Loss of chance associated with sub-optimal HPV vaccination coverage rate in France

Mathieu Uhart,Marjorie Adam,André Dahlab,Xavier Bresse

doi:10.1016/j.pvr.2017.02.004

Abstract

IntroductionSince 2007, HPV vaccination programs have been implemented in Europe. Significant real-life impact has already been reported in countries where the programs have been successfully implemented. In France, HPV vaccination coverage rate (VCR) is currently one of the lowest in Europe. This represents a missed opportunity for individuals who will not be protected. The study aimed to estimate the consequences of the sub-optimal VCR. MethodsA dynamic transmission model was calibrated to the French setting. Outcomes resulting from the vaccination of girls with quadrivalent HPV vaccine according to two theoretical VCR: 17% and 70%, reflecting the range of VCRs in Western Europe, were evaluated. ResultsOver 100 years, with the current low VCR, an additional 85,000 cancers, 28,000 deaths and more than 5 million avertable disease events overall would occur compared with a 70% VCR. At steady state, the 17% VCR was estimated to be associated with an additional 1700 cancers, 600 deaths and 66,000 avertable disease events each year, compared with a ‘standard’ EU VCR. ConclusionThe loss of chance associated with sub-optimal VCR is substantial for the French population and could amount to the occurrence of hundreds of avoidable deaths and thousands of disease events annually.

Highlights

Since 2007, Human papillomaviruses (HPVs) vaccination programs have been implemented in Europe
Over 100 years, it was estimated that the 17% vaccination coverage rate (VCR) observed in France would be associated with around more than 85,000 additional cancers, almost 28,000 additional deaths and more than 5 million diseases events overall compared with a 70% VCR (Table 3)
It was estimated that in the first ten years of the vaccination program, 73,837 additional diseases events including 73,067 genital warts, 346 CIN1, 421 CIN2+ and 3 cervical cancers would be averted with a 70% VCR scenario compared with 17% VCR

Summary

Introduction

Since 2007, HPV vaccination programs have been implemented in Europe. Significant real-life impact has already been reported in countries where the programs have been successfully implemented. In France, HPV vaccination coverage rate (VCR) is currently one of the lowest in Europe. This represents a missed opportunity for individuals who will not be protected. Results: Over 100 years, with the current low VCR, an additional 85,000 cancers, 28,000 deaths and more than 5 million avertable disease events overall would occur compared with a 70% VCR. The 17% VCR was estimated to be associated with an additional 1700 cancers, 600 deaths and 66,000 avertable disease events each year, compared with a ‘standard’ EU VCR. In France, almost 4700 new cases of cancer of the cervix, vulva, vagina and anus, attributable to HPV, are estimated to occur every year [3]. Unlike for cervical cancer in women, no systematic and effective screening exists for other HPV-related cancers

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