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Fasseeh AN, Korra N, Elezbawy B, Sedrak AS, Gamal M, Eldessouki R, Eldebeiky M, George M, Seyam A, Abourawash A, Khalifa AY, Shaheen M, Abaza S, Kaló Z. Framework for developing cost-effectiveness analysis threshold: the case of Egypt. J Egypt Public Health Assoc 2024; 99:12. [PMID: 38825614 PMCID: PMC11144683 DOI: 10.1186/s42506-024-00159-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/01/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Cost-effectiveness analyses rarely offer useful insights to policy decisions unless their results are compared against a benchmark threshold. The cost-effectiveness threshold (CET) represents the maximum acceptable monetary value for achieving a unit of health gain. This study aimed to identify CET values on a global scale, provide an overview of using multiple CETs, and propose a country-specific CET framework specifically tailored for Egypt. The proposed framework aims to consider the globally identified CETs, analyze global trends, and consider the local structure of Egypt's healthcare system. METHODS We conducted a literature review to identify CET values, with a particular focus on understanding the basis of differentiation when multiple thresholds are present. CETs of different countries were reviewed from secondary sources. Additionally, we assembled an expert panel to develop a national CET framework in Egypt and propose an initial design. This was followed by a multistakeholder workshop, bringing together representatives of different governmental bodies to vote on the threshold value and finalize the recommended framework. RESULTS The average CET, expressed as a percentage of the gross domestic product (GDP) per capita across all countries, was 135%, with a range of 21 to 300%. Interestingly, while the absolute value of CET increased with a country's income level, the average CET/GDP per capita showed an inverse relationship. Some countries applied multiple thresholds based on disease severity or rarity. In the case of Egypt, the consensus workshop recommended a threshold ranging from one to three times the GDP per capita, taking into account the incremental relative quality-adjusted life years (QALY) gain. For orphan medicines, a CET multiplier between 1.5 and 3.0, based on the disease rarity, was recommended. A two-times multiplier was proposed for the private reimbursement threshold compared to the public threshold. CONCLUSION The CET values in most countries appear to be closely related to the GDP per capita. Higher-income countries tend to use a lower threshold as a percentage of their GDP per capita, contrasted with lower-income countries. In Egypt, experts opted for a multiple CET framework to assess the value of health technologies in terms of reimbursement and pricing.
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Affiliation(s)
- Ahmad N Fasseeh
- Faculty of Pharmacy Alexandria University, Alexandria, Egypt
- Syreon Middle East, Alexandria, Egypt
| | | | | | - Amal S Sedrak
- Department of Public Health, Cairo University, Cairo, Egypt
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | - Mary Gamal
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | - Randa Eldessouki
- Department of Community Health, Fayoum University, Fayoum, Egypt
| | - Mariam Eldebeiky
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | | | - Ahmed Seyam
- Universal Health Insurance Authority, Cairo, Egypt
| | | | - Ahmed Y Khalifa
- World Health Organization Representative Office, Cairo, Egypt
| | | | | | - Zoltán Kaló
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
- Syreon Research Institute, Budapest, Hungary
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Gylling A, Uusi-Rauva K, Toppila I, Hiltunen-Back E. The Burden of Genital Warts in Finland: Cross-Sectional Analysis of the Prevalence and Direct Medical Costs in 2018. Vaccines (Basel) 2023; 11:1202. [PMID: 37515019 PMCID: PMC10384701 DOI: 10.3390/vaccines11071202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/21/2023] [Accepted: 06/24/2023] [Indexed: 07/30/2023] Open
Abstract
Genital warts (GWs) caused by the human papilloma virus (HPV) are a significant health problem due to high prevalence and rate of recurrence. Bivalent vaccine has been used since the start of the national vaccination program in 2013, making it feasible to study the GW burden in Finland. There is no national and up-to-date information available on the prevalence and the burden of GWs in the various healthcare sectors in Finland. The present study investigated the prevalence, healthcare resource use, and direct medical costs of the treatment of GWs in Finland in 2018 using data in national healthcare registers. GW cases were identified based on diagnoses in public healthcare and GW-related prescription medications. Cost analysis included public healthcare contacts, procedures in private care, and medications. The study showed that approximately 12,000 GWs cases were treated in Finland in 2018. Since less than half of GW diagnoses were recorded in public healthcare registers, determining the exact costs was challenging. The estimated direct treatment costs in 2018 were 2.6 M€, which is higher than the previous estimation in Finland, yet still likely an underestimation of the true burden. These results provide information for the management of the GW burden in Finland.
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Affiliation(s)
| | | | | | - Eija Hiltunen-Back
- Venereal Diseases Outpatient Clinic, Inflammation Center, Skin and Allergy Hospital, Helsinki University Hospital, 00029 Helsinki, Finland
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Cheung TH, Cheng SSY, Hsu D, Wing-Lei Wong Q, Pavelyev A, Sukarom I, Saxena K. Health impact and cost-effectiveness of implementing gender-neutral vaccination with the 9-valent HPV vaccine in Hong Kong. Hum Vaccin Immunother 2023; 19:2184605. [PMID: 37183965 DOI: 10.1080/21645515.2023.2184605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Human papillomavirus (HPV) can cause several diseases, including cancers, in both sexes. In January 2020, the Hong Kong government launched a school-based vaccination program for girls 10-12 years of age with the 9-valent HPV (9vHPV) vaccine for the prevention of HPV-related diseases; however, boys were not included. The current study estimated the potential health and economic impact of a routine gender-neutral vaccination (GNV) approach compared with the current female-only vaccination (FOV) strategy. We used a dynamic transmission model, adapted to Hong Kong. The model estimates changes in HPV-related disease incidence and mortality, treatment costs (in 2019 Hong Kong dollars), quality-adjusted life years (QALY), and incremental cost-effectiveness ratios (ICERs) over a 100-year time horizon. The base case analysis compared FOV with the 9vHPV vaccine with routine GNV (coverage rate 70%) for the prevention of HPV-related diseases. Compared with a FOV approach, routine GNV with the 9vHPV vaccine is predicted to provide greater reductions in cumulative HPV-related disease incidence and mortality, as well as lower HPV-related treatment costs. In the base case analysis, the ICER was $248,354 per QALY for routine GNV. As compared with FOV, routine GNV fell below the cost-effectiveness ceiling of $382,046/year for Hong Kong. These results highlight the potential value of a routine GNV program with the 9vHPV vaccine among 12-year-olds in Hong Kong to reduce the public health and economic burden of HPV-related diseases.
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Affiliation(s)
- Tak Hong Cheung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Danny Hsu
- Global Medical and Scientific Affairs, MSD Hong Kong, Hong Kong, China
| | | | - Andrew Pavelyev
- Center for Observational and Real-World Evidence, Merck & Co., Inc, Rahway, NJ, USA
| | - Isaya Sukarom
- Center for Observational and Real-world Evidence, MSD Thailand, Bangkok, Thailand
| | - Kunal Saxena
- Center for Observational and Real-World Evidence, Merck & Co., Inc, Rahway, NJ, USA
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Doggen K, van Hoek AJ, Luyten J. Accounting for Adverse Events Following Immunization in Economic Evaluation: Systematic Review of Economic Evaluations of Pediatric Vaccines Against Pneumococcus, Rotavirus, Human Papillomavirus, Meningococcus and Measles-Mumps-Rubella-Varicella. PHARMACOECONOMICS 2023; 41:481-497. [PMID: 36809673 DOI: 10.1007/s40273-023-01252-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES Economic evaluations of vaccines should accurately represent all relevant economic and health consequences of vaccination, including losses due to adverse events following immunization (AEFI). We investigated to what extent economic evaluations of pediatric vaccines account for AEFI, which methods are used to do so and whether inclusion of AEFI is associated with study characteristics and the vaccine's safety profile. METHODS A systematic literature search (MEDLINE, EMBASE, Cochrane Systematic Reviews and Trials, Database of the Centre for Reviews and Dissemination of the University of York, EconPapers, Paediatric Economic Database Evaluation, Tufts New England Cost-Effectiveness Analysis Registry, Tufts New England Global Health CEA, International Network of Agencies for Health Technology Assessment Database) was performed for economic evaluations published between 2014 and 29 April 2021 (date of search) pertaining to the five groups of pediatric vaccines licensed in Europe and the United States since 1998: the human papillomavirus (HPV) vaccines, the meningococcal vaccines (MCV), the measles-mumps-rubella-varicella (MMRV) combination vaccines, the pneumococcal conjugate vaccines (PCV) and the rotavirus vaccines (RV). Rates of accounting for AEFI were calculated, stratified by study characteristics (e.g., region, publication year, journal impact factor, level of industry involvement) and triangulated with the vaccine's safety profile (Advisory Committee on Immunization Practices [ACIP] recommendations and information on safety-related product label changes). The studies accounting for AEFI were analyzed in terms of the methods used to account for both cost and effect implications of AEFI. RESULTS We identified 112 economic evaluations, of which 28 (25%) accounted for AEFI. This proportion was significantly higher for MMRV (80%, four out of five evaluations), MCV (61%, 11 out of 18 evaluations) and RV (60%, nine out of 15 evaluations) compared to HPV (6%, three out of 53 evaluations) and PCV (5%, one out of 21 evaluations). No other study characteristics were associated with a study's likelihood of accounting for AEFI. Vaccines for which AEFI were more frequently accounted for also had a higher frequency of label changes and a higher level of attention to AEFI in ACIP recommendations. Nine studies accounted for both the cost and health implications of AEFI, 18 studies considered only costs and one only health outcomes. While the cost impact was usually estimated based on routine billing data, the adverse health impact of AEFI was usually estimated based on assumptions. DISCUSSION Although (mild) AEFI were demonstrated for all five studied vaccines, only a quarter of reviewed studies accounted for these, mostly in an incomplete and inaccurate manner. We provide guidance on which methods to use to better quantify the impact of AEFI on both costs and health outcomes. Policymakers should be aware that the impact of AEFI on cost-effectiveness is likely to be underestimated in the majority of economic evaluations.
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Affiliation(s)
- Kris Doggen
- Faculty of Medicine, KU Leuven, Leuven, Belgium
- Belgian Intermutualistic Agency, Brussels, Belgium
| | - Albert Jan van Hoek
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Jeroen Luyten
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Kapucijnenvoer 35, 3000, Leuven, Belgium.
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Diakite I, Nguyen S, Sabale U, Pavelyev A, Saxena K, Tajik AA, Wang W, Palmer C. Public health impact and cost-effectiveness of switching from bivalent to nonavalent vaccine for human papillomavirus in Norway: incorporating the full health impact of all HPV-related diseases. J Med Econ 2023; 26:1085-1098. [PMID: 37608730 DOI: 10.1080/13696998.2023.2250194] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/24/2023]
Abstract
AIM The objective of this study was to estimate and compare the cost-effectiveness of switching from a bivalent to a nonavalent human papillomavirus (HPV) vaccination program in Norway, incorporating all nonavalent vaccine-preventable HPV-related diseases and in the context of the latest cervical cancer screening program. METHODS A well-established dynamic transmission model of the natural history of HPV infection and disease was adapted to the Norwegian population. We determined the number of cases of HPV-related diseases and subsequent number of deaths, and the economic burden of HPV-related disease under the current standard of care conditions of bivalent and nonavalent vaccinations of girls and boys aged 12 years. RESULTS Compared to bivalent vaccination, nonavalent vaccination averted an additional 4,357 cases of HPV-related cancers, 421,925 cases of genital warts, and 543 cases of recurrent respiratory papillomatosis (RRP) over a 100-year time horizon. Nonavalent vaccination also averted an additional 1,044 deaths over the 100-year time horizon when compared with bivalent vaccination. Total costs were higher for the nonavalent strategy (10.5 billion NOK [€1.03 billion] vs. 9.3-9.4 billion NOK [€915-925 million] for bivalent vaccination). A switch to nonavalent vaccination had a higher vaccination cost (4.4 billion NOK [€433 million] vs. 2.7 billion NOK [€266 million] for bivalent vaccination) but resulted in a savings of 627-694 million NOK [€62-68 million] in treatment costs. A switch to nonavalent vaccination demonstrated an incremental cost-effectiveness ratio of 102,500 NOK (€10,086) per QALY versus bivalent vaccination. CONCLUSIONS Using a model that incorporated the full range of HPV-related diseases, and the latest cervical cancer screening practices, we found that switching from bivalent to nonavalent vaccination would be considered cost-effective in Norway.
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Affiliation(s)
- Ibrahim Diakite
- Health Economic and Decision Sciences, Merck & Co., Inc., Rahway, NJ, USA
| | | | - Ugne Sabale
- Center for Observational and Real-World Evidence, MSD, Stockholm, Sweden
| | - Andrew Pavelyev
- Health Economic and Decision Sciences, Merck & Co., Inc., Rahway, NJ, USA
| | - Kunal Saxena
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Rahway, NJ, USA
| | | | - Wei Wang
- Health Economic and Decision Sciences, Merck & Co., Inc., Rahway, NJ, USA
| | - Cody Palmer
- Health Economic and Decision Sciences, Merck & Co., Inc., Rahway, NJ, USA
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Portnoy A, Pedersen K, Nygård M, Trogstad L, Kim JJ, Burger EA. Identifying a Single Optimal Integrated Cervical Cancer Prevention Policy in Norway: A Cost-Effectiveness Analysis. Med Decis Making 2022; 42:795-807. [PMID: 35255741 DOI: 10.1177/0272989x221082683] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Interventions targeting the same disease but at different points along the disease continuum (e.g., screening and vaccination to prevent cervical cancer [CC]) are often evaluated in isolation, which can affect cost-effectiveness profiles and policy conclusions. We evaluated nonavalent human papillomavirus (HPV) vaccine (9vHPV) compared with bivalent HPV vaccine (2vHPV) alongside deintensified screening intervals for a vaccinated birth cohort to inform a single optimal integrated CC prevention policy. METHODS Using a multimodeling approach, we evaluated the health and economic impacts of alternative CC screening strategies for a Norwegian birth cohort eligible for HPV vaccination in 2021 assuming they received 1) 2vHPV or 2) 9vHPV. We conducted 1) a restricted analysis that evaluated the optimal HPV vaccine under current screening guidelines; and 2) a comprehensive analysis including alternative screening and vaccination strategy combinations. We calculated incremental cost-effectiveness ratios (ICERs) and evaluated them according to different cost-effectiveness thresholds. RESULTS Assuming a cost-effectiveness threshold of $40,000 per quality-adjusted life year (QALY) gained, we found that, while holding screening intensity fixed, switching the routine vaccination program in Norway from 2vHPV to 9vHPV would not be considered cost-effective (ICER of $132,700 per QALY gained). However, when allowing for varying intensities of CC screening, we found that switching to 9vHPV would be cost-effective compared with 2vHPV under an alternative threshold of $55,000 per QALY gained, if coupled with reductions in the number of lifetime screens. CONCLUSIONS Our analysis highlights the importance of evaluating the full potential policy landscape for country-level decision makers considering policy adoption, including nonindependent primary and secondary prevention efforts, to draw appropriate conclusions and avoid sub-optimal outcomes. HIGHLIGHTS Without evaluating the full potential policy landscape, including primary and secondary prevention efforts, country-level decision makers may not be able to draw appropriate policy conclusions, resulting in suboptimal outcomes.An applied example from cervical cancer prevention in Norway compared a restricted analysis of current screening guidelines to a comprehensive analysis including alternative screening and vaccination strategy combinations.We found that a switch from bivalent to nonavalent human papillomavirus vaccine would be considered cost-effective in Norway if coupled with reductions in the number of lifetime screens compared with the current screening strategy.A comprehensive analysis that considers how different types of interventions along the disease continuum affect each other will be critical for decision makers interpreting cost-effectiveness analysis results.
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Affiliation(s)
- Allison Portnoy
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kine Pedersen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Lill Trogstad
- The Norwegian Institute of Public Health, Oslo, Norway
| | - Jane J Kim
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Emily A Burger
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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Logel M, Laurie C, El-Zein M, Guichon J, Franco EL. A review of ethical and legal aspects of gender-neutral human papillomavirus vaccination. Cancer Epidemiol Biomarkers Prev 2022; 31:919-931. [PMID: 35247878 DOI: 10.1158/1055-9965.epi-21-1256] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/12/2022] [Accepted: 02/25/2022] [Indexed: 12/24/2022] Open
Abstract
While launching a campaign to eliminate cervical cancer, the World Health Organization called to halt human papillomavirus (HPV) gender-neutral vaccination (GNV) because of limited vaccine supply, raising ethical and legal questions about female-only vaccination versus GNV. We identified ethical and legal aspects of HPV GNV by searching MEDLINE for records up to February 19, 2021. We also provided an overview of HPV vaccines, the evolution of HPV vaccine recommendations in North America, and a timeline of male HPV vaccination introduction by searching PubMed, Google, and government websites. Four HPV vaccines are available: Cervarix®, Gardasil®, Gardasil®9, and Cecolin®. Vaccine recommendations in North America evolved from female only to eventually include males. Following the Food and Drug Administration's approval of the first HPV vaccine for males (2009), 35 countries began vaccinating males (2011-2020). Based on 56 eligible records out of 652, we identified the following constructs: lower male awareness of HPV and vaccination (n=13), limited economic resources (n=5), shared social responsibility (n=18), unprotected groups from female-only HPV vaccination (n=10), limited screening for HPV-associated noncervical cancers (n=6), consideration of ethical principles (n=17), and HPV vaccine mandates (n=5). Ethical and legal aspects must be considered when recommending vaccination for females only or GNV.
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Gender Differences in Knowledge and Attitude towards HPV and HPV Vaccine among College Students in Wenzhou, China. Vaccines (Basel) 2021; 10:vaccines10010010. [PMID: 35062671 PMCID: PMC8779512 DOI: 10.3390/vaccines10010010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/17/2021] [Accepted: 12/17/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: This study aimed to determine human papillomavirus (HPV)-related awareness and willingness to receive HPV vaccination among college students, in Wenzhou, and its associated factors. Methods: A cross-sectional epidemiological study was conducted among college students in Wenzhou to investigate their knowledge, attitude, and factors affecting their willingness to receive HPV vaccination. Results: A total of 1035 questionnaires were collected, of which 1002 were valid (males: 374, females: 628). In total, 904 (90.2%) college students had heard of HPV, with a lower rate among males than females (85.3% vs. 93.2%, p < 0.05) and 693 (69.2%) had heard of the HPV vaccine, with a significantly lower rate among males than females (53.7% vs. 78.3%, p < 0.05). Overall awareness of HPV and HPV vaccine among males and females was moderate, with lower awareness among males. A total of 55.9% of males and 80.4% of females indicated that they would be willing to receive the HPV vaccine, a significant difference (p < 0.001). The price, safety of HPV vaccine, and lack of knowledge about HPV and HPV vaccine were the major barriers to HPV vaccination for college students. Compared to females, inadequate knowledge of HPV was the main barrier factor for HPV vaccination among male college students. Conclusions: The overall knowledge level of males is lower than that of females. For male college students, providing more knowledge about HPV infection is helpful to promote their willingness to vaccinate. It is necessary to promote HPV-related knowledge for male and female college students, respectively.
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Lozar T, Nagvekar R, Rohrer C, Dube Mandishora RS, Ivanus U, Fitzpatrick MB. Cervical Cancer Screening Postpandemic: Self-Sampling Opportunities to Accelerate the Elimination of Cervical Cancer. Int J Womens Health 2021; 13:841-859. [PMID: 34566436 PMCID: PMC8458024 DOI: 10.2147/ijwh.s288376] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/30/2021] [Indexed: 12/24/2022] Open
Abstract
The persisting burden of cervical cancer in underserved populations and low-resource regions worldwide, worsened by the onset of the COVID-19 pandemic, requires proactive strategies and expanded screening options to maintain and improve screening coverage and its effects on incidence and mortality from cervical cancer. Self-sampling as a screening strategy has unique advantages from both a public health and individual patient perspective. Some of the barriers to screening can be mitigated by self-sampling, and resources can be better allocated to patients at the highest risk of developing cervical cancer. This review summarizes the implementation options for self-sampling and associated challenges, evidence in support of self-sampling, the available devices, and opportunities for expansion beyond human papillomavirus testing.
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Affiliation(s)
- Taja Lozar
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
- University of Ljubljana, Ljubljana, Slovenia
| | - Rahul Nagvekar
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - Charles Rohrer
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Racheal Shamiso Dube Mandishora
- University of Zimbabwe College of Health Sciences, Department of Medical Microbiology, Harare, Zimbabwe
- Early Detection, Prevention and Infections Group, International Agency for Research on Cancer, Lyon, France
| | - Urska Ivanus
- University of Ljubljana, Ljubljana, Slovenia
- National Cervical Cancer Screening Programme and Registry ZORA, Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Association of Slovenian Cancer Societies, Ljubljana, 1000, Slovenia
| | - Megan Burke Fitzpatrick
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Milecki T, Michalak M, Milecki J, Michalak M, Kadziszewski R, Kuncman Ł, Jarzemski P, Milecki P, Antczak A. Polish Medical Students' Knowledge Regarding Human Papillomavirus's Ways of Transmission, Risk of Cancer Development and Vaccination, and Their Intention to Recommend Vaccination. Vaccines (Basel) 2021; 9:vaccines9070776. [PMID: 34358192 PMCID: PMC8310167 DOI: 10.3390/vaccines9070776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction: Human papillomavirus (HPV) is associated with six types of cancer in men and women. A vaccine against HPV, preferably administered before initial sexual intercourse, has been proven to be highly effective in preventing these cancers. An effective healthcare provider recommendation has significant influence on HPV vaccine uptake; therefore, it is critical that medical students receive comprehensive training in this area. Aim: The aim of the study was to assess the knowledge of medical students regarding Human Papillomavirus’s (HPV) ways of transmission, risk of cancer development, and vaccination against HPV. This study also investigated factors among medical students that would affect their intention to recommend HPV vaccination to others. Materials and Methods: The study was conducted among 1061 (678 women and 383 men) medical students who filled in our questionnaire. The medical students were divided into two subgroups: (1) pre-clinical medical students (MS pre-clinical; first-to third-year students; n = 683) and (2) clinical medical students (MS clinical; fourth-to six-year students; n = 378). Results: A total259 (24.41%) of the 1061 medical students were vaccinated against HPV. We found a significant improvement in the general level of knowledge in the later years of education (4–6) compared to the early years of education (1–3). However, it was demonstrated that, despite medical education advancements, there are still significant gaps of knowledge about the relationship between HPV infection and cancers other than cervical cancer, as well as in relation to the routes by which HPV is transmitted. Medical students’ intentions to recommend HPV vaccine to others were related to their own HPV-related knowledge and their own vaccination status. Conclusion: Medical students have gaps of knowledge regarding particular issues and aspects of HPV. It is necessary to further educate medical students in the field of prevention and in the treatment of lesions caused by HPV infection. Medical students’ intention to recommend the HPV vaccine can be improved by including them and members of their families in the HPV vaccination program.
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Affiliation(s)
- Tomasz Milecki
- Department of Urology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (M.M.); (J.M.); (R.K.); (A.A.)
- Correspondence:
| | - Maciej Michalak
- Department of Urology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (M.M.); (J.M.); (R.K.); (A.A.)
| | - Jakub Milecki
- Department of Urology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (M.M.); (J.M.); (R.K.); (A.A.)
| | - Michał Michalak
- Department of Computer Sciences and Statistics, University of Medical Sciences, 61-701 Poznan, Poland;
| | - Radosław Kadziszewski
- Department of Urology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (M.M.); (J.M.); (R.K.); (A.A.)
| | - Łukasz Kuncman
- Department of Radiotherapy, Medical University of Lodz, 90-419 Lodz, Poland;
| | - Piotr Jarzemski
- Department of Urology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus Univeristy in Torun, 87-100 Torun, Poland;
| | - Piotr Milecki
- Department of Electro–Radiology, University of Medical Sciences, 61-701 Poznan, Poland;
- Radiotherapy Department, Greater Poland Cancer Centre, 61-866 Poznan, Poland
| | - Andrzej Antczak
- Department of Urology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (M.M.); (J.M.); (R.K.); (A.A.)
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Simoens S, Bento-Abreu A, Merckx B, Joubert S, Vermeersch S, Pavelyev A, Varga S, Morais E. Health Impact and Cost-Effectiveness of Implementing Gender-Neutral Vaccination With the 9-Valent Human Papillomavirus Vaccine in Belgium. Front Pharmacol 2021; 12:628434. [PMID: 33912045 PMCID: PMC8072375 DOI: 10.3389/fphar.2021.628434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/09/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Routine human papillomavirus (HPV) immunization in Belgium is currently regionally managed, with school-aged girls receiving the 9-valent HPV (9vHPV) vaccine in Flanders and Wallonia-Brussels with a national catch-up program for females only. This study will assess whether expanding these programs to gender-neutral vaccination (GNV) with the 9vHPV vaccine is a cost-effective strategy in Belgium. Methods: A validated HPV-type transmission dynamic model estimated the potential health and economic impact of regional vaccination programs, comparing GNV versus female-only vaccination (FOV) with the 9vHPV vaccine in individuals aged 11-12 years in Flanders, GNV with the 9vHPV vaccine versus FOV with the 2-valent HPV (2vHPV) vaccine in individuals aged 12-13 years in Wallonia-Brussels, and national catch-up GNV versus FOV with the 9vHPV vaccine for those aged 12-18 years. Vaccination coverage rates of 90, 50, and 50% in both males and females were used in the base cases for the three programs, respectively, and sensitivity analyses were conducted. All costs are from the third-party payer perspective, and outcome measures were reported over a 100-year time horizon. Results: GNV with the 9vHPV vaccine was projected to decrease the cumulative incidence of HPV 6/11/16/18/31/33/45/52/58-related diseases relative to FOV in both Flanders and Wallonia-Brussels. Further reductions were also projected for catch-up GNV with the 9vHPV vaccine, including reductions of 6.8% (2,256 cases) for cervical cancer, 7.1% (386 cases) and 18.8% (2,784 cases) for head and neck cancer in females and males, respectively, and 30.3% (82,103 cases) and 44.6% (102,936 cases) for genital warts in females and males, respectively. As a result, a GNV strategy would lead to reductions in HPV-related deaths. Both regional and national catch-up GNV strategies were projected to reduce cumulative HPV-related disease costs and were estimated to be cost-effective compared with FOV with incremental cost-effectiveness ratios of €8,062, €4,179, and €6,127 per quality-adjusted life-years in the three programs, respectively. Sensitivity analyses were consistent with the base cases. Conclusions: A GNV strategy with the 9vHPV vaccine can reduce the burden of HPV-related disease and is cost-effective compared with FOV for both regional vaccination programs and the national catch-up program in Belgium.
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Affiliation(s)
- Steven Simoens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | | | | | | | | | - Andrew Pavelyev
- Merck & Co., Inc., Kenilworth, NJ, United States
- HCL America, Inc., Sunnyvale, CA, United States
| | - Stefan Varga
- Merck & Co., Inc., Kenilworth, NJ, United States
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Portnoy A, Pedersen K, Trogstad L, Hansen BT, Feiring B, Laake I, Smith MA, Sy S, Nygård M, Kim JJ, Burger EA. Impact and cost-effectiveness of strategies to accelerate cervical cancer elimination: A model-based analysis. Prev Med 2021; 144:106276. [PMID: 33678239 DOI: 10.1016/j.ypmed.2020.106276] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/28/2020] [Accepted: 09/27/2020] [Indexed: 12/12/2022]
Abstract
Following the global call for action by the World Health Organization to eliminate cervical cancer (CC), we evaluated how each CC policy decision in Norway influenced the timing of CC elimination, and whether introducing nonavalent human papillomavirus (HPV) vaccine would accelerate elimination timing and be cost-effective. We used a multi-modeling approach that captured HPV transmission and cervical carcinogenesis to estimate the CC incidence associated with six past and future CC prevention policy decisions compared with a pre-vaccination scenario involving 3-yearly cytology-based screening. Scenarios examined the introduction of routine HPV vaccination of 12-year-old girls with quadrivalent vaccine in 2009, a temporary catch-up program for females aged up to 26 years in 2016-2018 with bivalent vaccine, the universal switch to bivalent vaccine in 2017, expansion to include 12-year-old boys in 2018, the switch from cytology- to HPV-based screening for women aged 34-69 in 2020, and the potential switch to nonavalent vaccine in 2021. Introducing routine female vaccination in 2009 enabled elimination to be achieved by 2056 and prevented 17,300 cases. Cumulatively, subsequent policy decisions accelerated elimination to 2039. According to our modeling assumptions, switching to the nonavalent vaccine would not be considered 'good value for money' at relevant cost-effectiveness thresholds in Norway unless the incremental cost was $19 per dose or less (range: $17-24) compared to the bivalent vaccine. CC control policies implemented over the last decade in Norway may have accelerated the timeframe to elimination by more than 17 years and prevented over 23,800 cases by 2110.
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Affiliation(s)
- Allison Portnoy
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA.
| | - Kine Pedersen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Lill Trogstad
- The Norwegian Institute of Public Health, Oslo, Norway
| | | | - Berit Feiring
- The Norwegian Institute of Public Health, Oslo, Norway
| | - Ida Laake
- The Norwegian Institute of Public Health, Oslo, Norway
| | - Megan A Smith
- Cancer Council New South Wales, Sydney, Australia; Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Stephen Sy
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA
| | | | - Jane J Kim
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA
| | - Emily A Burger
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA; Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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Impact of a Gender-Neutral HPV Vaccination Program in Men Who Have Sex with Men (MSM). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030963. [PMID: 33499347 PMCID: PMC7908442 DOI: 10.3390/ijerph18030963] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/14/2021] [Accepted: 01/14/2021] [Indexed: 12/23/2022]
Abstract
A major challenge in human papillomavirus (HPV) vaccine programs is the universal gender-neutral recommendation, as well as estimation of its long-term effect. The objective of this study is to predict the added benefit of male vaccination, especially in men who have sex with men (MSM), and to analyze the impact of the program on society. We propose a mathematical model of the HPV infection based on a network paradigm. Data from Spain allowed constructing the sexual network. HPV force of infection was taken from literature. Different scenarios using variable vaccine coverage in both males and females were studied. Strong herd immunity is shown in the heterosexual population, with an important decrease of HPV 6/11 infections both in men and in unvaccinated women with an only-women vaccination at 14 years of age. No impact of this program occurred in the infection incidence in MSM. This group would only benefit from a vaccination program that includes males. However, the impact at short term would be lower than in heterosexual men. The protection of MSM can only be achieved by direct vaccination of males. This may have important consequences for public health.
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Qendri V, Bogaards JA, Baussano I, Lazzarato F, Vänskä S, Berkhof J. The cost-effectiveness profile of sex-neutral HPV immunisation in European tender-based settings: a model-based assessment. Lancet Public Health 2020; 5:e592-e603. [PMID: 33120045 DOI: 10.1016/s2468-2667(20)30209-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/27/2020] [Accepted: 09/10/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND In many European countries, human papillomavirus (HPV) vaccine uptake among girls has remained below target levels, supporting the scope for vaccination of boys. We aimed to investigate if sex-neutral HPV vaccination can be considered cost-effective compared with girls-only vaccination at uptake levels equal to those among girls and under tender-based vaccination costs achieved throughout Europe. METHODS We investigated the cost-effectiveness of sex-neutral HPV vaccination in European tender-based settings. We applied a Bayesian synthesis framework for health economic evaluation to 11 countries (Austria, Belgium, Croatia, Estonia, Italy, Latvia, the Netherlands, Poland, Slovenia, Spain, and Sweden), accommodating country-specific information on key epidemiological and economic parameters, and on current HPV vaccination programmes. We used projections from three independently developed HPV transmission models to tailor region-specific herd effects. The main outcome measures in the comparison of sex-neutral with girls-only vaccination were cancer cases prevented and incremental cost-effectiveness ratios (ICERs), defined as the cost in international dollars (I$) per life-year gained. FINDINGS The total number of cancer cases to be prevented by vaccinating girls at currently realised vaccine uptake varied from 318 (95% CI 197-405) per cohort of 200 000 preadolescents (100 000 girls plus 100 000 boys) in Croatia (under 20% uptake of the 9-valent vaccine) to 1904 (1741-2101) in Estonia (under 70% uptake of the 9-valent vaccine). Vaccinating boys at equal coverage increased these respective numbers by 168 (95% CI 121-213) in Croatia and 467 (391-587) in Estonia. Sex-neutral vaccination was likely to be cost-effective, with ICERs of sex-neutral compared with girls-only vaccination varying from I$4300 per life-year gained in Latvia (95% credibility interval 3450-5160; 40% uptake) to I$25 720 per life-year gained in Spain (21 380-30 330; 80% uptake). At uniform 80% uptake, a favourable cost-effectiveness profile was retained for most of the countries investigated (Austria, Belgium, Italy, Latvia, the Netherlands, Slovenia, Spain, and Sweden). INTERPRETATION Sex-neutral HPV vaccination is economically attractive in European tender-based settings. However, tendering mechanisms need to ensure that vaccination of boys will remain cost-effective at high vaccine uptake rates. FUNDING European Commission 7th Framework Programme and WHO.
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Affiliation(s)
- Venetia Qendri
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, Netherlands.
| | - Johannes A Bogaards
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, Netherlands; Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | | | - Fulvio Lazzarato
- Unit of Cancer Epidemiology, AOU Cittá della Salute e della Scienza, Hospital of Turin, Turin, Italy
| | - Simopekka Vänskä
- Infectious Disease Control and Vaccination Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Johannes Berkhof
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, Netherlands
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Fogelberg S, Clements MS, Pedersen K, Sy S, Sparén P, Kim JJ, Burger EA. Cost-effectiveness of cervical cancer screening with primary HPV testing for unvaccinated women in Sweden. PLoS One 2020; 15:e0239611. [PMID: 32997696 PMCID: PMC7526933 DOI: 10.1371/journal.pone.0239611] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/09/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Sweden revised their cervical cancer screening program in 2017 to include cytology-based screening for women aged 23-29 years and primary human papillomavirus (HPV) testing for women aged 30-64 years; however, alternative strategies may be preferred. To inform cervical cancer prevention policies for unvaccinated women, we evaluated the cost-effectiveness of alternative screening strategies, including the current Swedish guidelines. METHODS We adapted a mathematical simulation model of HPV and cervical cancer to the Swedish context using primary epidemiologic data. We compared the cost-effectiveness of alternative screening strategies that varied by the age to start screening, the age to switch from cytology to HPV testing, HPV strategies not preceded by cytology, screening frequency, and management of HPV-positive/cytology-negative women. RESULTS We found that the current Swedish guidelines were more costly and less effective than alternative primary HPV-based strategies. All cost-efficient strategies involved primary HPV testing not preceded by cytology for younger women. Given a cost-effectiveness threshold of €85,619 per quality-adjusted life year gained, the optimal strategy involved 5-yearly primary HPV-based screening for women aged 23-50 years and 10-yearly HPV-based screening for women older than age 50 years. CONCLUSIONS Primary screening based on HPV alone may be considered for unvaccinated women for those countries with similar HPV burdens.
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Affiliation(s)
- Sara Fogelberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mark S. Clements
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kine Pedersen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Stephen Sy
- Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jane J. Kim
- Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Emily A. Burger
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Mercuri G, Rodrigues SA, Martins RHG. An estimate of the incidence and prevalence of laryngeal papillomatosis in São Paulo State (Brasil). Rev Assoc Med Bras (1992) 2020; 66:1247-1251. [DOI: 10.1590/1806-9282.66.9.1247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/15/2020] [Indexed: 11/22/2022] Open
Abstract
SUMMARY BACKGROUND: Recurrent laryngeal papillomatosis, caused by the Human Papilloma Virus, has a significant economic impact worldwide and there are no epidemiological data of this disease in Brasil. OBJECTIVE: The objective of the study was to estimate the incidence and prevalence of laryngeal papillomatosis of some otorhinolaryngology centers in São Paulo State (Brasil). METHODS: A questionnaire containing data on the number of new and follow-up cases diagnosed with laryngeal papillomatosis was sent to the Otorhinolaryngology services (n=35) of São Paulo State (Brasil). RESULTS: A total of 20 otorhinolaryngology centers answered the questionnaire. Of these, the five largest regional health centers were selected as follows: Campinas (42 cities – 4,536,657 inhabitants), Sao Jose do Rio Preto (102 cities – 1,602,845 inhabitants), Ribeirão Preto (26 cities – 1,483,715 inhabitants), Bauru (68 cities – 1,770,427 inhabitants), and Sorocaba (47 cities – 2,478,208 inhabitants). The incidence and prevalence of each regional health centers were, respectively: Campinas (5.51;7.27), Sorocaba (2.02;6.86), São José do Rio Preto (1.87;7.49), Ribeirão Preto (11.46;22.92), and Bauru (3.95;7.91). CONCLUSION: The incidence and prevalence of the laryngeal papillomatosis of the five largest regional health centers of the interior of São Paulo State (Brasil) varied between 1.87 to 11.46 and 6.86 to 22.92 per 1,000,000 inhabitants, respectively for a total population of 11,871,852 inhabitants.
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Dynamic factors affecting HPV-attributable fraction for head and neck cancers. Curr Opin Virol 2019; 39:33-40. [DOI: 10.1016/j.coviro.2019.07.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 07/26/2019] [Indexed: 12/24/2022]
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Hylin H, Thrane H, Pedersen K, Kristiansen IS, Burger EA. The healthcare costs of treating human papillomavirus-related cancers in Norway. BMC Cancer 2019; 19:426. [PMID: 31064346 PMCID: PMC6505196 DOI: 10.1186/s12885-019-5596-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/10/2019] [Indexed: 12/24/2022] Open
Abstract
Background Public health efforts to prevent human papillomavirus (HPV)-related cancers include HPV vaccination and cervical cancer screening. We quantified the annual healthcare cost of six HPV-related cancers in order to provide inputs in cost-effectiveness analyses and quantify the potential economic savings from prevention of HPV-related cancers in Norway. Methods Using individual patient-level data from three unlinked population-based registries, we estimated the mean healthcare costs 1) annually across all phases of disease, 2) during the first 3 years of care following diagnosis, and 3) for the last 12 months of life for patients diagnosed with an HPV-related cancer. We included episodes of care related to primary care physicians, specialist care (private specialists and hospital-based care and prescriptions), and prescription drugs redeemed at pharmacies outside hospitals between 2012 and 2014. We valued costs (2014 €1.00 = NOK 8.357) based on diagnosis-related groups (DRG), patient copayments, reimbursement fees and pharmacy retail prices. Results In 2014, the total healthcare cost of HPV-related cancers amounted to €39.8 million, of which specialist care accounted for more than 99% of the total cost. The annual maximum economic burden potentially averted due to HPV vaccination will be lower for vulvar, penile and vaginal cancer (i.e., €984,620, €762,964 and €374,857, respectively) than for cervical, anal and oropharyngeal cancers (i.e., €17.2 million, €6.7 million and €4.6 million, respectively). Over the first three years of treatment following cancer diagnosis, patients diagnosed with oropharyngeal cancer incurred the highest total cost per patient (i.e. €49,774), while penile cancer had the lowest total cost per patient (i.e. €18,350). In general, costs were highest the first year following diagnosis and then declined; however, costs increased rapidly again towards end of life for patients who did not survive. Conclusion HPV-related cancers constitute a considerable economic burden to the Norwegian healthcare system. As the proportion of HPV-vaccinated individuals increase and secondary prevention approaches advance, this study highlights the potential economic burden avoided by preventing these cancers. Electronic supplementary material The online version of this article (10.1186/s12885-019-5596-2) contains supplementary material, which is available to authorized users.
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Posso H, León-Maldonado L, Allen-Leigh B, Salmerón J, Quiterio M, Giuliano AR, Sudenga SL, Nyitray AG, Torres BN, Abrahamsen M, Lazcano-Ponce E. Prevalence and incidence of anal human papillomavirus infection in Mexican men: Need for universal prevention policies. SALUD PUBLICA DE MEXICO 2019; 60:645-652. [PMID: 30699269 DOI: 10.21149/8454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 08/30/2018] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Describe the natural history of anal HPV among men. MATERIALS AND METHODS Prospective study among men 18-70 years (n=665), from Cuernavaca, Mexico who completed questionnaires and provided specimens (HPV genotyped) at enrollment and 1+ follow-up visit. HPV prevalence and incidence were estimated. Prevalence ratios were calculated with Poisson regression using robust variance estimation. Person-time for incident HPV infection was estimated using number of events modeled as Poisson variable for total person-months. RESULTS Anal infection prevalence: any HPV type=15%, high-risk=8.4%, HPV16=1.4%, tetravalent vaccine types (4vHPV)=4.4%, nonavalent vaccine types (9vHPV)=6.3%. Factors associated with prevalence: 50+ lifetime female sex partners (adjusted prevalence ratio, a PR=3.25, 95% CI:1.12- 9.47), 10+ lifetime male sex partners (aPR=3.06, 95%CI:1.4- 6.68), and 1+ recent male anal sex partners (aPR=2.28, 95%CI:1.15-4.5). Anal incidence rate: high-risk HPV=7.8/1000 person-months (95%CI:6.0-10.1), HPV16=1.8/1000 personmonths (95%CI:1.1-2.9),4vHPV=3.4/1000 person-months (95%CI:2.3-4.9) and 9vHPV=5.5/1000 person-months (95%CI:4.1-7.5). CONCLUSIONS Implementation of universal HPV vaccination programs, including men, is a public health priority.
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Affiliation(s)
- Hector Posso
- Universidad de la Sabana. Chia-Cundinamarca, Colombia
| | - Leith León-Maldonado
- Cátedra Conacyt, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
| | - Betania Allen-Leigh
- Dirección de Salud Reproductiva, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
| | - Jorge Salmerón
- Centro de Investigación en Políticas, Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México. Ciudad de México, México.,Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
| | - Manuel Quiterio
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social. Cuernavaca, Morelos, México
| | - Anna R Giuliano
- Center for Infection Research in Cancer, Moffitt Cancer Center and Research Institute.Tampa, Florida
| | - Staci L Sudenga
- Center for Infection Research in Cancer, Moffitt Cancer Center and Research Institute.Tampa, Florida
| | - Alan G Nyitray
- Department of Epidemiology, The University of Texas School of Public Health. Houston, Texas, USA
| | - B Nelson Torres
- Center for Infection Research in Cancer, Moffitt Cancer Center and Research Institute.Tampa, Florida
| | - Martha Abrahamsen
- Center for Infection Research in Cancer, Moffitt Cancer Center and Research Institute.Tampa, Florida
| | - Eduardo Lazcano-Ponce
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
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Abramowitz L, Descamps P, Denis F, Dommergues MA, Pradat P, St Guily JL, Judlin P. Papillomavirus and cancers: should we extend vaccination to boys in France? J Public Health (Oxf) 2019; 39:e229-e234. [PMID: 27679660 DOI: 10.1093/pubmed/fdw099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 08/16/2016] [Indexed: 11/12/2022] Open
Abstract
Background In 2006, the HPV (Human papillomavirus) 6/11/16/18 quadrivalent vaccine was approved by the European Medicines Agency and obtained its marketing authorization in both girls and boys. Currently, the French guidelines recommend and refund vaccination of girls aged 11 to 14 with a catch-up program for females from 15 to 19 years old. Discussion In France, HPV vaccination coverage tends to decrease. At the end of 2015, the vaccination coverage with three doses reached only 14% in 16-year-old girls (three doses). Although men are also affected by HPV-related diseases such as anal cancer, ano-genital warts, penile cancer or upper aerodigestive tract cancer, vaccine recommendations in France are for girls only. To face the high prevalence of anal cancer and related diseases, the best option is vaccination. Moreover, by offering men a way to prevent diseases against which they do not have any protection yet, universal vaccination could better take into account the ethical issues of prevention. In this paper, we present the point of view of different medical specialties concerning the potential benefit of extending vaccination to boys. Conclusion HPV vaccination of both genders could benefit from a better public acceptance and contribute to a better coverage, especially in countries with low vaccination rates.
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Affiliation(s)
- Laurent Abramowitz
- APHP, Service de Gastroentérologie et de Proctologie, CHU Bichat, Paris, France
| | - Philippe Descamps
- Service de Gynécologie-Obstétrique, Pôle « Femme-Mère-Enfant », CHU d'Angers, Angers, France
| | - François Denis
- Service de Bactériologie-Virologie-Hygiène, CHU Dupuytren, Limoges, France
| | | | - Pierre Pradat
- Service d'Hépatologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Jean Lacau St Guily
- Service d'ORL et Chirurgie Cervico-Faciale, Hôpital Tenon, Université Paris 6, Pierre et Marie Curie, Paris, France
| | - Philippe Judlin
- Service de Gynécologie-Obstétrique, Clinique Universitaire, Maternité Régionale Universitaire, Nancy, France
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King E, Ottensmeier C, Pollock KGJ. Novel Approaches for Vaccination Against HPV-Induced Cancers. Curr Top Microbiol Immunol 2019; 405:33-53. [PMID: 25735921 DOI: 10.1007/82_2015_430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
To date, more than 5 % of all cancers are as a result of human papillomavirus (HPV) infection, and this incidence is increasing. Early recognition of disease is associated with good survival, but late presentation results in devastating consequences. Prevention is better than cure, and there are now successful prophylactic vaccination programmes in place. We discuss these and the prospect of therapeutic vaccinations in the near future to address a growing need for improved therapeutic options.
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Affiliation(s)
- Emma King
- University of Southampton, Southampton, UK.
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Qendri V, Bogaards JA, Berkhof J. Pricing of HPV vaccines in European tender-based settings. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:271-280. [PMID: 30051152 PMCID: PMC6439217 DOI: 10.1007/s10198-018-0996-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/18/2018] [Indexed: 05/07/2023]
Abstract
BACKGROUND Vaccine price is one of the most influential parameters in economic evaluations of HPV vaccination programmes. Vaccine tendering is a cost-containment method widely used by national or regional health authorities, but information on tender-based HPV vaccine prices is scarce. METHODS Procurement notices and awards for the HPV vaccines, published from January 2007 until January 2018, were systematically retrieved from the online platform for public procurement in Europe. Information was collected from national or regional tenders organized for publicly funded preadolescent vaccination programmes against HPV. The influence of variables on the vaccine price was estimated by means of a mixed-effects model. FINDINGS Prices were collected from 178 procurements announced in 15 European countries. The average price per dose for the first-generation HPV vaccines decreased from €101.8 (95% CI 91.3-114) in 2007 to €28.4 (22.6-33.5) in 2017, whereas the average dose price of the 9-valent vaccine in 2016-2017 was €49.1 (38.0-66.8). Unit prices were, respectively, €7.5 (4.4-10.6) and €34.4 (27.4-41.4) higher for the 4-valent and 9-valent vaccines than for the 2-valent vaccine. Contract volume and duration, level of procurement (region or country), per capita GDP and number of offers received had a significant effect on vaccine price. INTERPRETATION HPV vaccine procurement is widely used across Europe. The fourfold decrease in the average tender-based prices compared to list prices confirms the potential of tendering as an efficient cost-containment strategy, thereby expanding the indications for cost-effective HPV vaccination to previously ineligible target groups.
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Affiliation(s)
- Venetia Qendri
- Department of Epidemiology and Biostatistics, VU University Medical Center, PO Box 7057, MF F-wing ST, 1007 MB, Amsterdam, The Netherlands.
| | - Johannes A Bogaards
- Department of Epidemiology and Biostatistics, VU University Medical Center, PO Box 7057, MF F-wing ST, 1007 MB, Amsterdam, The Netherlands
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, VU University Medical Center, PO Box 7057, MF F-wing ST, 1007 MB, Amsterdam, The Netherlands
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Qendri V, Bogaards JA, Berkhof J. Who Will Benefit From Expanding HPV Vaccination Programs to Boys? JNCI Cancer Spectr 2018; 2:pky076. [PMID: 31360888 PMCID: PMC6649811 DOI: 10.1093/jncics/pky076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/07/2018] [Accepted: 11/20/2018] [Indexed: 01/05/2023] Open
Abstract
Indications for human papillomavirus vaccination programs are expanding to boys. However, the rationale behind their inclusion is often not clear. Using a Bayesian synthesis framework and assuming equal vaccine coverage in both sexes, we assessed how the incremental number of cancer cases prevented and life-years gained from boys’ vaccination are distributed between women, heterosexual men, and men who have sex with men (MSM). Below 60% coverage, at least 50% of the gains from boys’ vaccination was attributable to cervical cancer prevention, whereas at 80% coverage, 50% of the gains was attributable to women, 15% to heterosexual men, and 35% to MSM. Above 90% coverage, 85–100% of the gains from boys’ vaccination was attributable to anal and oropharyngeal cancer prevention, mainly in MSM. Sex-neutral vaccination can be advocated on grounds of bolstering herd protection to women and directly protecting men, particularly MSM, with the clinical significance of either argument determined by the coverage.
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Affiliation(s)
- Venetia Qendri
- Correspondence to: Venetia Qendri, MSc, Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, PO Box 7057 MF F-wing ST, 1007 MB Amsterdam, the Netherlands (e-mail: )
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Qendri V, Schurink-Van 't Klooster TM, Bogaards JA, Berkhof J. Ten years of HPV vaccination in the Netherlands: current evidence and future challenges in HPV-related disease prevention. Expert Rev Vaccines 2018; 17:1093-1104. [PMID: 30417704 DOI: 10.1080/14760584.2018.1547196] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Girls-only vaccination against human papillomavirus (HPV) type 16 and 18 was implemented in the Netherlands in 2009. Despite the evidence of the efficacy against precancerous lesions, cross-protection induced by the vaccine and a greater potential for cancer prevention than cervical cancer only, vaccine coverage in the girls-only program has remained below target levels. AREAS COVERED In this paper, we review the literature from the Netherlands on the effectiveness and cost-effectiveness of HPV vaccination since vaccine introduction, give an account of the coverage, safety and effectiveness of HPV vaccination as has been reported in the Dutch surveillance program and discuss challenges of the current HPV vaccination program. EXPERT COMMENTARY Girls-only HPV vaccination may confer a substantial health gain in HPV-related disease prevention. However, vaccine coverage declined remarkably recently possibly related to safety concerns, limiting the benefits from girls' vaccination and increasing the potential additional benefit of sex-neutral HPV vaccination. Considering the emergence of novel vaccination and screening options and the change from cytology- to HPV-based screening in 2017, further research is required to inform decisions on the optimization of an integrated vaccination and screening program.
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Affiliation(s)
- V Qendri
- a Department of Epidemiology and Biostatistics , Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam , Netherlands
| | - T M Schurink-Van 't Klooster
- b Center for Infectious Disease Control , National Institute for Public Health and the Environment , Bilthoven , Netherlands
| | - J A Bogaards
- a Department of Epidemiology and Biostatistics , Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam , Netherlands.,b Center for Infectious Disease Control , National Institute for Public Health and the Environment , Bilthoven , Netherlands
| | - J Berkhof
- a Department of Epidemiology and Biostatistics , Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam , Netherlands
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Diaz M, de Sanjosé S, Bosch FX, Bruni L. Present challenges in cervical cancer prevention: Answers from cost-effectiveness analyses. Rep Pract Oncol Radiother 2018; 23:484-494. [PMID: 30534011 PMCID: PMC6277268 DOI: 10.1016/j.rpor.2018.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 04/08/2018] [Indexed: 12/20/2022] Open
Abstract
Simulation models are commonly used to address important health policy issues that cannot be explored through experimental studies. These models are especially useful to determine a set of strategies that result in a good value for money (cost-effectiveness). Several mathematical models simulating the natural history of HPV and related diseases, especially cervical cancer, have been developed to calculate a relative effectiveness and cost-effectiveness of HPV vaccination and cervical cancer screening interventions. Virtually all cost-effectiveness analyses identify HPV vaccination programmes for preadolescent girls to be cost-effective, even for relatively low vaccination coverage rates. Routine vaccination of preadolescent girls is the primary target population for HPV vaccination as it shows to provide the greatest health impact. Cost-effectiveness analyses assessing other vaccine target groups are less conclusive. Adding additional age-cohorts would accelerate health benefits in some years, although cost-effectiveness becomes less favourable as age at vaccination increases. Including men in HPV vaccination programmes may be a less efficient strategy if done at the expense of female vaccination coverage for reducing the burden of HPV in the population. However, as the HPV vaccine price decreases, the cost-effectiveness of universal vaccination improves, becoming equally as efficient as female-only vaccination. Vaccine price is a decisive factor in the cost-effectiveness analyses. The lower the price, the greater the likelihood that vaccination groups other than the primary target would be considered cost-effective.
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Affiliation(s)
- Mireia Diaz
- Unit of Infections and Cancer (UNIC-I&I), Cancer Epidemiology Research Programme (CERP), Institut Català d’Oncologia (ICO) – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- CIBERONC, Barcelona, Spain
| | - Silvia de Sanjosé
- Cancer Epidemiology Research Programme (CERP), Institut Català d’Oncologia (ICO) – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- CIBERESP, Barcelona, Spain
- Path, Reproductive Health Programme, Geneva, Switzerland
| | - F. Xavier Bosch
- CIBERONC, Barcelona, Spain
- Cancer Epidemiology Research Programme (CERP), Institut Català d’Oncologia (ICO) – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Laia Bruni
- Unit of Infections and Cancer (UNIC-I&I), Cancer Epidemiology Research Programme (CERP), Institut Català d’Oncologia (ICO) – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- CIBERONC, Barcelona, Spain
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Age-Structured Population Modeling of HPV-related Cervical Cancer in Texas and US. Sci Rep 2018; 8:14346. [PMID: 30254252 PMCID: PMC6156590 DOI: 10.1038/s41598-018-32566-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/10/2018] [Indexed: 01/27/2023] Open
Abstract
Human papillomavirus (HPV)-related cervical cancer is a major public health threat to women, with >10,000 new cases diagnosed annually in the United States between 2008 and 2012. Since HPV vaccines can protect against ~80% of HPV-associated cervical cancers, the economic and epidemiological impacts of HPV vaccination have been extensively investigated, particularly at the national level. However, vaccination policies are state-specific, and state-level models are required for state-specific policy decisions. This study adapted an age-structured population model to describe the dynamics of HPV-related cervical cancer in Texas, with model parameters calibrated for Texas. The Year 2000 parameter set was the start point, and the model's predictions from 2001-2010 were well matched with the real incidence numbers in 23 age groups, suggesting the validity of the model. Application of the model to the Year 2010 parameter set predicted that, over the next 10 decades, incidence would decrease rapidly within the first decade and more slowly thereafter. Sensitivity analysis determined the impact of selected parameters (e.g., vaccine coverage rate) on future disease incidence. When compared with the US parameter sets, the Texas population was more sensitive to changes in HPV transmission and vaccination (e.g., ~8% difference in the predicted disease decline).
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Soe NN, Ong JJ, Ma X, Fairley CK, Latt PM, Jing J, Cheng F, Zhang L. Should human papillomavirus vaccination target women over age 26, heterosexual men and men who have sex with men? A targeted literature review of cost-effectiveness. Hum Vaccin Immunother 2018; 14:3010-3018. [PMID: 30024823 DOI: 10.1080/21645515.2018.1496878] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) vaccination for young women up to age 26 is highly cost-effective and has been implemented in 65 countries globally. We investigate the cost-effectiveness for HPV vaccination program in older women (age > 26 years), heterosexual men and men who have sex with men (MSM). METHOD A targeted literature review was conducted on PubMed for publications between January 2000 and January 2017 according to the PRISMA guidelines. We included English-language articles that reported the incremental cost-effectiveness ratio (ICER) of HPV vaccination programs for women over age 26, heterosexual men, and MSM and identified the underlying factors for its cost-effectiveness. RESULTS We included 36 relevant articles (six, 26 and four in older women, heterosexual men and MSM, respectively) from 17 countries (12 high-income (HICs) and five low- and middle-income (LMICs) countries). Most (4/6) studies in women over age 26 did not show cost-effectiveness ($65,000-192,000/QALY gained). Two showed cost-effectiveness, but only when the vaccine cost was largely subsidised and protection to non-naïve women was also considered. Sixteen of 26 studies in heterosexual men were cost-effective (ICER = $19,600-52,800/QALY gained in HICs; $49-5,860/QALY gained in LMICs). Nonavalent vaccines, a low vaccine price, fewer required doses, and a long vaccine protection period were key drivers for cost-effectiveness. In contrast, all four studies on MSM consistently reported cost-effectiveness (ICER = $15,000-$43,000/QALY gained), particularly in MSM age < 40 years and those who were HIV-positive. Countries' vaccination coverage did not significantly correlate with its per-capita Gross National Income. CONCLUSION Targeted HPV vaccination for MSM should be next priority in HPV prevention after having established a solid girls vaccination programme. Vaccination for heterosexual men should be considered when 2-dose 4vHPV/9vHPV vaccines become available with a reduced price, whereas targeted vaccination for women over age 26 is unlikely to be cost-effective.
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Affiliation(s)
- Nyi Nyi Soe
- a Research Centre for Public Health, School of Medicine , Tsinghua University , Beijing , China
| | - Jason J Ong
- b Melbourne Sexual Health Centre, Alfred Health , Melbourne , Australia.,c Central Clinical School, Faculty of Medicine , Monash University , Melbourne , Australia.,d London School of Hygiene and Tropical Medicine , London , UK
| | - Xiaomeng Ma
- a Research Centre for Public Health, School of Medicine , Tsinghua University , Beijing , China
| | - Christopher K Fairley
- b Melbourne Sexual Health Centre, Alfred Health , Melbourne , Australia.,c Central Clinical School, Faculty of Medicine , Monash University , Melbourne , Australia
| | - Phyu Mon Latt
- e Section of Epidemiology and Biostatistics, School of Population Health , The University of Auckland , Auckland , New Zealand
| | - Jun Jing
- a Research Centre for Public Health, School of Medicine , Tsinghua University , Beijing , China
| | - Feng Cheng
- a Research Centre for Public Health, School of Medicine , Tsinghua University , Beijing , China
| | - Lei Zhang
- a Research Centre for Public Health, School of Medicine , Tsinghua University , Beijing , China.,b Melbourne Sexual Health Centre, Alfred Health , Melbourne , Australia.,c Central Clinical School, Faculty of Medicine , Monash University , Melbourne , Australia.,f School of Public Health and Preventive Medicine, Faculty of Medicine , Monash University , Melbourne , Australia
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Revisiting assumptions about age-based mixing representations in mathematical models of sexually transmitted infections. Vaccine 2018; 36:5572-5579. [PMID: 30093290 DOI: 10.1016/j.vaccine.2018.07.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 07/16/2018] [Accepted: 07/22/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Sexual mixing between heterogeneous population subgroups is an integral component of mathematical models of sexually transmitted infections (STIs). This study compares the fit of different mixing representations to survey data and the impact of different mixing assumptions on the predicted benefits of hypothetical human papillomavirus (HPV) vaccine strategies. METHODS We compared novel empirical (data-driven) age mixing structures with the more commonly-used assortative-proportionate (A-P) mixing structure. The A-P mixing structure assumes that a proportion of sexual contacts - known as the assortativity constant, typically estimated from survey data or calibrated - occur exclusively within one's own age group and the remainder mixes proportionately among all age groups. The empirical age mixing structure was estimated from the National Survey on Sexual Attitudes and Lifestyles 3 (Natsal-3) using regression methods, and the assortativity constant was estimated from Natsal-3 as well. Using a simplified HPV transmission model under each mixing assumption, we calibrated the model to British HPV16 prevalence data, then estimated the reduction in steady-state prevalence and the number of infections averted due to expanding HPV vaccination from 12- through 26-year-old females alone to 12-year-old males or 27- to 39-year-old females. RESULTS Empirical mixing provided a better fit to the Natsal-3 data than the best-fitting A-P structure. Using the model with empirical mixing as a reference, the model using the A-P structure often under- or over-estimated the benefits of vaccination, in one case overestimating by 2-fold the number of infections prevented due to extended female catch-up in a high vaccine uptake setting. CONCLUSIONS An empirical mixing structure more accurately represents sexual mixing survey data, and using the less accurate, yet commonly-used A-P structure has a notable effect on estimates of HPV vaccination benefits. This underscores the need for mixing structures that are less dependent on unverified assumptions and are directly informed by sexual behavior data.
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Wolff E, Elfström KM, Haugen Cange H, Larsson S, Englund H, Sparén P, Roth A. Cost-effectiveness of sex-neutral HPV-vaccination in Sweden, accounting for herd-immunity and sexual behaviour. Vaccine 2018; 36:5160-5165. [PMID: 30017146 DOI: 10.1016/j.vaccine.2018.07.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 07/06/2018] [Accepted: 07/10/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The aim was to assess cost-effectiveness of expanding the Swedish HPV-vaccination program to include preadolescent boys, by comparing health-effects and costs of HPV-related disease, with a sex-neutral vaccination program versus only vaccinating girls. METHODS We used a dynamic compartmental model to simulate the burden of HPV16/18-related disease in Sweden, accounting for indirect effects of vaccination through herd-immunity. The model accounted for sexual behaviour, such as age preferences and men who have sex with men. The main outcome was number of individuals with HPV-related cancers (cervical, genital, anal and oropharyngeal cancer) and cervical intraepithelial neoplasia (CIN). Costs included in the analysis were those incurred when treating HPV-related cancer and CIN, production losses during sick-leave, and acquisition and administration of vaccine. Health effects were measured as quality-adjusted life years (QALY). The time horizon was set to 100 years, and both effects and costs were discounted by 3% annually. Health effects and costs were accumulated over the time horizon and used to create an incremental cost-effectiveness ratio. RESULTS A sex-neutral vaccination program would reduce HPV-related cancer and CIN, both due to direct effects among vaccinated as well as through herd-immunity, further decreasing HPV-related cancer burden annually by around 60 cases among men and women respectively in steady-state. The cost per gained QALY was estimated to 40,000 euro. Applying the procurement price of 2017, sex-neutral vaccination was dominant. CONCLUSION Introducing a sex-neutral HPV-vaccination program would be good value for money also in Sweden where there this 80% coverage in the current HPV-vaccination program for preadolescent girls. The cost-effectiveness of a sex-neutral program is highly dependent on the price of the vaccine, the lower the price the more favourable it is to also vaccinate boys.
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Affiliation(s)
- Ellen Wolff
- Public Health Agency of Sweden, Nobels väg 18, 171 82 Solna, Sweden; Gothenburg University, Institute of Medicine, Medicinaregatan 3, 405 30 Gothenburg, Sweden.
| | - K Miriam Elfström
- Karolinska Institutet, Stockholm Nobels väg 6, 171 77 Stockholm, Sweden; Regional Cancer Centre of Stockholm-Gotland, Västgötagatan 2, Sweden
| | - Hedda Haugen Cange
- Institute of Clinical Sciences, Sahlgrenska University Hospital, Dept. of Obstetrics and Gynecology, Sahlgrenska University Hospital, Östra, SE 416 85 Gothenburg, Sweden
| | - Sofie Larsson
- Public Health Agency of Sweden, Nobels väg 18, 171 82 Solna, Sweden; Gothenburg University, Institute of Medicine, Medicinaregatan 3, 405 30 Gothenburg, Sweden
| | - Helene Englund
- Public Health Agency of Sweden, Nobels väg 18, 171 82 Solna, Sweden
| | - Pär Sparén
- Karolinska Institutet, Stockholm Nobels väg 6, 171 77 Stockholm, Sweden
| | - Adam Roth
- Public Health Agency of Sweden, Nobels väg 18, 171 82 Solna, Sweden; Institution for Translational Medicine, Lund University, J Waldenströms g 35, CRC, hus 92, plan 11, Malmö, Sweden
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Stanley C, Secter M, Chauvin S, Selk A. HPV vaccination in male physicians: A survey of gynecologists and otolaryngology surgeons' attitudes towards vaccination in themselves and their patients. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2018; 5:89-95. [PMID: 29524677 PMCID: PMC5887017 DOI: 10.1016/j.pvr.2018.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 03/01/2018] [Accepted: 03/04/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Attitudes and barriers towards HPV vaccination were explored in a population of male surgeons in Gynecology and Otolaryngology in Ontario, Canada. MATERIALS/METHODS An internet-based survey was distributed to male residents and physicians affiliated with the departments of Obstetrics and Gynecology, and Otolaryngology at six Ontario universities. The survey consisted of 16 questions (3 demographic, 3 workplace exposure, 6 regarding personal vaccination, and 3 regarding patient vaccination). Subgroup analyses examined differences between residents versus staff physicians and gynecologists versus otolaryngologists. RESULTS Most respondents (51/63, 81.0%) had not been vaccinated against HPV, yet would consider vaccination in the future (41/51, 80.4%). Significantly more residents would consider vaccination compared to staff physicians (p = .03). Personal protection from benign HPV disease was the most common motivating factor (25/59, 42.4%) among participants. A notable barrier to vaccination was "age over recommendations" (9/44, 20.4%). Most participants would recommend the HPV vaccine to both male patients (49/62, 79.0%) and male partners of female patients (47/62, 75.8%). CONCLUSIONS This study demonstrates male gynecologists and otolaryngologists had largely favorable attitudes towards HPV vaccination though few had received vaccination. These findings may be used to increase HPV vaccine uptake among male health care professionals and their patients.
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Affiliation(s)
- Claire Stanley
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada M5S 1A8
| | - Michael Secter
- Department of Obstetrics and Gynecology, Sunnybrook Health Science Centre, Toronto, Ontario, Canada M4N 3M5
| | - Sarah Chauvin
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada M5S 1A8
| | - Amanda Selk
- Department of Obstetrics and Gynecology, Women's College Hospital, Toronto, Ontario, Canada M5S 1B2; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada M5G 1E2.
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Malagón T, Laurie C, Franco EL. Human papillomavirus vaccination and the role of herd effects in future cancer control planning: a review. Expert Rev Vaccines 2018; 17:395-409. [PMID: 29715059 DOI: 10.1080/14760584.2018.1471986] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Vaccine herd effects are the indirect protection that vaccinated persons provide to those who remain susceptible to infection, due to the reduced transmission of infections. Herd effects have been an important part of the discourse on how to best implement human papillomavirus (HPV) vaccines and prevent HPV-related diseases. AREAS COVERED In this paper, we review the theory of HPV vaccine herd effects derived from mathematical models, give an account of observed HPV vaccine herd effects worldwide, and examine the implications of vaccine herd effects for future cervical cancer screening efforts. EXPERT COMMENTARY HPV vaccine herd effects improve the cost-effectiveness of vaccinating preadolescent girls, but contribute to making gender-neutral vaccination less economically efficient. Vaccination coverage and sexual mixing patterns by age are strong determinants of herd effects. Many countries worldwide are starting to observe reductions in HPV-related outcomes likely attributable to herd effects, most notably declining anogenital warts in young men, and declining HPV-16/18 infection prevalence in young unvaccinated women. Policy makers making recommendations for cervical cancer screening will have to consider HPV vaccination coverage and herd effects, as these will affect the positive predictive value of screening and the risk of cervical cancer in unvaccinated women.
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Affiliation(s)
- Talía Malagón
- a Division of Cancer Epidemiology, Faculty of Medicine , McGill University , Montréal , Canada
| | - Cassandra Laurie
- a Division of Cancer Epidemiology, Faculty of Medicine , McGill University , Montréal , Canada
| | - Eduardo L Franco
- a Division of Cancer Epidemiology, Faculty of Medicine , McGill University , Montréal , Canada
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Santos AS, Guerra-Junior AA, Godman B, Morton A, Ruas CM. Cost-effectiveness thresholds: methods for setting and examples from around the world. Expert Rev Pharmacoecon Outcomes Res 2018; 18:277-288. [PMID: 29468951 DOI: 10.1080/14737167.2018.1443810] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Cost-effectiveness thresholds (CETs) are used to judge if an intervention represents sufficient value for money to merit adoption in healthcare systems. The study was motivated by the Brazilian context of HTA, where meetings are being conducted to decide on the definition of a threshold. AREAS COVERED An electronic search was conducted on Medline (via PubMed), Lilacs (via BVS) and ScienceDirect followed by a complementary search of references of included studies, Google Scholar and conference abstracts. Cost-effectiveness thresholds are usually calculated through three different approaches: the willingness-to-pay, representative of welfare economics; the precedent method, based on the value of an already funded technology; and the opportunity cost method, which links the threshold to the volume of health displaced. An explicit threshold has never been formally adopted in most places. Some countries have defined thresholds, with some flexibility to consider other factors. An implicit threshold could be determined by research of funded cases. EXPERT COMMENTARY CETs have had an important role as a 'bridging concept' between the world of academic research and the 'real world' of healthcare prioritization. The definition of a cost-effectiveness threshold is paramount for the construction of a transparent and efficient Health Technology Assessment system.
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Affiliation(s)
- André Soares Santos
- a Department of Social Pharmacy, College of Pharmacy , Universidade Federal de Minas Gerais (UFMG) , Belo Horizonte , Brazil
| | - Augusto Afonso Guerra-Junior
- a Department of Social Pharmacy, College of Pharmacy , Universidade Federal de Minas Gerais (UFMG) , Belo Horizonte , Brazil.,b SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), College of Pharmacy , Universidade Federal de Minas Gerais (UFMG) , Belo Horizonte , Brazil
| | - Brian Godman
- c Department of Pharmacoepidemiology , Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde , Glasgow , United Kingdom.,d Division of Clinical Pharmacology , Karolinska Institute, Karolinska University Hospital Huddinge , Stockholm , Sweden
| | - Alec Morton
- e Department of Management Science , University of Strathclyde Business School , Glasgow , UK
| | - Cristina Mariano Ruas
- a Department of Social Pharmacy, College of Pharmacy , Universidade Federal de Minas Gerais (UFMG) , Belo Horizonte , Brazil
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Lin A, Ong KJ, Hobbelen P, King E, Mesher D, Edmunds WJ, Sonnenberg P, Gilson R, Bains I, Choi YH, Tanton C, Soldan K, Jit M. Impact and Cost-effectiveness of Selective Human Papillomavirus Vaccination of Men Who Have Sex With Men. Clin Infect Dis 2017; 64:580-588. [PMID: 28011615 PMCID: PMC5404831 DOI: 10.1093/cid/ciw845] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 12/14/2016] [Indexed: 02/01/2023] Open
Abstract
Background. Men who have sex with men (MSM) have a high lifetime risk of anogenital warts and cancers related to infection with human papillomavirus (HPV). They also benefit less from herd protection than heterosexual males in settings with female-only HPV vaccination. Methods. We evaluated the potential health impact and cost-effectiveness of offering vaccination to MSM who visit genitourinary medicine (GUM) clinics. We used a mathematical model of HPV 6/11/16/18 sexual transmission within an MSM population in England, parameterized with sexual behaviour, GUM attendance, HPV prevalence, HIV prevalence, warts, and cancer incidence data. Interventions considered were offering HPV vaccination to either HIV-positive MSM or MSM regardless of HIV status, for age bands 16–25, 16–30, 16–35, and 16–40 years. Results. Substantial declines in anogenital warts and male HPV-related cancer incidence are projected to occur following an offer of vaccination to MSM. MSM not attending GUM clinics will partially benefit from herd protection. Offering vaccination to HIV-positive MSM up to age 40 is likely to be cost-effective if vaccine procurement and administration costs are below £96.50 a dose. At £48 a dose, offering vaccination to all MSM up to age 40 is likely to be cost-effective. Conclusions. Quadrivalent HPV vaccination of MSM via GUM clinics is likely to be an effective and cost-effective way of reducing the burden of HPV-related disease in MSM.
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Affiliation(s)
- Allen Lin
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Department of Systems Biology, Harvard Medical School, Boston, Massachusetts, USA
| | - Koh J Ong
- National Infections Service-Colindale, Public Health England, London, UK
| | - Peter Hobbelen
- National Infections Service-Colindale, Public Health England, London, UK
| | - Eleanor King
- Research Department of Infection and Population Health, University College London, London, UK
| | - David Mesher
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,National Infections Service-Colindale, Public Health England, London, UK
| | - W John Edmunds
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Pam Sonnenberg
- Research Department of Infection and Population Health, University College London, London, UK
| | - Richard Gilson
- Research Department of Infection and Population Health, University College London, London, UK
| | - Irenjeet Bains
- National Infections Service-Colindale, Public Health England, London, UK
| | - Yoon H Choi
- National Infections Service-Colindale, Public Health England, London, UK
| | - Clare Tanton
- Research Department of Infection and Population Health, University College London, London, UK
| | - Kate Soldan
- National Infections Service-Colindale, Public Health England, London, UK
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,National Infections Service-Colindale, Public Health England, London, UK
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Das R, Machalek DA, Molesworth EG, Garland SM. Using Facebook to Recruit Young Australian Men Into a Cross-Sectional Human Papillomavirus Study. J Med Internet Res 2017; 19:e389. [PMID: 29150417 PMCID: PMC5712010 DOI: 10.2196/jmir.8739] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 01/16/2023] Open
Abstract
Background Young men can be difficult to engage in health research using traditional methods of recruitment. Social networking sites are increasingly being used to recruit participants into health research, due to their cost effectiveness, overall generalizability, and wide reach. Objective The aim of this study was to determine the feasibility of using Facebook to recruit young Australian men into a human papillomavirus (HPV) prevalence study. Methods We recruited male permanent residents of Australia, aged 18 to 35 years, into the HPV in Young Males (HYM) study through targeted advertising placed on Facebook. Consenting participants completed an online questionnaire and provided a self-collected penile swab for HPV DNA detection and genotyping. We compared sociodemographic characteristics of the study population with those of the general Australian male population, based on Australian 2011 census data. Results Between February 2015 and February 2017, targeted Facebook advertisements reached 1,523,239 men, resulting in 41,811 clicks through to the study website, with 1072 (2.56%) converting to lodgment of an expression of interest. Of these, 681 (63.53%) provided written informed consent and 535 (78.6% of recruited participants) completed all the study requirements. Reasons for participating in the study included altruism, past history of HPV, gaining more knowledge about HPV or the vaccine, working in the health industry, and the monetary compensation. The average advertising cost per completed study participant was Aus $48. Compared with the census population, HYM study participants were more likely to be Australian born (P<.001), be from Victoria (P=.003) or the Australian Capital Territory (P=.004), reside in a major city (P<.001), and have completed undergraduate (P<.001) or postgraduate education (P<.001). HYM study participants were less likely to report being a current smoker (P=.03), but were more likely to identify as bisexual or homosexual (294/529, 55.6%, P<.001), than the general population. Conclusions Using Facebook is a feasible and efficient strategy for the recruitment of men from across Australia for HPV testing. This method could be used for monitoring the impact of HPV vaccination. Additional targeting may achieve a sample that is broadly demographically representative of the Australian population. Future research should explore how the sexual risk behavior characteristics of populations recruited through Facebook compare with those of traditional recruitment methods.
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Affiliation(s)
- Roopa Das
- Melbourne Medical School, University of Melbourne, Parkville, Australia.,Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Australia
| | - Dorothy A Machalek
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Australia.,Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia
| | - Edmund G Molesworth
- Melbourne Medical School, University of Melbourne, Parkville, Australia.,Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Australia
| | - Suzanne M Garland
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Australia.,Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia.,The Royal Children's Hospital, Parkville, Australia
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35
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Nymark LS, Sharma T, Miller A, Enemark U, Griffiths UK. Inclusion of the value of herd immunity in economic evaluations of vaccines. A systematic review of methods used. Vaccine 2017; 35:6828-6841. [PMID: 29146380 DOI: 10.1016/j.vaccine.2017.10.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 10/04/2017] [Accepted: 10/12/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objectives of this review were to identify vaccine economic evaluations that include herd immunity and describe the methodological approaches used. METHODS We used Kim and Goldie's search strategy from a systematic review (1976-2007) of modelling approaches used in vaccine economic evaluations and additionally searched PubMed/MEDLINE and Embase for 2007-2015. Studies were classified according to modelling approach used. Methods for estimating herd immunity effects were described, in particular for the static models. RESULTS We identified 625 economic evaluations of vaccines against human-transmissible diseases from 1976 to 2015. Of these, 172 (28%) included herd immunity. While 4% of studies included herd immunity in 2001, 53% of those published in 2015 did this. Pneumococcal, human papilloma and rotavirus vaccines represented the majority of studies (63%) considering herd immunity. Ninety-five of the 172 studies utilised a static model, 59 applied a dynamic model, eight a hybrid model and ten did not clearly state which method was used. Relatively crude methods and assumptions were used in the majority of the static model studies. CONCLUSION The proportion of economic evaluations using a dynamic model has increased in recent years. However, 55% of the included studies used a static model for estimating herd immunity. Values from a static model can only be considered reliable if high quality surveillance data are incorporated into the analysis. Without this, the results are questionable and they should only be included in sensitivity analysis.
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Affiliation(s)
- Liv S Nymark
- Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark; Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serums Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Tarang Sharma
- Nordic Cochrane Centre, Rigshospitalet, Blegdamsvej 9, DK- 2100 Copenhagen Ø, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200 København N, Denmark
| | | | - Ulrika Enemark
- Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark; Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serums Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark
| | - Ulla Kou Griffiths
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK; UNICEF, 3 UN Plaza, New York, NY 10007, USA
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36
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Qendri V, Bogaards JA, Berkhof J. Health and Economic Impact of a Tender-Based, Sex-Neutral Human Papillomavirus 16/18 Vaccination Program in the Netherlands. J Infect Dis 2017; 216:210-219. [PMID: 28586466 DOI: 10.1093/infdis/jix272] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/02/2017] [Indexed: 12/27/2022] Open
Abstract
Background Uptake of human papillomavirus (HPV) vaccine among girls in the Dutch immunization program has plateaued at around 60%. Vaccinating boys may be an appealing complementary strategy for the prevention of HPV-related diseases, especially since tender negotiations and reduced dosing schemes have driven down the cost of vaccination. Methods We expanded a previously published Bayesian synthesis framework to account for all vaccine type-related cancers and herd immunity effects from vaccinating girls and boys. We evaluated the efficiency of vaccinating boys relative to increasing vaccine uptake among girls and assessed the cost-effectiveness of a sex-neutral program. Results Vaccinating 40% of boys along with 60% of girls yielded the same gain in life-years (LYs) as increasing the uptake in girls from 60% to 80%. The incremental cost-effectiveness ratio (ICER) of vaccinating boys was €9134/LY (95% credible interval [CrI], €7323/LY-€11231/LY) under 3% discounting. The ceiling vaccination costs at which the ICER remained below the per capita gross domestic product threshold was €240 (95% CrI, €200-€280) per vaccinated boy. If girls' uptake increased to 90%, the ceiling costs decreased to €70 (95% CrI, €40-€100) per vaccinated boy. Conclusions Vaccinating boys along with girls is only modestly less efficient than increasing uptake among girls and highly likely to be cost-effective under current vaccine costs and uptake in the Netherlands.
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Affiliation(s)
- Venetia Qendri
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam
| | - Johannes A Bogaards
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam.,Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam
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Setiawan D, Oktora MP, Hutubessy R, Riewpaiboon A, Postma MJ. The health-economic studies of HPV vaccination in Southeast Asian countries: a systematic review. Expert Rev Vaccines 2017; 16:933-943. [PMID: 28730914 DOI: 10.1080/14760584.2017.1357472] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The cervical cancer-related burden is an important problem in Southeast Asian (SEA) countries. However, only 3 out of 11 countries implement the comprehensive prevention program. Areas covered: This is a retrospective review from all relevant studies until 2015 from two main databases, MEDLINE/Pubmed and Embase in order to provide an evidence on the health economics of HPV vaccination in the region. Expert commentary: The implementation of HPV vaccination will generate substantial health and economic benefit in SEA countries since the number of cervical cancer cases in this region are generally high. Therefore, a clear recommendation on how HPV vaccination should be implemented in a country, for example on how many doses will be used, how much cost is required or is it a school based- or clinical based-delivery, is critically required.
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Affiliation(s)
- Didik Setiawan
- a PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy , University of Groningen , Groningen , The Netherlands.,b Faculty of Pharmacy , Universitas Muhammadiyah Purwokerto , Purwokerto , Indonesia
| | - Monika Puri Oktora
- a PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy , University of Groningen , Groningen , The Netherlands
| | - Raymond Hutubessy
- c Initiative for Vaccine Research , World Health Organization , Geneva , Switzerland
| | - Arthorn Riewpaiboon
- d Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy , Mahidol University , Thailand
| | - Maarten J Postma
- a PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy , University of Groningen , Groningen , The Netherlands.,e Institute of Science in Healthy Aging & healthcaRE (SHARE) , University Medical Center Groningen (UMCG) , Groningen , The Netherlands
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Shapiro GK, Guichon J, Prue G, Perez S, Rosberger Z. A Multiple Streams analysis of the decisions to fund gender-neutral HPV vaccination in Canada. Prev Med 2017; 100:123-131. [PMID: 28435081 DOI: 10.1016/j.ypmed.2017.04.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 04/03/2017] [Accepted: 04/09/2017] [Indexed: 12/25/2022]
Abstract
In Canada, the human papillomavirus (HPV) vaccine is licensed and recommended for females and males. Although all Canadian jurisdictions fund school-based HPV vaccine programs for girls, only six jurisdictions fund school-based HPV vaccination for boys. The research aimed to analyze the factors that underpin government decisions to fund HPV vaccine for boys using a theoretical policy model, Kingdon's Multiple Streams framework. This approach assesses policy development by examining three concurrent, but independent, streams that guide analysis: Problem Stream, Policy Stream, and Politics Stream. Analysis from the Problem Stream highlights that males are affected by HPV-related diseases and are involved in transmitting HPV infection to their sexual partners. Policy Stream analysis makes clear that while the inclusion of males in HPV vaccine programs is suitable, equitable, and acceptable; there is debate regarding cost-effectiveness. Politics Stream analysis identifies the perspectives of six different stakeholder groups and highlights the contribution of government officials at the provincial and territorial level. Kingdon's Multiple Streams framework helps clarify the opportunities and barriers for HPV vaccine policy change. This analysis identified that the interpretation of cost-effectiveness models and advocacy of stakeholders such as citizen-advocates and HPV-affected politicians have been particularly important in galvanizing policy change.
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Affiliation(s)
- Gilla K Shapiro
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal H3A 1B1, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal H3T 1E4, Quebec, Canada.
| | - Juliet Guichon
- Department of Community Health Sciences, 3280 Hospital Drive, Calgary T2N 4N1, Alberta, Canada
| | - Gillian Prue
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, United Kingdom
| | - Samara Perez
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal H3A 1B1, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal H3T 1E4, Quebec, Canada
| | - Zeev Rosberger
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal H3A 1B1, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal H3T 1E4, Quebec, Canada; Louise Granofsky Psychosocial Oncology Program, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal H3T 1E4, Quebec, Canada; Departments of Psychiatry and Oncology, McGill University, 1205 Dr. Penfield Avenue, Montreal H3A 1B1, Quebec, Canada
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Favato G, Easton T, Vecchiato R, Noikokyris E. Ecological validity of cost-effectiveness models of universal HPV vaccination: A systematic literature review. Vaccine 2017; 35:2622-2632. [PMID: 28408119 DOI: 10.1016/j.vaccine.2017.03.093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 03/13/2017] [Accepted: 03/31/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The protective (herd) effect of the selective vaccination of pubertal girls against human papillomavirus (HPV) implies a high probability that one of the two partners involved in intercourse is immunised, hence preventing the other from this sexually transmitted infection. The dynamic transmission models used to inform immunisation policy should include consideration of sexual behaviours and population mixing in order to demonstrate an ecological validity, whereby the scenarios modelled remain faithful to the real-life social and cultural context. The primary aim of this review is to test the ecological validity of the universal HPV vaccination cost-effectiveness modelling available in the published literature. METHODS The research protocol related to this systematic review has been registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42016034145). Eight published economic evaluations were reviewed. RESULTS None of the studies showed due consideration of the complexities of human sexual behaviour and the impact this may have on the transmission of HPV. DISCUSSION Our findings indicate that all the included models might be affected by a different degree of ecological bias, which implies an inability to reflect the natural demographic and behavioural trends in their outcomes and, consequently, to accurately inform public healthcare policy. In particular, ecological bias have the effect to over-estimate the preference-based outcomes of selective immunisation. A relatively small (15-20%) over-estimation of quality-adjusted life years (QALYs) gained with selective immunisation programmes could induce a significant error in the estimate of cost-effectiveness of universal immunisation, by inflating its incremental cost effectiveness ratio (ICER) beyond the acceptability threshold. The results modelled here demonstrate the limitations of the cost-effectiveness studies for HPV vaccination, and highlight the concern that public healthcare policy might have been built upon incomplete studies.
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Affiliation(s)
- Giampiero Favato
- Institute for Leadership and Management of Health (ILMH), Kingston Business School, Kingston University, Kingston Hill, Kingston-upon-Thames KT2 7LB, UK; Kingston Business School, Kingston University, Kingston Hill, Kingston-upon-Thames KT2 7LB, UK.
| | - Tania Easton
- Kingston Business School, Kingston University, Kingston Hill, Kingston-upon-Thames KT2 7LB, UK
| | - Riccardo Vecchiato
- Institute for Leadership and Management of Health (ILMH), Kingston Business School, Kingston University, Kingston Hill, Kingston-upon-Thames KT2 7LB, UK; Kingston Business School, Kingston University, Kingston Hill, Kingston-upon-Thames KT2 7LB, UK
| | - Emmanouil Noikokyris
- Kingston Business School, Kingston University, Kingston Hill, Kingston-upon-Thames KT2 7LB, UK
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Setiawan D, Luttjeboer J, Pouwels KB, Wilschut JC, Postma MJ. Immunogenicity and safety of human papillomavirus (HPV) vaccination in Asian populations from six countries: a meta-analysis. Jpn J Clin Oncol 2017; 47:265-276. [PMID: 28042137 DOI: 10.1093/jjco/hyw192] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 12/05/2016] [Indexed: 11/14/2022] Open
Abstract
Cervical cancer is a serious public-health problem in Asian countries. Since human papillomavirus (HPV) infection is the main risk factor for cervical cancer, HPV vaccination is considered a promising strategy to prevent cervical cancer. However, comprehensive immunogenicity and safety information for Asian populations is lacking. We searched four electronic databases including PubMed, EMBASE, Cochrane Library, and clinicaltrials.gov. We reviewed selected manuscripts and extracted the pooled relative risk (RR) from immunogenicity and safety information on HPV vaccination among women in Asian countries. We identified two quadrivalent-vaccine studies and eight bivalent-vaccine studies conducted in Asian countries. Analysis across these studies suggested that the HPV vaccines significantly enhanced HPV16- and HPV18-specific antibody among both uninfected (RR 85.69; 95% confidence interval (CI) 31.51-233.04 and 62.77; 95% CI 37.4-105.51) and infected individuals (RR 8.60; 95% CI 6.95-10.64 and RR 8.13; 95% CI 5.96-11.11). Furthermore, HPV vaccination among Asian populations has a favorable safety profile, with only slightly higher risks of local (RR: 1.89; 95% CI 1.65-2.17) and systemic (RR: 1.33; 95% CI 1.18-1.50) adverse events in vaccinated individuals compared with controls. For Asian populations, HPV vaccines enhance the level of HPV16- and HPV18-specific antibodies for both uninfected and infected individuals. Also, the risk of adverse events related to vaccination are acceptable. More data are needed to establish vaccine efficacy with regard to prevention of HPV infection and further outcomes including cervical intraepithelial neoplasia (CIN) and cervical cancer.
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Affiliation(s)
- Didik Setiawan
- Unit of PharmacoEpidemiology & Pharmacoeconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.,Faculty of Pharmacy, University of Muhammadiyah Purwokerto, Purwokerto, Indonesia
| | - Jos Luttjeboer
- Unit of PharmacoEpidemiology & Pharmacoeconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Koen B Pouwels
- Unit of PharmacoEpidemiology & Pharmacoeconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.,Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Jan C Wilschut
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen
| | - Maarten J Postma
- Unit of PharmacoEpidemiology & Pharmacoeconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.,Institute of Science in Healthy Aging & healthcaRE (SHARE), University Medical Center Groningen (UMCG), Groningen.,Department of Epidemiology, UMCG, Groningen, The Netherlands
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Lupato V, Holzinger D, Höfler D, Menegaldo A, Giorgi Rossi P, Del Mistro A, Da Mosto MC, Pawlita M, Boscolo-Rizzo P. Prevalence and Determinants of Oral Human Papillomavirus Infection in 500 Young Adults from Italy. PLoS One 2017; 12:e0170091. [PMID: 28103272 PMCID: PMC5245874 DOI: 10.1371/journal.pone.0170091] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 12/28/2016] [Indexed: 01/05/2023] Open
Abstract
Although the prevalence of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) is increasing in developed countries and becoming a relevant health issue, the natural history of oral HPV infection is still unclear. Estimating the infection's prevalence in specific populations and identifying risk factors can widen our understanding of its natural history and help to delineate appropriate prevention strategies. This study sought to (i) determine oral HPV prevalence and genotype distribution in a large series of young Italian adults, (ii) validate an oral rinse sampling/storage protocol, and (iii) pinpoint factors associated with oral HPV infection. Five hundred students, nurses, and technicians (19-35 years-old) studying and working at/for the University of Padua were recruited. Each participant was provided with an oral rinse sampling kit and instructions for use. They were also asked to complete an anonymous questionnaire concerning their demographic characteristics and behaviors. The questionnaires and oral rinse containers were labeled with the same identification code number. The oral rinse samples were tested using a bead-based multiplex BSGP5+/6+-MPG genotyping assay which amplifies the L1 region of 51 mucosal HPV types. The prevalence of oral HPV infection was 4.0% (95% confidence interval (CI), 2.5%-6.1%); those of 14 high-risk HPV types and of HPV-type 16 (HPV16) infection were 2.2% (95% CI, 1.1%-3.9%) and 1.6% (95% CI, 0.6%-3.1%), respectively. HPV16 was the most frequent genotype (40.0% of oral HPV infections). No association was found between oral infection and the co-variables studied (gender, tobacco, alcohol and illegal drug use, number of sex and oral sex partners, HPV vaccination status, history of HPV and sexually transmitted infections, abnormal pap smears, recurrent tonsillitis and tonsillectomy). The oral rinse sampling protocol outlined here proved to be simple, efficient and well tolerated, and the prevalence rate can be considered reliable and thus useful to guide future research. Determinants of oral HPV infection are still unclear and further studies are certainly warranted.
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Affiliation(s)
- Valentina Lupato
- Department of Neurosciences, Regional Center for Head and Neck Cancer, University of Padua, Treviso, Italy
- Unit of Otolaryngology, Azienda Ospedaliera “S. Maria degli Angeli”, Pordenone, Italy
| | - Dana Holzinger
- Division of Molecular Diagnostics of Oncogenic Infections, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniela Höfler
- Division of Molecular Diagnostics of Oncogenic Infections, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anna Menegaldo
- Department of Neurosciences, Regional Center for Head and Neck Cancer, University of Padua, Treviso, Italy
| | - Paolo Giorgi Rossi
- Interinstitutional Epidemiology Unit, Local Health Authority, Reggio Emilia, Italy
- Arcispedale S. Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Annarosa Del Mistro
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto—IRCCS, Padova, Italy
| | - Maria Cristina Da Mosto
- Department of Neurosciences, Regional Center for Head and Neck Cancer, University of Padua, Treviso, Italy
| | - Michael Pawlita
- Division of Molecular Diagnostics of Oncogenic Infections, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Paolo Boscolo-Rizzo
- Department of Neurosciences, Regional Center for Head and Neck Cancer, University of Padua, Treviso, Italy
- * E-mail:
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Suijkerbuijk AWM, Donken R, Lugnér AK, de Wit GA, Meijer CJLM, de Melker HE, Bogaards JA. The whole story: a systematic review of economic evaluations of HPV vaccination including non-cervical HPV-associated diseases. Expert Rev Vaccines 2016; 16:361-375. [PMID: 27807989 DOI: 10.1080/14760584.2017.1256778] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Many economic evaluations of HPV vaccination have been published, but most have focused on the prevention of cervical disease as a primary health outcome. The cost-effectiveness of vaccination is likely to be underestimated if not all HPV-associated diseases are taken into account. In this review, we assess the influence of non-cervical HPV-associated diseases on the incremental cost-effectiveness ratio (ICER) of preadolescent HPV vaccination. Areas covered: We systematically searched the literature and identified 18 studies that included non-cervical diseases in the estimates of cost-effectiveness of HPV-vaccination. When taking other HPV-related diseases into account compared to not including such other diseases, the mean ICERs were 2.85 times more favorable for girls only vaccination and 3.89 times for gender neutral vaccination. Expert commentary: Including non-cervical diseases in economic evaluations of HPV vaccination programs makes it more likely that the ICER falls beneath accepted cost-effectiveness thresholds and therefore increases the scope for gender neutral vaccination.
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Affiliation(s)
- Anita W M Suijkerbuijk
- a Center for Nutrition, Prevention and Health Services , National Institute for Public Health and the Environment (RIVM) , Bilthoven , The Netherlands
| | - Robine Donken
- b Center for Epidemiology and Surveillance , National Institute for Public Health and the Environment (RIVM) , Bilthoven , The Netherlands.,c Department of Pathology , VU University Medical Centre (VUmc) , Amsterdam , The Netherlands
| | - Anna K Lugnér
- b Center for Epidemiology and Surveillance , National Institute for Public Health and the Environment (RIVM) , Bilthoven , The Netherlands
| | - G Ardine de Wit
- a Center for Nutrition, Prevention and Health Services , National Institute for Public Health and the Environment (RIVM) , Bilthoven , The Netherlands.,d Julius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Chris J L M Meijer
- c Department of Pathology , VU University Medical Centre (VUmc) , Amsterdam , The Netherlands
| | - Hester E de Melker
- b Center for Epidemiology and Surveillance , National Institute for Public Health and the Environment (RIVM) , Bilthoven , The Netherlands
| | - Johannes A Bogaards
- b Center for Epidemiology and Surveillance , National Institute for Public Health and the Environment (RIVM) , Bilthoven , The Netherlands
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Skinner SR, Apter D, De Carvalho N, Harper DM, Konno R, Paavonen J, Romanowski B, Roteli-Martins C, Burlet N, Mihalyi A, Struyf F. Human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine for the prevention of cervical cancer and HPV-related diseases. Expert Rev Vaccines 2016; 15:367-87. [PMID: 26902666 DOI: 10.1586/14760584.2016.1124763] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Vaccines are available against human papillomavirus (HPV), the causal agent of cervical and other cancers. Efficacy data from the HPV-16/18 AS04-adjuvanted vaccine clinical trial program were reviewed. Six randomized, controlled phase II/III trials evaluating cervical endpoints enrolled women from diverse populations and geographical locations. The program analyzed extensively the cohorts most relevant from a public health perspective: the total vaccinated cohort (TVC), approximating a general population including those with existing or previous HPV infection, and TVC-naïve, approximating a population of young women before sexual debut. Results show that the vaccine reduces HPV-16/18 infection and associated cervical endpoints in women regardless of age, location, or sexual experience. It provides cross-protection against some non-vaccine oncogenic HPV types and types causing genital warts, and may be effective against vulvar, oral, and anal HPV infection. Early epidemiology data following its introduction suggest a decline in the prevalence of vaccine and some non-vaccine HPV types.
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Affiliation(s)
- S Rachel Skinner
- a Sydney University Discipline of Paediatrics and Child Health , The Children's Hospital at Westmead , Sydney , NSW , Australia.,b Vaccine Trials Group, Telethon Kids Institute , University of Western Australia , Perth , Australia
| | - Dan Apter
- c Family Federation of Finland , Sexual Health Clinic , Helsinki , Finland
| | - Newton De Carvalho
- d Department of Gynecology and Obstetrics, Gynecology and Obstetrics Infectious Diseases Sector , University of Parana , Curitiba , Parana , Brazil
| | - Diane M Harper
- e Department of Obstetrics and Gynecology, Geisel School of Medicine at Dartmouth , Hanover , NH , USA.,f Department of Family and Geriatric Medicine, University of Louisville School of Medicine , Louisville , KY , USA
| | - Ryo Konno
- g Department of Obstetrics and Gynaecology , Jichi Medical University Saitama Medical Center , Saitama , Japan
| | - Jorma Paavonen
- h Department of Obstetrics and Gynaecology , University of Helsinki , Helsinki , Finland
| | - Barbara Romanowski
- i Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry , University of Alberta , Edmonton , AB , Canada
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Flessa S, Dietz D, Weiderpass E. Health policy support under extreme uncertainty: the case of cervical cancer in Cambodia. EURO JOURNAL ON DECISION PROCESSES 2016. [DOI: 10.1007/s40070-015-0053-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Bucchi D, Stracci F, Buonora N, Masanotti G. Human papillomavirus and gastrointestinal cancer: A review. World J Gastroenterol 2016; 22:7415-7430. [PMID: 27672265 PMCID: PMC5011658 DOI: 10.3748/wjg.v22.i33.7415] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/29/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
Human papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide. Exposure to HPV is very common, and an estimated 65%-100% of sexually active adults are exposed to HPV in their lifetime. The majority of HPV infections are asymptomatic, but there is a 10% chance that individuals will develop a persistent infection and have an increased risk of developing a carcinoma. The International Agency for Research on Cancer has found that the following cancer sites have a strong causal relationship with HPV: cervix uteri, penis, vulva, vagina, anus and oropharynx, including the base of the tongue and the tonsils. However, studies of the aetiological role of HPV in colorectal and esophageal malignancies have conflicting results. The aim of this review was to organize recent evidence and issues about the association between HPV infection and gastrointestinal tumours with a focus on esophageal, colorectal and anal cancers. The ultimate goal was to highlight possible implications for prognosis and prevention.
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Ben Hadj Yahia MB, Jouin-Bortolotti A, Dervaux B. Extending the Human Papillomavirus Vaccination Programme to Include Males in High-Income Countries: A Systematic Review of the Cost-Effectiveness Studies. Clin Drug Investig 2016; 35:471-85. [PMID: 26187455 DOI: 10.1007/s40261-015-0308-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Giving the human papillomavirus (HPV) vaccination to females has been shown to be cost-effective in most countries. The epidemiological evidence and economic burden of HPV-related diseases have gradually been shown to be gender neutral. Randomized clinical trials report high efficacy, immunogenicity and safety of the HPV vaccine in males aged 16-26 years. Some pioneering countries extended their HPV vaccination programme to include males, regardless of the cost-effectiveness analysis results. Nevertheless, decision makers need evidence provided by modelling and economic studies to justify the funding of mass vaccination. This systematic review aims to assess the cost-effectiveness of extending the HPV vaccination programme to include males living in high-income countries. METHODS A systematic review of the cost-effectiveness analyses of HPV vaccination in males was performed. Data were extracted and analysed using a checklist adapted from the Consolidated Health Economic Evaluation Reporting Standards Statement. RESULTS Seventeen studies and 12 underlying mathematical models were identified. Model filiation showed evolution in time from aggregate models (static and dynamic) to individual-based models. When considering the health outcomes HPV vaccines are licensed for, regardless of modelling approaches and assumptions, extending vaccinations to males is rarely found to be cost-effective in heterosexual populations. Cost-effectiveness ratios become more attractive when all HPV-related diseases are considered and when vaccine coverage in females is below 40%. CONCLUSION Targeted vaccination of men who have sex with men (MSM) seems to be the best cost-effectiveness option. The feasibility of this strategy is still an open question, since early identification of this specific population remains difficult.
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Affiliation(s)
- Mohamed-Béchir Ben Hadj Yahia
- Department of Epidemiology, Health Economics and Prevention, Lille University Hospital, CHRU de Lille, Pôle S3P, Maison Régionale de la Recherche Clinique, 6, rue du Pr Laguesse, CS 70001, 59037, Lille Cedex, France,
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Pedersen K, Burger EA, Sy S, Kristiansen IS, Kim JJ. Cost-effective management of women with minor cervical lesions: Revisiting the application of HPV DNA testing. Gynecol Oncol 2016; 143:326-333. [PMID: 27542966 DOI: 10.1016/j.ygyno.2016.08.231] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 08/03/2016] [Accepted: 08/04/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lack of consensus in management guidelines for women with minor cervical lesions, coupled with novel screening approaches, such as human papillomavirus (HPV) genotyping, necessitate revisiting prevention policies. We evaluated the cost-effectiveness and resource trade-offs of alternative triage strategies to inform cervical cancer prevention in Norway. METHODS We used a decision-analytic model to compare the lifetime health and economic consequences associated with ten novel candidate approaches to triage women with minor cervical lesions. Candidate strategies varied by: 1) the triage test(s): HPV testing in combination with cytology, HPV testing alone with or without genotyping for HPV-16 and -18, and immediate colposcopy, and 2) the length of time between index and triage testing (i.e., 6, 12 or 18months). Model outcomes included quality-adjusted life-years (QALYs), lifetime societal costs, and resource use (e.g., colposcopy referrals). RESULTS The current Norwegian guidelines were less effective and more costly than candidate strategies. Given a commonly-cited willingness-to-pay threshold in Norway of $100,000 per QALY gained, the preferred strategy involved HPV genotyping with immediate colposcopy referral for HPV-16 or -18 positive and repeat HPV testing at 12months for non-HPV-16 or -18 positive ($78,010 per QALY gained). Differences in health benefits among candidate strategies were small, while resource use varied substantially. More effective strategies required a moderate increase in colposcopy referrals (e.g., a 9% increase for the preferred strategy) compared with current levels. CONCLUSION New applications of HPV testing may improve management of women with minor cervical lesions, yet are accompanied by a trade-off of increased follow-up procedures.
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Affiliation(s)
- Kine Pedersen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P.O. Box 1089 Blindern, 0317 Oslo, Norway
| | - Emily A Burger
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P.O. Box 1089 Blindern, 0317 Oslo, Norway; Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave, 2nd Floor, Boston, MA 02115, USA.
| | - Stephen Sy
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave, 2nd Floor, Boston, MA 02115, USA
| | - Ivar S Kristiansen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P.O. Box 1089 Blindern, 0317 Oslo, Norway
| | - Jane J Kim
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave, 2nd Floor, Boston, MA 02115, USA
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Burlamaqui JCF, Cassanti AC, Borim GB, Damrose E, Villa LL, Silva L. Human Papillomavirus and students in Brazil: an assessment of knowledge of a common infection - preliminary report. Braz J Otorhinolaryngol 2016; 83:120-125. [PMID: 27170346 PMCID: PMC9442715 DOI: 10.1016/j.bjorl.2016.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 02/02/2016] [Indexed: 11/19/2022] Open
Abstract
Introduction Human Papillomavirus (HPV) infection is the most prevalent sexually transmitted disease worldwide. One of the barriers to the implementation of prevention programs against the disease is the limited knowledge possessed by most populations regarding the virus and its possible consequences. Objective The purpose of this study was to evaluate the knowledge of Brazilian college students on transmission, clinical manifestations, and diseases correlated with HPV, highlighting the poor knowledge of a very common infection. Methods A total of 194 students answered a questionnaire about transmission, clinical features and the possible consequences of persistent HPV infection. The questionnaire was self-applied under the supervision of the authors. Results The clinical manifestations of HPV infection were not clear to most students. Incorrect assumptions of the clinical manifestations of HPV infection included: bleeding (25%), pain (37%) and rashes (22%). Twelve per cent of respondents did not recognize warts as an HPV-related disease. Regarding potential consequences of persistent infection, students did not recognize a relationship between HPV and laryngeal carcinoma (80.9%), pharyngeal carcinoma (78.9%), anal carcinoma (73.2%), vulvar carcinoma (65.4%) and vaginal carcinoma (54.6%). Large portions of the population evaluated were unaware of modes of HPV transmission beyond genital contact. Conclusion Knowledge of HPV by the population evaluated in this study is partial and fragmented. Lack of knowledge may contribute to the further spread of the disease. Public health policies for education and guidance of the population should be implemented in Brazil.
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Affiliation(s)
| | | | | | | | - Luisa Lina Villa
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Radiologia e Oncologia, São Paulo, SP, Brazil
| | - Leonardo Silva
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil.
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Yang DY, Bracken K. Update on the new 9-valent vaccine for human papillomavirus prevention. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2016; 62:399-402. [PMID: 27255620 PMCID: PMC4865336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To provide family physicians with information on the efficacy, safety, public health effects, and cost-effectiveness of the 9-valent human papillomavirus (HPV) vaccine. QUALITY OF EVIDENCE Relevant publications in PubMed up to May 2015 were reviewed and analyzed. Most evidence cited is level I (randomized controlled trials and meta-analyses) or level II (cross-sectional, case-control, and epidemiologic studies). Government reports and recommendations are also referenced. MAIN MESSAGE The 9-valent HPV vaccine, which protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58, is safe and effective and will further reduce the incidence of HPV infection, as well as HPV-related cancers. It can also indirectly protect unvaccinated individuals through herd immunity. With an effective vaccination program, most cervical cancers can be prevented. Analyses show that the cost-effectiveness of the 9-valent HPV vaccine in female patients is comparable to the original quadrivalent HPV vaccine (which protects against HPV types 6, 11, 16, and 18) currently in use. However, the usefulness of vaccinating male patients with the 9-valent HPV vaccine needs further investigation. CONCLUSION The 9-valent HPV vaccine offers more protection against HPV than the quadrivalent HPV vaccine does and is as safe. Analysis of cost-effectiveness favours its use, at least in adolescent girls. Therefore, physicians should recommend the 9-valent HPV vaccine to patients instead of the quadrivalent HPV vaccine.
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Affiliation(s)
- David Yi Yang
- Medical student at the Michael G. DeGroote School of Medicine at McMaster University in Hamilton, Ont.
| | - Keyna Bracken
- Associate Professor in the Department of Family Medicine at McMaster University
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Burger EA, Lee K, Saraiya M, Thompson TD, Chesson HW, Markowitz LE, Kim JJ. Racial and ethnic disparities in human papillomavirus-associated cancer burden with first-generation and second-generation human papillomavirus vaccines. Cancer 2016; 122:2057-66. [PMID: 27124396 DOI: 10.1002/cncr.30007] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/07/2016] [Accepted: 03/10/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND In the United States, the burden of human papillomavirus (HPV)-associated cancers varies by racial/ethnic group. HPV vaccination may provide opportunities for primary prevention of these cancers. Herein, the authors projected changes in HPV-associated cancer burden among racial/ethnic groups under various coverage assumptions with the available first-generation and second-generation HPV vaccines to evaluate changes in racial/ethnic disparities. METHODS Cancer-specific mathematical models simulated the burden of 6 HPV-associated cancers. Model parameters, informed using national registries and epidemiological studies, reflected sex-specific, age-specific, and racial/ethnic-specific heterogeneities in HPV type distribution, cancer incidence, stage of disease at detection, and mortality. Model outcomes included the cumulative lifetime risks of developing and dying of 6 HPV-associated cancers. The level of racial/ethnic disparities was evaluated under each alternative HPV vaccine scenario using several metrics of social group disparity. RESULTS HPV vaccination is expected to reduce the risks of developing and dying of HPV-associated cancers in all racial/ethnic groups as well as reduce the absolute degree of disparities. However, alternative metrics suggested that relative disparities would persist and in some scenarios worsen. For example, when assuming high uptake with the second-generation HPV vaccine, the lifetime risk of dying of an HPV-associated cancer for males decreased by approximately 60%, yet the relative disparity increased from 3.0 to 3.9. CONCLUSIONS HPV vaccines are expected to reduce the overall burden of HPV-associated cancers for all racial/ethnic groups and to reduce the absolute disparity gap. However, even with the second-generation vaccine, relative disparities will likely still exist and may widen if the underlying causes of these disparities remain unaddressed. Cancer 2016;122:2057-66. © 2016 American Cancer Society.
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Affiliation(s)
- Emily A Burger
- Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts.,Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Norway
| | - Kyueun Lee
- Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts.,Department of Health Research and Policy, Stanford University, Stanford, California
| | - Mona Saraiya
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Jane J Kim
- Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
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