected was US$48 for VIA/VILI and US$814 for careHPV. Despite higher costs, careHPV was more sensitive for CIN2+ cases detected compared to VIA/VILI (97% and 56%, respectively). The cost of colposcopy was US$6.6 per person while directed biopsy was US$33.0 and 4Q biopsy was US$48.0. CONCLUSION Depending on the willingness to pay for the detection of a case of cervical cancer, decision makers in Burkina Faso can consider a variety of cervical cancer screening strategies for WLHIV. While careHPV is more costly, it has the potential to be cost-effective depending on the willingness to pay threshold. Future research should explore the lifetime costs and benefits of cervical cancer screening to enable comparisons with interventions for other diseases.
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Affiliation(s)
- Angela Devine
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Alice Vahanian
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Bernard Sawadogo
- Centre de Recherche Internationale pour la Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - Souleymane Zan
- Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Fadima Yaya Bocoum
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Helen Kelly
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Clare Gilham
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nicolas Nagot
- Pathogenesis and control of chronic infections, INSERM, Etablissement Francais du Sang, University of Montpellier, Montpellier, France
| | - Jason J. Ong
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Rosa Legood
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nicolas Meda
- Centre de Recherche Internationale pour la Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - Alec Miners
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Philippe Mayaud
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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Wu Q, Jia M, Chen H, Zhang S, Liu Y, Prem K, Qian M, Yu H. The economic burden of cervical cancer from diagnosis to one year after final discharge in Henan Province, China: A retrospective case series study. PLoS One 2020; 15:e0232129. [PMID: 32379783 PMCID: PMC7205285 DOI: 10.1371/journal.pone.0232129] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/07/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In China, the disease burden of cervical cancer remains substantial. Human papillomavirus (HPV) vaccines are expensive and not yet centrally funded. To inform immunization policy, understanding the economic burden of the disease is necessary. This study adopted a societal perspective and investigated costs and quality of life changes associated with cervical cancer from diagnosis to one year after final discharge in Henan province, China. METHODS Inpatient records of cervical cancer patients admitted to the largest cancer hospital in Henan province between Jan. 2017 and Dec. 2018 were extracted. A telephone interview with four modules was conducted in Jun.-Jul. 2019 with a 40% random draw of patients to obtain direct non-medical costs and indirect costs associated with inpatients, costs associated with outpatient visits, and changes in quality of life status using the EQ-5D-5L instrument. Direct medical expenditures were converted to opportunity costs of care using cost-to-charge ratios obtained from hospital financial reports. For each clinical stage (IA-IV), total costs per case from diagnosis to one year after final discharge were extrapolated based on inpatient records, responses to the telephone interview, and recommendation on outpatient follow-ups by Chinese cervical cancer treatment guidelines. Loss in quality-adjusted life years was obtained using the 'under the curve' method and regression predictions. RESULTS A total of 3,506 inpatient records from 1,323 patients were obtained. Among 541 randomly selected patients, 309 completed at least one module of the telephone interview. The average total costs per case associated with cervical cancer from diagnosis to one year after final discharge ranged from $8,066-$22,888 (in 2018 US Dollar) and the quality-adjusted life years loss varied from 0.05-0.26 for IA-IV patients. CONCLUSIONS The economic burden associated with cervical cancer is substantial in Henan province. Our study provided important baseline information for cost-effectiveness analysis of HPV immunization program in China.
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Affiliation(s)
- Qianhui Wu
- School of Public Health, Fudan University, Shanghai, China
| | - Manman Jia
- Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongmin Chen
- Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Shaokai Zhang
- Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Yang Liu
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England, United Kingdom
| | - Kiesha Prem
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England, United Kingdom
| | - Mengcen Qian
- School of Public Health, Fudan University, Shanghai, China
- Key Laboratory Health Technology Assessment (Fudan University), Ministry of Health, Shanghai, China
| | - Hongjie Yu
- School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Shanghai, China
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Portnoy A, Campos NG, Sy S, Burger EA, Cohen J, Regan C, Kim JJ. Impact and Cost-Effectiveness of Human Papillomavirus Vaccination Campaigns. Cancer Epidemiol Biomarkers Prev 2019; 29:22-30. [DOI: 10.1158/1055-9965.epi-19-0767] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/13/2019] [Accepted: 10/23/2019] [Indexed: 11/16/2022] Open
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Mao X, Xiao X, Chen D, Yu B, He J. Tea and Its Components Prevent Cancer: A Review of the Redox-Related Mechanism. Int J Mol Sci 2019; 20:E5249. [PMID: 31652732 PMCID: PMC6862630 DOI: 10.3390/ijms20215249] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 02/07/2023] Open
Abstract
Cancer is a worldwide epidemic and represents a major threat to human health and survival. Reactive oxygen species (ROS) play a dual role in cancer cells, which includes both promoting and inhibiting carcinogenesis. Tea remains one of the most prevalent beverages consumed due in part to its anti- or pro-oxidative properties. The active compounds in tea, particularly tea polyphenols, can directly or indirectly scavenge ROS to reduce oncogenesis and cancerometastasis. Interestingly, the excessive levels of ROS induced by consuming tea could induce programmed cell death (PCD) or non-PCD of cancer cells. On the basis of illustrating the relationship between ROS and cancer, the current review discusses the composition and efficacy of tea including the redox-relative (including anti-oxidative and pro-oxidative activity) mechanisms and their role along with other components in preventing and treating cancer. This information will highlight the basis for the clinical utilization of tea extracts in the prevention or treatment of cancer in the future.
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Affiliation(s)
- Xiangbing Mao
- Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China.
- Key Laboratory of Animal Disease-Resistance Nutrition, Ministry of Education, Chengdu 611130, China.
- Key Laboratory of Animal Disease-Resistance Nutrition and Feed, Ministry of Agriculture and Rural Affairs, Chengdu 611130, China.
- Key Laboratory of Animal Disease-Resistance Nutrition, Chengdu 611130, China.
| | - Xiangjun Xiao
- Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China.
| | - Daiwen Chen
- Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China.
- Key Laboratory of Animal Disease-Resistance Nutrition, Ministry of Education, Chengdu 611130, China.
- Key Laboratory of Animal Disease-Resistance Nutrition and Feed, Ministry of Agriculture and Rural Affairs, Chengdu 611130, China.
- Key Laboratory of Animal Disease-Resistance Nutrition, Chengdu 611130, China.
| | - Bing Yu
- Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China.
- Key Laboratory of Animal Disease-Resistance Nutrition, Ministry of Education, Chengdu 611130, China.
- Key Laboratory of Animal Disease-Resistance Nutrition and Feed, Ministry of Agriculture and Rural Affairs, Chengdu 611130, China.
- Key Laboratory of Animal Disease-Resistance Nutrition, Chengdu 611130, China.
| | - Jun He
- Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China.
- Key Laboratory of Animal Disease-Resistance Nutrition, Ministry of Education, Chengdu 611130, China.
- Key Laboratory of Animal Disease-Resistance Nutrition and Feed, Ministry of Agriculture and Rural Affairs, Chengdu 611130, China.
- Key Laboratory of Animal Disease-Resistance Nutrition, Chengdu 611130, China.
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10
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Liu YJ, Keane A, Simms KT, Lew JB, Shi JF, Mazariego C, Yuill S, Jeronimo J, Qiao YL, Canfell K. Development and application of a framework to estimate health care costs in China: The cervical cancer example. PLoS One 2019; 14:e0222760. [PMID: 31574103 PMCID: PMC6773209 DOI: 10.1371/journal.pone.0222760] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 09/07/2019] [Indexed: 11/25/2022] Open
Abstract
Objectives Information on healthcare costs in low-and-middle-income countries is limited. This study presents a framework to perform healthcare cost estimates for each province in China. Methods This study has two aims. Using cervical cancer as an example, the first aim is to use data (including micro-costing data) from one province to derive estimates for other provinces in China. This used provincial and national Chinese-language statistical reports and considered levels of service delivery, hospital-seeking behaviour, and the urban/rural population distribution. The second aim is to characterise the relationship between the reference costs estimated using the method mentioned above and two sets of cost estimates derived using simplified cost-scaling method with per capita Gross Domestic Product (GDP), and the Human Development Index (HDI). For simplified methods, regression modelling characterised the relationship between province-specific healthcare costs and macro-economic indicators, then we used the exponential fit to extrapolate costs. Results Using the reference method, the estimated costs were found to vary substantially by urban/rural regions and between provinces; the ratios of highest to lowest provincial costs were 3.5 for visual inspection with acetic acid (VIA), 4.4 for cold knife conisation (CKC) and 4.6 for stage II cancer treatment. The HDI-based scaling method generally resulted in a better fit to reference costs than the GDP method. Conclusions These reference costs for cervical cancer can inform cost-effectiveness evaluation of cervical screening and HPV vaccination in China. HDI-based methods for cost-scaling-based on social, as well as purely economic, factors-have potential to provide more accurate estimates.
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Affiliation(s)
- Yi-Jun Liu
- School of Public Health, Zunyi Medical University, Zunyi, China
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia
| | - Adam Keane
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia
| | - Kate T. Simms
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia
| | - Jie-Bin Lew
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia
| | - Ju-Fang Shi
- Department of Epidemiology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Carolyn Mazariego
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia
| | - Susan Yuill
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia
| | - Jose Jeronimo
- Global Coalition against Cervical Cancer, Arlington, Virginia, United States of America
| | - You-Lin Qiao
- Department of Epidemiology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Karen Canfell
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia
- School of Public Health, University of Sydney, Sydney, Australia
- Prince of Wales Clinical School, Faculty of Medicine, UNSW, Sydney, Australia
- * E-mail:
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11
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Xia C, Hu S, Xu X, Zhao X, Qiao Y, Broutet N, Canfell K, Hutubessy R, Zhao F. Projections up to 2100 and a budget optimisation strategy towards cervical cancer elimination in China: a modelling study. LANCET PUBLIC HEALTH 2019; 4:e462-e472. [DOI: 10.1016/s2468-2667(19)30162-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/30/2019] [Accepted: 07/30/2019] [Indexed: 12/29/2022]
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Jahn B, Todorovic J, Bundo M, Sroczynski G, Conrads-Frank A, Rochau U, Endel G, Wilbacher I, Malbaski N, Popper N, Chhatwal J, Greenberg D, Mauskopf J, Siebert U. Budget Impact Analysis of Cancer Screening: A Methodological Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:493-511. [PMID: 31016686 DOI: 10.1007/s40258-019-00475-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Budget impact analyses (BIAs) describe changes in intervention- and disease-related costs of new technologies. Evidence on the quality of BIAs for cancer screening is lacking. OBJECTIVES We systematically reviewed the literature and methods to assess how closely BIA guidelines are followed when BIAs are performed for cancer-screening programs. DATA SOURCES Systematic searches were conducted in MEDLINE, EMBASE, EconLit, CRD (Centre for Reviews and Dissemination, University of York), and CEA registry of the Tufts Medical Center. STUDY ELIGIBILITY CRITERIA Eligible studies were BIAs evaluating cancer-screening programs published in English, 2010-2018. SYNTHESIS METHODS Standardized evidence tables were generated to extract and compare study characteristics outlined by the ISPOR BIA Task Force. RESULTS Nineteen studies were identified evaluating screening for breast (5), colorectal (6), cervical (3), lung (1), prostate (3), and skin (1) cancers. Model designs included decision-analytic models (13) and simple cost calculators (6). From all studies, only 53% reported costs for a minimum of 3 years, 58% compared to a mix of screening options, 42% reported model validation, and 37% reported uncertainty analysis for participation rates. The quality of studies appeared to be independent of cancer site. LIMITATIONS "Gray" literature was not searched, misinterpretation is possible due to limited information in publications, and focus was on international methodological guidelines rather than regional guidelines. CONCLUSIONS Our review highlights considerable variability in the extent to which BIAs evaluating cancer-screening programs followed recommended guidelines. The annual budget impact at least over the next 3-5 years should be estimated. Validation and uncertainty analysis should always be conducted. Continued dissemination efforts of existing best-practice guidelines are necessary to ensure high-quality analyses.
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Affiliation(s)
- Beate Jahn
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tyrol, Austria
| | - Jovan Todorovic
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tyrol, Austria
| | - Marvin Bundo
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tyrol, Austria
| | - Gaby Sroczynski
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tyrol, Austria
| | - Annette Conrads-Frank
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tyrol, Austria
| | - Ursula Rochau
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tyrol, Austria
| | - Gottfried Endel
- Evidence-based Health Care, Main Association of Austrian Social Insurance Institutions, Haidingergasse 1, 1030, Vienna, Austria
| | - Ingrid Wilbacher
- Evidence-based Health Care, Main Association of Austrian Social Insurance Institutions, Haidingergasse 1, 1030, Vienna, Austria
| | - Nikoletta Malbaski
- Evidence-based Health Care, Main Association of Austrian Social Insurance Institutions, Haidingergasse 1, 1030, Vienna, Austria
| | - Niki Popper
- DWH Simulation Services, DEXHELPP, Neustiftgasse 57-59, 1070, Vienna, Austria
- TU Wien, Information and Software Engineering Group (ifs - E194-01), Favoritenstraße 9-11/194-01, 1040, Vienna, Austria
| | - Jagpreet Chhatwal
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 101 Merrimac St, Boston, MA, 02114, USA
| | - Dan Greenberg
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Josephine Mauskopf
- RTI Health Solutions, RTI International, 3040 Cornwallis Rd, Durham, NC, 27709, USA
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tyrol, Austria.
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 101 Merrimac St, Boston, MA, 02114, USA.
- Division of Health Technology Assessment, ONCOTYROL-Center for Personalized Cancer Medicine, Karl-Kapferer-Straße 5, 6020, Innsbruck, Austria.
- Department of Health Policy and Management, Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Avenue, Boston, MA, 02115, USA.
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13
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Yu M, Xu B, Yang H, Xue S, Zhang R, Zhang H, Ying X, Dai Z. MicroRNA-218 regulates the chemo-sensitivity of cervical cancer cells through targeting survivin. Cancer Manag Res 2019; 11:6511-6519. [PMID: 31372052 PMCID: PMC6636183 DOI: 10.2147/cmar.s199659] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 04/10/2019] [Indexed: 12/24/2022] Open
Abstract
Background: Cervical cancer is one of the most lethal malignancies among women in the world. Every year about 311,365 women die because of cervical cancer. Chemo-resistance is the main reason of the lethal malignancies, and the mechanism of chemo-resistance in cervical cancer still remains largely elusive. Purpose: Previous studies reported that microRNAs played important biological roles in the chemo-resistance in many types of cancers, in the present study we tried to investigate the biological roles of microRNA-218 in chemo-resistance in cervical cancer cells. Results: Real-time PCR results indicated microRNA-218 was downregulated in cisplatin-resistant HeLa/DDP and SiHa/DDP cells compared with the mock HeLa and SiHa cells. CCK-8 assay results showed upregulation of microRNA-218 enhanced the cisplatin sensitivity of cervical cancer cells; while downregulation of microRNA-218 decreased the cisplatin sensitivity of cervical cancer cells. Dual-luciferase assay indicated survivin was a direct target of microRNA-218. Western blotting and PCR results indicated the expression of survivin in HeLa/DDP and SiHa/DDP cells was significantly increased compared with HeLa and SiHa cells. Further study indicated induction of microRNA-218 decreased the expression of survivin while inhibition of microRNA-218 increased the expression of survivin in cervical cancer cells. Cell apoptosis results indicated induction of microRNA-218 induced the cell apoptosis in cervical cancer cells. Conclusion: Our data revealed microRNA-218 enhanced the cisplatin sensitivity in cervical cancer cells through regulation of cell growth and cell apoptosis, which could potentially benefit to the cervical cancer treatment in the future.
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Affiliation(s)
- Minmin Yu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, People's Republic of China.,Department of Obstetrics and Gynecology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing 210003, People's Republic of China
| | - Baozhen Xu
- Department of Obstetrics and Gynecology, Nanjing Lishui People's Hospital, Nanjing 211200, People's Republic of China
| | - Hui Yang
- Department of Obstetrics and Gynecology, Huaian Maternal and Child Health Care Hospital, Huaian 223002, People's Republic of China
| | - Songlin Xue
- Department of Obstetrics and Gynecology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing 210003, People's Republic of China
| | - Rong Zhang
- Department of Obstetrics and Gynecology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing 210003, People's Republic of China
| | - Hongmei Zhang
- Department of Clinical Research Center, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing 210003, People's Republic of China
| | - Xiaoyan Ying
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, People's Republic of China
| | - Zhiqin Dai
- Department of Gynecologic Oncology, Jiangsu Cancer Hospital, Nanjing 210009, People's Republic of China
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14
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Granados-García V, Piña-Sánchez P, Reynoso-Noveron N, Flores YN, Toledano-Toledano F, Estrada-Gómez G, Apresa-García T, Briseño AA. Medical Cost to Treat Cervical Cancer Patients at a Social Security Third Level Oncology Hospital in Mexico City. Asian Pac J Cancer Prev 2019; 20:1547-1554. [PMID: 31128061 PMCID: PMC6857888 DOI: 10.31557/apjcp.2019.20.5.1547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Cervical Cancer (CC) is an important public health problem worldwide. In 2015, CC was the sixth leading cause of death for women aged 30-59 years in Mexico. Despite the importance of having high-quality and accurate estimates of CC treatment costs that can be used to effectively evaluate the impact of preventive programs, there is scarce information on this topic in Mexico. Objective: To estimate the treatment costs by stage diagnosis in patients with CC at a Mexican Social Security Institute (IMSS) oncology hospital in Mexico City. Methods: An observational retrospective study of the resources used to treat 346 women with CC was conducted. Medical charts were reviewed and relevant resource use information was extracted using a data collection instrument that was created based on treatment guidelines. Data were classified into nine cost categories to estimate the total cost per patient. Results: The mean age of patients in the study sample was 54.3 years (range: 41-67), and the average body mass index (BMI) was >26 kg/m2. Among the participants, 37% were smokers, 39% had diabetes, and 56% had hypertension. The medical cost for stages I-IV ranged from $4,738 to $6,058 USD, with an estimated average cost of $5,114 USD. Conclusion: Total treatment costs per patient are high, especially since they were estimated considering only 7.5 months of treatment. This is the first study to estimate the annual cost to treat CC in Mexico and to additionally document the resource pattern use, cost by stage of cancer, and the distribution by cost categories.
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Affiliation(s)
- Víctor Granados-García
- Epidemiological and Health Services Research Unit. Aging Area, 21st Century National Medical Center. Mexican Institute of Social Security (IMSS). Mexico City, Mexico. vic.granados @ gmail.com
| | - Patricia Piña-Sánchez
- Unit of Medical Research in Oncological Diseases, UMAE, Oncology Hospital, 21st Century National Medical Center, IMSS. Mexico City, Mexico
| | | | - Yvonne N Flores
- Epidemiological and Health Services Research Unit, Morelos Delegation, IMSS. Cuernavaca Morelos, Mexico.,UCLA Department of Health Policy and Management, Cancer Prevention and Control Research, Fielding School of Public, Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Filiberto Toledano-Toledano
- Evidence-Based Medicine Research Unit. Children’s Hospital of Mexico Federico Gómez, National Institute of Health. Mexico City, Mexico
| | - Gloria Estrada-Gómez
- Epidemiological and Health Services Research Unit. Aging Area, 21st Century National Medical Center. Mexican Institute of Social Security (IMSS). Mexico City, Mexico. vic.granados @ gmail.com
| | - Teresa Apresa-García
- Unit of Medical Research in Oncological Diseases, UMAE, Oncology Hospital, 21st Century National Medical Center, IMSS. Mexico City, Mexico
| | - Arely A Briseño
- Epidemiological and Health Services Research Unit, Morelos Delegation, IMSS. Cuernavaca Morelos, Mexico
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15
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Atkinson AE, Mandujano CAM, Bejarano S, Kennedy LS, Tsongalis GJ. Screening for Human Papillomavirus in a Low- and Middle-Income Country. J Glob Oncol 2019; 5:JGO1800233. [PMID: 31050922 PMCID: PMC6550056 DOI: 10.1200/jgo.18.00233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Low- and middle-income countries have high incidences of cervical cancer linked to human papillomavirus (HPV), and without resources for cancer screenings these countries bear 85% of all cervical cancer cases. To address some of these needs, brigade-style screening combined with sensitive polymerase chain reaction–based HPV testing to detect common high-risk HPV genotypes may be necessary. METHODS We deployed an inexpensive DNA extraction technique and a real-time polymerase chain reaction–based HPV genotyping assay, as well as Papanicolaou testing, in a factory in San Pedro Sula, Honduras, where 1,732 women were screened for cervical cancer. RESULTS We found that 28% of participants were positive for high-risk HPV, with 26% of HPV-positive participants having more than one HPV infection. Moreover, the most common HPV genotypes detected were different than those routinely found in the United States. CONCLUSION This work demonstrates a deployable protocol for HPV screening in low- and middle-income countries with limited resources to perform cytopathology assessment of Pap smears.
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Affiliation(s)
- Aaron E Atkinson
- Dartmouth Hitchcock Health System, Lebanon, NH.,Geisel School of Medicine at Dartmouth, Hanover, NH
| | | | | | - Linda S Kennedy
- Dartmouth Hitchcock Health System, Lebanon, NH.,Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Gregory J Tsongalis
- Dartmouth Hitchcock Health System, Lebanon, NH.,Geisel School of Medicine at Dartmouth, Hanover, NH
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16
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Pathways to a cancer-free future: A protocol for modelled evaluations to maximize the future impact of interventions on cervical cancer in Australia. Gynecol Oncol 2019; 152:465-471. [PMID: 30876490 DOI: 10.1016/j.ygyno.2018.12.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/05/2018] [Accepted: 12/21/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Australia's HPV vaccination and HPV-based cervical screening programs are changing the landscape in cervical cancer prevention. We aim to identify areas which can make the biggest further impact on cervical cancer burden. This protocol describes the first stage of a program of work called Pathways-Cervix that aims to generate evidence from modelled evaluations of interventions across the cervical cancer spectrum. METHODS Based on evidence from literature reviews and guidance from a multi-disciplinary Scientific Advisory Committee (SAC), the most relevant evaluations for prevention, diagnosis and treatment were identified. RESULTS Priority evaluations agreed by the SAC included: increasing/decreasing and retaining vaccination uptake at the current level; vaccinating older women; increasing screening participation; methods for triaging HPV-positive women; improving the diagnosis of cervical intraepithelial neoplasia (CIN) and cancer; treating cervical abnormalities and cancer; and vaccinating women treated for CIN2/3 to prevent recurrence. Evaluations will be performed using a simulation model, Policy1-Cervix previously used to perform policy evaluations in Australia. Exploratory modelling of interventions using idealised scenarios will initially be conducted in single birth cohorts. If these have a significant impact on findings then evaluations with more realistic assumptions will be conducted. Promising strategies will be investigated further by multi-cohort simulations predicting health outcomes, resource use and cost outcomes. CONCLUSIONS Pathways-Cervix will assess the relative benefits of strategies and treatment options in a systematic and health economic framework, producing a list of 'best buys' for future decision-making in cervical cancer control.
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17
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Lince-Deroche N, van Rensburg C, Roseleur J, Sanusi B, Phiri J, Michelow P, Smith JS, Firnhaber C. Costs and cost-effectiveness of LEEP versus cryotherapy for treating cervical dysplasia among HIV-positive women in Johannesburg, South Africa. PLoS One 2018; 13:e0203921. [PMID: 30308014 PMCID: PMC6181291 DOI: 10.1371/journal.pone.0203921] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 08/30/2018] [Indexed: 11/19/2022] Open
Abstract
Background Cervical cancer incidence is significant in countries, such as South Africa, with high burdens of both HIV and human papillomavirus (HPV). Cervical cancer is largely preventable if dysplasia is diagnosed and treated early, but there is debate regarding the best approaches for screening and treatment, especially for low-resource settings. Currently South Africa provides Pap smears followed by colposcopic biopsy and LEEP if needed in its public health facilities. We estimated the costs and cost-effectiveness of two approaches for treating cervical intraepithelial neoplasia grade 2 or higher (CIN2+) among HIV-infected women, most of whom were taking antiretroviral treatment, at a public HIV treatment facility in Johannesburg, South Africa. Methods Method effectiveness was derived from an intention-to-treat analysis of data gathered in a clinical trial completed previously at the study facility. In the trial, women who were diagnosed with CIN2+ and eligible for cryotherapy were randomized to cryotherapy or LEEP. If women were CIN2+ at six months as determined via Pap smear and colposcopic biopsy, all women—regardless of their original treatment assignment—received LEEP. “Cure” was then defined as the absence of disease at 12 months based on Pap smear and colposcopic biopsy. Health service costs were estimated using micro-costing between June 2013 and April 2014. Capital costs were annualized using a discount rate of 3%. Two different service volume scenarios were considered, and results from an as-treated analysis were considered in sensitivity analysis. Results In total, 166 women with CIN2+ were enrolled (86 had LEEP; 80 had cryotherapy). At 12 months, cumulative loss to follow-up was 12.8% (11/86) for the LEEP group and 13.8% (11/80) for cryotherapy. Based on the unadjusted intention-to-treat analysis conducted for this economic evaluation, there was no significant difference in efficacy. At 12 months, 83.8% (95% CI 73.8–91.1) of women with CIN2+ at baseline and randomized to cryotherapy were free of CIN2+ disease. In contrast, 76.7% (95% CI 66.4–85.2) of women assigned to LEEP were free from disease. On average, women initially treated with cryotherapy were less costly per patient randomized at US$ 118.00 (113.91–122.10), and per case “cured” at US$ 140.90 (136.01–145.79). Women in the LEEP group cost US$ 162.56 (157.90–167.22) per patient randomized and US$ 205.59 (199.70–211.49) per case cured. In the as-treated analysis, which was based on trial data, LEEP was more efficacious than cryotherapy; however, the difference was not significant. Cryotherapy remained more cost-effective than LEEP in all sensitivity and scenario analyses. Conclusions For this cost-effectiveness analysis, using an intention-to-treat approach and taking into consideration uncertainty in the clinical and cost outcomes, a strategy involving cryotherapy plus LEEP if needed at six months was dominant to LEEP plus LEEP again at six months if needed for retreatment. However, compared to other studies comparing LEEP and cryotherapy, the efficacy results were low in both treatment groups–possibly due to the HIV-positivity of the participants. Further research is needed, but at present choosing the “right” treatment option may be less important than ensuring access to treatment and providing careful monitoring of treatment outcomes.
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Affiliation(s)
- Naomi Lince-Deroche
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Craig van Rensburg
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jaqueline Roseleur
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Busola Sanusi
- Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, United States of America
| | - Jane Phiri
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pam Michelow
- Cytology Unit, National Health Laboratory Service and Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jennifer S. Smith
- Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States of America
| | - Cindy Firnhaber
- Right to Care, Johannesburg, South Africa
- Clinical HIV Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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18
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Atkinson A, Studwell C, Bejarano S, Castellón AMZ, Espinal JAP, Deharvengt S, LaRochelle EPM, Kennedy LS, Tsongalis GJ. Rural distribution of human papilloma virus in low- and middle-income countries. Exp Mol Pathol 2018; 104:146-150. [PMID: 29551573 DOI: 10.1016/j.yexmp.2018.03.001] [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] [Received: 03/02/2018] [Accepted: 03/02/2018] [Indexed: 10/17/2022]
Abstract
Cervical cancer rates in low- and middle-income countries (LMICs) are higher than in developed countries and account for 80% of an estimated 500,000 new cases annually. Factors that contribute to this are that diagnostic and prevention strategies designed for developed countries suffer from the combination of low vaccination rates and limitations due to lack of consistent access to both healthcare and supplies. Here we: 1) improve upon our LMIC deployable HPV test and 2) determine both the high and low-risk HPV genotype prevalence in an isolated Honduran population. We found an unexpected HPV distribution with an abundance of HPV 52 and HPV 72 infections. In this context, molecular testing using a LMIC deployable approach for the detection of HPV can aid in both the triage of HPV positive cytology-based follow up and provide information regarding HPV genotype distribution in support of vaccination strategies.
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Affiliation(s)
- Aaron Atkinson
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Courtney Studwell
- University of Connecticut, Diagnostic Genetic Sciences Program, Storrs, CT, USA
| | | | | | | | - Sophie Deharvengt
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Linda S Kennedy
- Norris Cotton Cancer Center, Lebanon, NH, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Gregory J Tsongalis
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA; Norris Cotton Cancer Center, Lebanon, NH, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
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19
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Nguyen AD, Hoang MV, Nguyen CC. Medical costs for the treatment of cervical cancer at central hospitals in Vietnam. Health Care Women Int 2017; 39:442-449. [PMID: 29125392 DOI: 10.1080/07399332.2017.1402912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Cervical cancer remains the second most common cancer amongst female aged 15 to 44 years old in Vietnam. We estimated medical costs for the treatment of cervical cancer patients. We employed the standard costing approach and health care provider perspective. We first computed the unit cost of 22 medical services related to cervical cancer treatments and then, based on standard cervical cancer treatment protocols, we estimated the cost of nine treatment scenarios for cervical cancer patients. We found that the medical costs for treatment of cervical cancers at central hospitals in Vietnam increased as the cancer progresses into later stages.
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Affiliation(s)
- Anh Duy Nguyen
- a Assisted Reproductive Department , Hanoi Obstetrics and Gynecology Hospital , Hanoi , Vietnam
| | - Minh Van Hoang
- b Center for Population Health Sciences, Hanoi University of Public Health , Hanoi , Vietnam
| | - Chuong Canh Nguyen
- c Screening and Diagnostic Prenatal Center, Hanoi Obstetrics and Gynecology Hospital , Hanoi , Vietnam
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20
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Mo X, Gai Tobe R, Wang L, Liu X, Wu B, Luo H, Nagata C, Mori R, Nakayama T. Cost-effectiveness analysis of different types of human papillomavirus vaccination combined with a cervical cancer screening program in mainland China. BMC Infect Dis 2017; 17:502. [PMID: 28720082 PMCID: PMC5516327 DOI: 10.1186/s12879-017-2592-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 07/04/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND China has a high prevalence of human papillomavirus (HPV) and a consequently high burden of disease with respect to cervical cancer. The HPV vaccine has proved to be effective in preventing cervical cancer and is now a part of routine immunization programs worldwide. It has also proved to be cost effective. This study aimed to assess the cost-effectiveness of 2-, 4-, and 9-valent HPV vaccines (hereafter, HPV2, 4 or 9) combined with current screening strategies in China. METHODS A Markov model was developed for a cohort of 100,000 HPV-free girls to simulate the natural history to HPV infection. Three recommended screening methods (1. liquid-based cytology test + HPV DNA test; 2. pap smear cytology test + HPV DNA test; 3. visual inspection with acetic acid) and three types of HPV vaccination program (HPV2/4/9) were incorporated into 15 intervention options, and the incremental cost-effectiveness ratio (ICER) was calculated to determine the dominant strategies. Costs, transition probabilities and utilities were obtained from a review of the literature and national databases. One-way sensitivity analyses and threshold analyses were performed for key variables in different vaccination scenarios. RESULTS HPV9 combined with screening showed the highest health impact in terms of reducing HPV-related diseases and increasing the number of quality-adjusted life years (QALYs). Under the current thresholds of willingness to pay (WTP, 3 times the per capita GDP or USD$ 23,880), HPV4/9 proved highly cost effective, while HPV2 combined with screening cost more and was less cost effective. Only when screening coverage increased to 60% ~ 70% did the HPV2 and screening combination strategy become economically feasible. CONCLUSIONS The combination of the HPV4/9 vaccine with current screening strategies for adolescent girls was highly cost-effective and had a significant impact on reducing the HPV infection-related disease burden in Mainland China.
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Affiliation(s)
- Xiuting Mo
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
- Department of Health Policy, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo, 157-8535 Japan
| | - Ruoyan Gai Tobe
- Department of Health Policy, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo, 157-8535 Japan
| | - Lijie Wang
- Department of Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Xianchen Liu
- College of Pharmacy, The University of Tennessee Health Science Center, Memphis, TN USA
| | - Bin Wu
- Medical Decision and Economic Group, Department of Pharmacy, Ren Ji Hospital affiliated with Medical School of Shanghai Jiao tong University, Shanghai, China
| | - Huiwen Luo
- Nanjing Drum Tower Hospital affiliated Medical School of Nanjing University, Nanjing, China
| | - Chie Nagata
- Department of Education for Clinical Research, National Centre for Child Health and Development, Tokyo, Japan
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo, 157-8535 Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
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Ginindza TG, Sartorius B, Dlamini X, Östensson E. Cost analysis of Human Papillomavirus-related cervical diseases and genital warts in Swaziland. PLoS One 2017; 12:e0177762. [PMID: 28531205 PMCID: PMC5439687 DOI: 10.1371/journal.pone.0177762] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/03/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) has proven to be the cause of several severe clinical conditions on the cervix, vulva, vagina, anus, oropharynx and penis. Several studies have assessed the costs of cervical lesions, cervical cancer (CC), and genital warts. However, few have been done in Africa and none in Swaziland. Cost analysis is critical in providing useful information for economic evaluations to guide policymakers concerned with the allocation of resources in order to reduce the disease burden. MATERIALS AND METHODS A prevalence-based cost of illness (COI) methodology was used to investigate the economic burden of HPV-related diseases. We used a top-down approach for the cost associated with hospital care and a bottom-up approach to estimate the cost associated with outpatient and primary care. The current study was conducted from a provider perspective since the state bears the majority of the costs of screening and treatment in Swaziland. All identifiable direct medical costs were considered for cervical lesions, cervical cancer and genital warts, which were primary diagnoses during 2015. A mix of bottom up micro-costing ingredients approach and top-down approaches was used to collect data on costs. All costs were computed at the price level of 2015 and converted to dollars ($). RESULTS The total annual estimated direct medical cost associated with screening, managing and treating cervical lesions, CC and genital warts in Swaziland was $16 million. The largest cost in the analysis was estimated for treatment of high-grade cervical lesions and cervical cancer representing 80% of the total cost ($12.6 million). Costs for screening only represented 5% of the total cost ($0.9 million). Treatment of genital warts represented 6% of the total cost ($1million). CONCLUSION According to the cost estimations in this study, the economic burden of HPV-related cervical diseases and genital warts represents a major public health issue in Swaziland. Prevention of HPV infection with a national HPV immunization programme for pre-adolescent girls would prevent the majority of CC related deaths and associated costs.
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Affiliation(s)
- Themba G. Ginindza
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- * E-mail:
| | - Benn Sartorius
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Ellinor Östensson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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22
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Mboumba Bouassa RS, Prazuck T, Lethu T, Jenabian MA, Meye JF, Bélec L. Cervical cancer in sub-Saharan Africa: a preventable noncommunicable disease. Expert Rev Anti Infect Ther 2017; 15:613-627. [PMID: 28440679 DOI: 10.1080/14787210.2017.1322902] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Infections caused by high-risk human papillomavirus (HPV) are responsible for 7.7% of cancers in developing countries, mainly cervical cancer. This disease is steadily increasing in sub-Saharan Africa, with more than 75,000 new cases and 50,000 deaths yearly, further increased by HIV infection. Areas covered: The current status of cervical cancer associated with HPV in sub-Saharan Africa has been systematically revised. The main issues discussed here are related to the public health burden of cervical cancer in sub-Saharan Africa and predictions for the coming decades, including molecular epidemiology and determinants of HPV infection in Africa, and promising prevention measures currently being evaluated in Africa. Expert commentary: By the year 2030, cervical cancer will kill more than 443,000 women yearly worldwide, most of them in sub-Saharan Africa. The increase in the incidence of cervical cancer in Africa could counteract the progress made by African women in reducing maternal mortality and longevity. Nevertheless, cervical cancer is a potentially preventable noncommunicable disease, and intervention strategies to eliminate cervical cancer as a public health concern should be urgently implemented.
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Affiliation(s)
- Ralph-Sydney Mboumba Bouassa
- a Laboratoire de virologie, hôpital Européen Georges Pompidou , Assistance Publique-Hôpitaux de Paris , France.,b Department of Immunology, INSERM U970 , Université Paris Descartes, Sorbonne Paris-Cité , Paris , France
| | - Thierry Prazuck
- c Service des Maladies Infectieuses et Tropicales , Centre Hospitalier Régional Orléans La Source , Orléans , France
| | - Thérèse Lethu
- d Department of health and well-being , Global Health Objectives , Geneva , Switzerland
| | - Mohammad-Ali Jenabian
- e Departement des Sciences Biologiques et Centre de recherche BioMed , Universite du Quebec a Montreal (UQAM) , Montreal , QC , Canada
| | - Jean-François Meye
- f Service de Gynécologie Obstétrique, Centre Hospitalo-Universitaire d'Angondjé, Libreville et Faculté de Médecine de Libreville , Université des Sciences de la Santé , Libreville , Gabon
| | - Laurent Bélec
- a Laboratoire de virologie, hôpital Européen Georges Pompidou , Assistance Publique-Hôpitaux de Paris , France.,b Department of Immunology, INSERM U970 , Université Paris Descartes, Sorbonne Paris-Cité , Paris , France
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23
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Vodicka EL, Babigumira JB, Mann MR, Kosgei RJ, Lee F, Mugo NR, Okech TC, Sakr SR, Garrison LP, Chung MH. Costs of integrating cervical cancer screening at an HIV clinic in Kenya. Int J Gynaecol Obstet 2016; 136:220-228. [PMID: 28099724 DOI: 10.1002/ijgo.12025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/12/2016] [Accepted: 10/25/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To estimate the societal-level costs of integrating cervical cancer screening into HIV clinics in Nairobi, Kenya. METHODS A cross-sectional micro-costing study was performed at Coptic Hope Center for Infectious Diseases and Kenyatta National Hospital, Kenya, between July 1 and October 31, 2014. To estimate direct medical, non-medical, and indirect costs associated with screening, a time-and-motion study was performed, and semi-structured interviews were conducted with women aged at least 18 years attending the clinic for screening during the study period and with clinic staff who had experience relevant to cervical cancer screening. RESULTS There were 148 patients and 23 clinic staff who participated in interviews. Visual inspection with acetic acid was associated with the lowest estimated marginal per-screening costs ($3.30), followed by careHPV ($18.28), Papanicolaou ($24.59), and Hybrid Capture 2 screening ($31.15). Laboratory expenses were the main cost drivers for Papanicolaou and Hybrid Capture 2 testing ($11.61 and $16.41, respectively). Overhead and patient transportation affected the costs of all methods. Indirect costs were cheaper for single-visit screening methods ($0.43 per screening) than two-visit screening methods ($2.88 per screening). CONCLUSIONS Integrating cervical cancer screening into HIV clinics would be cost-saving from a societal perspective compared with non-integrated screening. These findings could be used in cost-effectiveness analyses to assess incremental costs per clinical outcome in an integrated setting.
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Affiliation(s)
| | | | | | - Rose J Kosgei
- University of Nairobi, Nairobi, Kenya.,Kenyatta National Hospital, Nairobi, Kenya
| | - Fan Lee
- University of Washington, Seattle, WA, USA
| | - Nelly R Mugo
- University of Nairobi, Nairobi, Kenya.,Kenyatta National Hospital, Nairobi, Kenya.,Kenya Medical Research Institute, Nairobi, Kenya
| | - Timothy C Okech
- United States International University, University of Lukasa, Nairobi, Kenya
| | - Samah R Sakr
- Coptic Hope Center for Infectious Diseases, Nairobi, Kenya
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24
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Zhang Q, Liu YJ, Hu SY, Zhao FH. Estimating long-term clinical effectiveness and cost-effectiveness of HPV 16/18 vaccine in China. BMC Cancer 2016; 16:848. [PMID: 27814703 PMCID: PMC5097411 DOI: 10.1186/s12885-016-2893-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 10/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) 16 and 18 are the two most common HPV oncogenic types that can be prevented by vaccination. This study aimed at assessing the cost-effectiveness of 3 doses of the bivalent HPV vaccine in rural and urban settings in China. METHODS A Markov model was adapted to reflect the lifetime of a modelled 100,000 12-year-old girls cohort in rural and urban settings in China. Input parameters were obtained from published literature, official reports and a two-round expert review panel. Clinical and economic outcomes of vaccination at age 12 with screening was compared to screening only. In the base case analysis, a 3 % discount rate, the vaccine cost of 247 CNY (US$ 39, PAHO vaccine cost in 2013), two rounds of screening in a life time and 70 % coverage for both screening and vaccination were used. One-way, two-way and probabilistic sensitivity analyses were performed. We used different thresholds of cost-effectiveness to reflect the diversity of economic development in China. RESULTS Vaccination in addition to screening could prevent 60 % more cervical cancer cases and deaths than screening only. The incremental cost effectiveness ratio varied largely when changing cost of vaccination and discount in one way analysis. Vaccination was very cost-effective when the vaccine cost ranged 87-630 CNY (US$ 13.8-100) in rural and 87-750 CNY (US$ 13.8-119) in urban; and remained cost-effective when the vaccine cost ranged 630-1,700 CNY (US$ 100-270) in rural and 750-1,900 CNY (US$ 119-302) in urban in two way analysis. Probabilistic sensitivity analyses showed that model results were robust. CONCLUSIONS In both rural and urban, the vaccination cost and discounting are important factors determining the cost-effectiveness of HPV vaccination; policy makers in China should take these into account when making a decision on the introduction of HPV vaccine. In areas with a high burden of cervical cancer and limited screening activities, HPV vaccination should be prioritized. However, the vaccine cost needs to be reduced in order to make it very cost-effective and affordable as well, in particular in poverty areas with high disease burden.
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Affiliation(s)
- Qian Zhang
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yi-Jun Liu
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
- Department of Preventive Medicine, School of Public Health, Zunyi Medical College, Zunyi, 563099, China
| | - Shang-Ying Hu
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Fang-Hui Zhao
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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25
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Chanthavilay P, Reinharz D, Mayxay M, Phongsavan K, Marsden DE, Moore L, White LJ. Economic Evaluation of Screening Strategies Combined with HPV Vaccination of Preadolescent Girls for the Prevention of Cervical Cancer in Vientiane, Lao PDR. PLoS One 2016; 11:e0162915. [PMID: 27631732 PMCID: PMC5025134 DOI: 10.1371/journal.pone.0162915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 08/30/2016] [Indexed: 11/19/2022] Open
Abstract
Background Several approaches to reduce the incidence of invasive cervical cancers exist. The approach adopted should take into account contextual factors that influence the cost-effectiveness of the available options. Objective To determine the cost-effectiveness of screening strategies combined with a vaccination program for 10-year old girls for cervical cancer prevention in Vientiane, Lao PDR. Methods A population-based dynamic compartment model was constructed. The interventions consisted of a 10-year old girl vaccination program only, or this program combined with screening strategies, i.e., visual inspection with acetic acid (VIA), cytology-based screening, rapid human papillomavirus (HPV) DNA testing, or combined VIA and cytology testing. Simulations were run over 100 years. In base-case scenario analyses, we assumed a 70% vaccination coverage with lifelong protection and a 50% screening coverage. The outcome of interest was the incremental cost per Disability-Adjusted Life Year (DALY) averted. Results In base-case scenarios, compared to the next best strategy, the model predicted that VIA screening of women aged 30–65 years old every three years, combined with vaccination, was the most attractive option, costing 2 544 international dollars (I$) per DALY averted. Meanwhile, rapid HPV DNA testing was predicted to be more attractive than cytology-based screening or its combination with VIA. Among cytology-based screening options, combined VIA with conventional cytology testing was predicted to be the most attractive option. Multi-way sensitivity analyses did not change the results. Compared to rapid HPV DNA testing, VIA had a probability of cost-effectiveness of 73%. Compared to the vaccination only option, the probability that a program consisting of screening women every five years would be cost-effective was around 60% and 80% if the willingness-to-pay threshold is fixed at one and three GDP per capita, respectively. Conclusions A VIA screening program in addition to a girl vaccination program was predicted to be the most attractive option in the health care context of Lao PDR. When compared with other screening methods, VIA was the primary recommended method for combination with vaccination in Lao PDR.
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Affiliation(s)
- Phetsavanh Chanthavilay
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, Canada
- * E-mail:
| | - Daniel Reinharz
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, Canada
- Institut de la Francophonie pour la Médecine tropicale, Vientiane, Lao PDR
| | - Mayfong Mayxay
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine and Global Health, Churchill Hospital, University of Oxford, Oxford, United Kingdom
| | | | - Donald E. Marsden
- Centre for Tropical Medicine and Global Health, Churchill Hospital, University of Oxford, Oxford, United Kingdom
| | - Lynne Moore
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, Canada
| | - Lisa J. White
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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26
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Chuang LT, Temin S, Camacho R, Dueñas-Gonzalez A, Feldman S, Gultekin M, Gupta V, Horton S, Jacob G, Kidd EA, Lishimpi K, Nakisige C, Nam JH, Ngan HYS, Small W, Thomas G, Berek JS. Management and Care of Women With Invasive Cervical Cancer: American Society of Clinical Oncology Resource-Stratified Clinical Practice Guideline. J Glob Oncol 2016; 2:311-340. [PMID: 28717717 PMCID: PMC5493265 DOI: 10.1200/jgo.2016.003954] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose To provide evidence-based, resource-stratified global recommendations to clinicians and policymakers on the management and palliative care of women diagnosed with invasive cervical cancer. Methods ASCO convened a multidisciplinary, multinational panel of cancer control, medical and radiation oncology, health economic, obstetric and gynecologic, and palliative care experts to produce recommendations reflecting resource-tiered settings. A systematic review of literature from 1966 to 2015 failed to yield sufficiently strong quality evidence to support basic- and limited-resource setting recommendations; a formal consensus-based process was used to develop recommendations. A modified ADAPTE process was also used to adapt recommendations from existing guidelines. Results Five existing sets of guidelines were identified and reviewed, and adapted recommendations form the evidence base. Eight systematic reviews, along with cost-effectiveness analyses, provided indirect evidence to inform the consensus process, which resulted in agreement of 75% or greater. Recommendations Clinicians and planners should strive to provide access to the most effective evidence-based antitumor and palliative care interventions. If a woman cannot access these within her own or neighboring country or region, she may need to be treated with lower-tier modalities, depending on capacity and resources for surgery, chemotherapy, radiation therapy, and supportive and palliative care. For women with early-stage cervical cancer in basic settings, cone biopsy or extrafascial hysterectomy may be performed. Fertility-sparing procedures or modified radical or radical hysterectomy may be additional options in nonbasic settings. Combinations of surgery, chemotherapy, and radiation therapy (including brachytherapy) should be used for women with stage IB to IVA disease, depending on available resources. Pain control is a vital component of palliative care. Additional information is available at www.asco.org/rs-cervical-cancer-treatment-guideline and www.asco.org/guidelineswiki. It is the view of ASCO that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.
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Affiliation(s)
- Linus T Chuang
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Sarah Temin
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Rolando Camacho
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Alfonso Dueñas-Gonzalez
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Sarah Feldman
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Murat Gultekin
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Vandana Gupta
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Susan Horton
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Graciela Jacob
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Elizabeth A Kidd
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Kennedy Lishimpi
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Carolyn Nakisige
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Joo-Hyun Nam
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Hextan Yuen Sheung Ngan
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - William Small
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Gillian Thomas
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
| | - Jonathan S Berek
- , Icahn School of Medicine at Mt Sinai, New York, NY; , American Society of Clinical Oncology, Alexandria, VA; , retired, Mallorca, Spain; , Instituto Nacional de Cancerologia, Mexico City, Mexico; , Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA; , Turkish Ministry of Health, Ankara, Turkey; , patient representative, V Care Foundation, Mumbai, India; , University of Waterloo, Waterloo; , Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada; , Instituto Nacional de Cancerologia, Buenos Aires, Argentina; and , Stanford Comprehensive Cancer Institute, Stanford, CA; , Cancer Diseases Hospital, Lusaka, Zambia; , Mulago Hospital, Kampala, Uganda; , Asan Medical Center, Seoul, South Korea; , University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China; and , Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University, Chicago, IL
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Liu YJ, Zhang Q, Hu SY, Zhao FH. Effect of vaccination age on cost-effectiveness of human papillomavirus vaccination against cervical cancer in China. BMC Cancer 2016; 16:164. [PMID: 26919850 PMCID: PMC4768405 DOI: 10.1186/s12885-016-2207-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 02/20/2016] [Indexed: 01/09/2023] Open
Abstract
Background The cost-effectiveness of human papillomavirus (HPV) vaccination in women pre-sexual debut has been demonstrated in many countries. This study aimed to estimate the cost-effectiveness of a 3-dose bivalent HPV vaccination at ages 12 to 55 year in both rural and urban settings in China. Methods The Markov cohort model simulated the natural history of HPV infection and included the effect of screening and HPV vaccination over the lifetime of a 100,000 female cohort. Transition probabilities and utilities were obtained from published literature. Cost data were estimated by Delphi panel using healthcare payers’ perspective. Vaccine cost was assumed Hong Kong listed price. Vaccine efficacy (VE) was based on the PATRICIA trial data assuming VE irrespective of HPV type at all ages on incident HPV. Costs and outcomes were discounted at 3 %. Cervical cancer cases and incremental cost-effectiveness ratio (ICER) for vaccination and screening compared with screening alone were estimated for each vaccination age. Reduced VE in women post-sexual debut were investigated in scenario analyses. Results With 70 % vaccination coverage, a reduction of cancer cases varying from 585 to 33 in rural and 691 to 32 in urban were estimated at ages 12 to 55, respectively. The discounted ICERs of vaccination at any age under 23 years in rural and any age under 25 years in urban were lower than the current threshold. Scenario analyses with lower VE post-sexual debut confirmed the results with age 20 in rural and 21 in urban had consistent lower ICERs. The more ‘catch-up’ cohorts vaccinated at the start of a program, the more cancer lesions are avoided in the long-term. Conclusions Vaccination at any age under 23 years old in rural and any age under 25 years old in urban were cost-effective. Catch-up to the age of 25 years in rural and urban could still be cost-effective. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2207-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yi-Jun Liu
- Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), 17 South Panjiayuan Lane, P.O. Box 2258, Beijing, 100021, China.,Department of Preventive Medicine, School of Public Health, Zunyi Medical College, 201 Dalian Road, Zunyi, 563099, China
| | - Qian Zhang
- Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), 17 South Panjiayuan Lane, P.O. Box 2258, Beijing, 100021, China
| | - Shang-Ying Hu
- Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), 17 South Panjiayuan Lane, P.O. Box 2258, Beijing, 100021, China.
| | - Fang-Hui Zhao
- Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), 17 South Panjiayuan Lane, P.O. Box 2258, Beijing, 100021, China
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Zong LJ, Zhang YZ, Yang XS, Jiang J, Cui BX, Qiao YB, Li L, Jiang K, Zhang WJ, Kong BH, Shen K. Evaluation of several screening approaches for detection of cervical lesions in rural Shandong, China. Asian Pac J Cancer Prev 2016; 16:1907-12. [PMID: 25773843 DOI: 10.7314/apjcp.2015.16.5.1907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The study was designed to: (1) investigate the prevalence of high-risk human papillomavirus (HR- HPV) infection and cervical neoplasia; and (2) evaluate clinical performance of visual inspection with acetic acid/ Lugol's iodine (VIA /VILI), Pap smear, high-risk human papillomavirus (HR-HPV) DNA test for detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and (3) explore appropriate screening approach in rural areas of Shandong Province. MATERIALS AND METHODS A total of 3,763 eligible women from Yiyuan County in Yimeng mountainous areas of rural Shandong, China, were enrolled and underwent Pap smear, HR-HPV DNA testing by Hybrid Capture 2 (HC2), and VIA /VILI tests. Women positive in any test were referred to colposcopy and biopsy as indicated. RESULTS The prevalence of HR-HPV infection among all enrolled women was 11.1% and that in healthy women was 9.9%. In total 33 cases of CIN1, 16 cases of CIN2, 6 cases of CIN3 but none of cervical cancer were detected and the crude prevalence of CIN2+ was 0.58%. For detecting CIN2+, the sensitivity of HR-HPV DNA testing, VIA/VILI, Pap smear was 90.9%, 77.3%, 81.8%, respectively. Pap smear had the best specificity of 98.2%, followed by HR-HPV DNA testing with specificity of 89.4%, VIA/VILI had the lowest specificity of 81.2%. Colposcopy referral rate of HR-HPV DNA testing, VIA/VILI, Pap smear was 11.1%, 18.5%, 2.3%, respectively. CONCLUSIONS Our results suggest that HR-HPV DNA testing alone might be appropriate for primary cervical cancer screening in rural low-resource areas of Shandong Province, China.
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Affiliation(s)
- Li-Ju Zong
- Department of Gynecology and Obstetrics, Qilu Hospital of Shandong University, Jinan, People's Republic of China E-mail
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Abstract
We conducted a systematic review summarizing data on incidence of high- and low-grade lesions in women with normal baseline cervical cytology, stratified by age (<30 and ⩾30 years), and baseline human papillomavirus (HPV) infection. Incidence of high- and low-grade lesions in women aged ⩾30 years with a baseline HPV infection increased over follow-up time (5-127 months), although incidence generally remained <10%. Without baseline HPV infection, incidence of high-grade lesions remained low over follow-up time (<5% over 5-122 months). Incidence of high-grade lesions in women aged ⩾30 years with baseline HPV infection appeared similar to that in women aged <30 years. In some women aged <30 years, high-grade lesions can develop relatively shortly after initial HPV infection. We observed an increase in low-grade lesions over time in women aged ⩾30 years with baseline HPV infection, potentially indicative of an HPV infection that is potentially progressing to higher grade lesions.
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30
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Zhang SK, Kang LN, Chang IJ, Zhao FH, Hu SY, Chen W, Shi JF, Zhang X, Pan QJ, Li SM, Qiao YL. The natural history of cervical cancer in chinese women: results from an 11-year follow-up study in china using a multistate model. Cancer Epidemiol Biomarkers Prev 2014; 23:1298-305. [PMID: 24789847 DOI: 10.1158/1055-9965.epi-13-0846] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND It is important to understand the natural history of cervical cancer, which has implications for cancer prevention and management. However, a dearth of studies on the long-term development of cervical cancer exists in China. METHODS We investigated the natural history of cervical cancer in Chinese women by creating a multistate model using 11 years of follow-up data from the Shanxi Province Cervical Cancer Screening Study I conducted from 1999 to 2010. In 1999, a total of 1,997 eligible women, ages 35 to 45 years, were enrolled in Xiangyuan County, Shanxi Province. Participants were followed up in 2005 and 2010, respectively. RESULTS The average time a subject spent in CIN1 before transiting into another state was 1.4693 years [95% confidence interval (CI): 1.1215-1.9251] and the average time a subject spent in CIN2 was 2.9822 years (95% CI: 1.9790-4.4938). A subject's transition probability from CIN1 to normal increased with time. However, the transition probability from CIN1 to CIN2 was relatively lower, with 3-, 5-, and 10-year transition probabilities of 0.1415, 0.1066, and 0.0437. Comparison of 5-year transition probabilities between CIN2 to normal/CIN1 and CIN2 to CIN3(+) yielded a ratio of 2.74. CONCLUSIONS Women with CIN1 had a substantial tendency for regression. Similarly, women with CIN2 had a higher probability of regression to normal/CIN1 than progression to CIN3(+). Findings in this study may have significant implications for the development and evaluation of formal cervical cancer preventive strategies in China. IMPACT This study may serve as a valuable reference to future research on other multistate cancer processes.
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Affiliation(s)
- Shao-Kai Zhang
- Authors' Affiliations: Departments of Cancer Epidemiology
| | - Le-Ni Kang
- Authors' Affiliations: Departments of Cancer Epidemiology
| | - Irene J Chang
- Authors' Affiliations: Departments of Cancer Epidemiology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Fang-Hui Zhao
- Authors' Affiliations: Departments of Cancer Epidemiology
| | - Shang-Ying Hu
- Authors' Affiliations: Departments of Cancer Epidemiology
| | - Wen Chen
- Authors' Affiliations: Departments of Cancer Epidemiology
| | - Ju-Fang Shi
- Authors' Affiliations: Departments of Cancer Epidemiology
| | | | | | - Shu-Min Li
- Gynecology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and
| | - You-Lin Qiao
- Authors' Affiliations: Departments of Cancer Epidemiology,
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Li J, Ping Z, Ning H. MiR-218 impairs tumor growth and increases chemo-sensitivity to cisplatin in cervical cancer. Int J Mol Sci 2012; 13:16053-64. [PMID: 23443110 PMCID: PMC3546678 DOI: 10.3390/ijms131216053] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 10/15/2012] [Accepted: 10/25/2012] [Indexed: 12/30/2022] Open
Abstract
MicroRNAs are noncoding RNA molecules of 18–25 nucleotides that regulate gene expression at the post-transcriptional levels. Recent data revealed that miR-218 played key roles in tumor metastasis. Here, we described the regulation and function of miR-218 in cervical cancer. Overexpression of miR-218 reduced the proliferation of the human cervical cancer cell line HeLa and induced cell apoptosis through the AKT-mTOR signaling pathway. In addition, it forced expression of miR-218 suppressed tumor growth in the orthotopic mouse model of HeLa cells. Furthermore, miR-218 increased chemosensitivity to cisplatin (CDDP) in vitro. Our results indicated that targeting miR-218 may provide a strategy for blocking the development of cervical cancer.
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Affiliation(s)
- Jiarui Li
- Department of Gynecology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China; E-Mails: (J.L.); (Z.P.)
| | - Zhang Ping
- Department of Gynecology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China; E-Mails: (J.L.); (Z.P.)
| | - Hui Ning
- Department of Gynecology and Obstetrics, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China
- Author to whom correspondence should be addressed; E-Mail: ; Tel./Fax: +86-21-8187-1114
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