Cost-effectiveness Of HPV Vaccination Research Articles

Economic Evaluation of Expanding HPV Vaccination Programs for Boys: A Systematic Review

Background: Human papillomavirus is responsible for almost all cases of cervical and non-cervical cancers. Various treatments have been carried out, but they have not been effective enough in reducing the burden. The U.S. Food and Drug Administration has approved three HPV vaccines for use. Since its recommendation in 2006, HPV infections have significantly decreased by 88% among teen girls and 81% among young adult women. Additionally, research has indicated that HPV vaccine is cost-effective in preventing both cervical and non-cervical cancers. The primary target group of HPV vaccination is girls aged 9-14, but some countries are starting to expand their programs according to the WHO recommendation for secondary targets: boys and adult women. This study gave updated information regarding the expansion of HPV vaccination programs for boys. Objective: To systematically review the health economic studies to evaluate the cost-effectiveness of expanding HPV vaccination program for including boys to prevent HPV-related cancer. Method: An electronic literature search was performed on two databases (Pubmed and ScienceDirect) to identify studies published from 2013 to 2023 in English and Indonesian. Three search strategies were used, including the terms «economic evaluation», «HPV», and «boys». The screening and selection of the literature was performed according to the PRISMA statement. Results: A total of 306 articles were identified. Only 26 of them were deemed relevant. This research compiled studies from countries with varying economic levels on the expansion of vaccination programs in boys to prevent or reduce cervical, anogenital, and HNC cancers. All the studies used a modeling approach to estimate the number of cases averted and the health care costs. Sixteen studies found that it was cost-effective to expand HPV vaccination programs to include boys. The ICER values were found to be sensitive to the vaccine price, duration of protection, and vaccination coverage. Conclusion: Expanding HPV vaccination to boys is considered a cost-effective solution for preventing HPV-related cancers, based on studies conducted in many countries. It is recommended to conduct an economic evaluation to estimate the cost-effectiveness of HPV vaccination as a prevention method for HPV-related cancers in low and middle-income countries like Indonesia. To begin the study, it is suggested to expand the HPV vaccination target to boys with a lower-priced vaccine and increased vaccination coverage.

Using a Dynamic Model to Estimate the Cost-Effectiveness of HPV Vaccination in Iran.

This study aimed to determine the cost-effectiveness of vaccination against HPV. An age-sex structured dynamic disease transmission model was created to estimate the spread of HPV and the HPV-related incidence of cervical cancer (CC) in Iran. Sixteen age groups of men and women were incorporated to reflect the differences in sexual preferences, vaccination uptake, and disease-related outcomes. Three scenarios were evaluated by using an Incremental Cost-Effectiveness Ratio (ICER) with gained quality-adjusted life years (QALYs). ICER values below one gross domestic product (GDP) per capita are evaluated as highly cost-effective. Vaccination reduces the number of infections and CC-related mortality. Over time, the vaccinated group ages and older age groups experience protection. An initial investment is required and savings in treatment spending reduce the impact over time. Vaccinating girls only was found to be cost-effective, with an ICER close to once the GDP per capita. Vaccinating both sexes was shown to be less cost-effective compared to girls only, and vaccinating boys only was not found to be cost-effective, with an ICER between once and three times, and greater than three times the GDP per capita, respectively. The estimates are conservative since societal cost-saving and the impact of other HPV-related illnesses were not considered and would likely reduce the ICERs.

Evaluating the cost-effectiveness of HPV vaccination for adolescent girls in Japan: A comparison of 2-valent, 4-valent, and 9-valent HPV vaccines with consideration of cross-protection

ObjectiveIn April 2023, the Japanese Health Ministry panel approved the inclusion of the 9-valent human papillomavirus (9vHPV) vaccine in the National Immunization Program, alongside the 2-valent (2vHPV) and 4-valent HPV (4vHPV) vaccines. In response to this, we evaluated the cost-effectiveness of these three vaccines for routine immunization of girls aged 12–16 in Japan, considering the cross-protection of 2vHPV and 4vHPV vaccines. MethodsWe constructed an age-structured mathematical model for HPV transmission, aiming to quantify the economic and epidemiological effects of various HPV vaccination strategies over a 70-year period in Japan. We determined incremental costs and quality-adjusted life years (QALYs) for each strategy, applying a 3% annual discount. Univariate and probabilistic sensitivity analyses were conducted to assess the uncertainty of our model results, with all evaluations done in 2023. ResultsOur projections indicate that the HPV vaccination program in Japan will significantly reduce the incidence of HPV-related diseases. All HPV vaccination strategies, using the 2vHPV, 4vHPV, and 9vHPV vaccines, were found to be cost-effective compared to no vaccination, with incremental cost-effectiveness ratios of ¥971,447/QALY, ¥1,237,297/QALY, and ¥742,084/QALY, respectively. Direct comparisons between vaccines demonstrated that the 9vHPV vaccination was more cost-effective than the 2vHPV vaccination, whereas 4vHPV vaccination was dominated by 2vHPV vaccination. ConclusionsOur study validates the cost-effectiveness of implementing the 9vHPV vaccine as the primary option over the 2vHPV or 4vHPV vaccine for girls in Japan. These findings underscore the need to improve the acceptance rate and coverage of HPV vaccinations in the country.

Cost-Effectiveness of HPV vaccination; Need for Economic and Social Policy Intervention.

Cost-Effectiveness of HPV vaccination; Need for Economic and Social Policy Intervention.

The potential cost-effectiveness of HPV vaccination among girls in Mongolia

IntroductionCervical cancer is a leading cause of cancer among women in Mongolia with an age-standardized incidence rate of 23.5 per 100,000. HPV vaccination has not been introduced nationally and Gavi co-financing support is not available in Mongolia. Extended Gavi pricing for HPV vaccine may be available from vaccine manufacturers for a number of years. To inform introduction decision-making, we evaluated the potential cost-effectiveness of HPV vaccination among girls and young women in Mongolia. MethodsWe used UNIVAC (version 1.4), a static decision model, to evaluate the health and economic outcomes of single-cohort vaccination among females from the government perspective compared to no vaccination. We modeled vaccine introduction over 10 birth cohorts starting in 2022 comparing quadrivalent or bivalent vaccine selection and vaccine pricing variations. We used locally-specific data for cancer incidence, mortality, treatment and costs. Model outcomes included cancer cases, hospitalizations, deaths, disability-adjusted life years (DALY), and costs presented in 2018 USD. Incremental costs and health outcomes were discounted at 3% and aggregated into an Incremental Cost-Effectiveness Ratio (ICER). ResultsThe base-case scenario of HPV vaccination among 9 year-old girls was projected to avert 5,692 cervical cancer cases, 3,240 deaths, and 11,886 DALYs and incur $2.4–3.1M more costs compared to no vaccination. At prices of ($4.50-$4.60/dose), we estimated an ICER of $166-$265/DALY averted among 9-year-olds. When price per dose was increased to reported mean vaccine purchase price for non-Gavi LMICs ($14.17/dose), the ICER ranged from $556–820/DALY averted. ConclusionHPV vaccination among girls is highly likely to be a cost-effective investment in Mongolia compared to no vaccination with projected ICERs less than 20% of the 2018 GDP per capita of $3,735.

The cost-effectiveness of bivalent, quadrivalent, and nine-valent HPV vaccination in Asia: a systematic review.

The aim of this study was to systematically review the cost-effectiveness of HPV vaccination in Asia. We performed a systematic review of papers indexed in PubMed, Scopus, and Web of Science covering the period from 1 January 2000 to 13 August 2020. Sixteen studies were included in the review. Half of them (8 studies) evaluated the cost-effectiveness of HPV vaccination in high-income countries and regions (HICs) while the other eight studies were set in low- and middle-income countries and regions (LMICs). In HICs, the implementation of bivalent, quadrivalent and nine-valent HPV vaccination was all shown to be cost-effective. Most studies (7/8) also showed that it was cost-effective to implement bivalent, quadrivalent, and nine-valent HPV vaccines in LMICs. However, one study concluded that it was not cost-effective to implement bivalent HPV vaccination in Thailand. In general, the implementation of bivalent, quadrivalent and nine-valent HPV vaccination for adolescent girls was cost-effective in both high-income countries and regions and low- and middle-income countries and regions in Asia. Policy makers in HICs could consider expanding the target vaccinated population, while for LMICs it is essential to reduce HPV vaccine price to a level at which the implementation of HPV vaccination is cost-effective.

Cost effectiveness of HPV vaccination and screening in LMICs

Cost effectiveness of HPV vaccination and screening in LMICs

Effects of Demography, Disability Weights and Cervical Cancer Burden on HPV Vaccination Impact Estimates in 177 Countries: PRIME Modelling Study

Background: The Papillomavirus Rapid Interface for Modelling and Economics (PRIME) has been used around the world to assess the health impact and cost-effectiveness of HPV vaccination in girls. We updated PRIME with new data and methods for demography, disability weights and cervical cancer burden, and generated revised estimates of the health impact of HPV vaccination in 177 countries. Methods: Population demography in PRIME was updated with the United Nations World Population Prospects (UNWPP) 2017 release, disability weights of the Global Burden of Disease (GBD) 2017 study, and cervical cancer burden from the Global Cancer Incidence, Mortality and Prevalence (GLOBOCAN) 2018 release. We estimated the lifetime health benefits for routine vaccination of 9-year old girls during 2020-2029 at 90% coverage in 177 countries. Findings: When the health impact of vaccination was compared to the counterfactual scenario of no vaccination, the combined updates of using UNWPP 2017, disability weights of GBD 2017 study and cervical cancer burden estimates of GLOBOCAN 2018 result in 27%, 53% and 76% increase in cases, deaths and DALYs averted per vaccinated girl respectively, in comparison to previous estimates. The demography update is the major driver for the change in the health impact estimates. Interpretation: The updated PRIME estimates suggest that HPV vaccination will have higher health benefits in comparison to prior forecasts, and thereby being more cost-effective. The WHO African region is expected to gain the highest relative health benefits and should be prioritised for HPV vaccination. Funding Statement: Gavi, the Vaccine Alliance and Bill & Melinda Gates Foundation (OPP1157270). Declaration of Interests: authors declare that there are no conflicts of interest. Ethics Approval Statement: The authors state: All data used were from secondary sources in the public domain, and ethics approval was thereby not required.

Present challenges in cervical cancer prevention: Answers from cost-effectiveness analyses.

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.

Cost-effectiveness of HPV vaccination in the context of high cervical cancer incidence and low screening coverage.

Estonia has high cervical cancer incidence and low screening coverage. We modelled the impact of population-based bivalent, quadrivalent or nonavalent HPV vaccination alongside cervical cancer screening. A Markov cohort model of the natural history of HPV infection was used to assess the cost-effectiveness of vaccinating a cohort of 12-year-old girls with bivalent, quadrivalent or nonavalent vaccine in two doses in a national, school-based vaccination programme. The model followed the natural progression of HPV infection into subsequent genital warts (GW); premalignant lesions (CIN1-3); cervical, oropharyngeal, vulvar, vaginal and anal cancer. Vaccine coverage was assumed to be 70%. A time horizon of 88years (up to 100years of age) was used to capture all lifetime vaccination costs and benefits. Costs and utilities were discounted using an annual discount rate of 5%. Vaccination of 12-year-old girls alongside screening compared to screening alone had an incremental cost-effectiveness ratio (ICER) of €14,007 (bivalent), €14,067 (quadrivalent) and €11,633 (nonavalent) per quality-adjusted life-year (QALY) in the base-case scenario and ranged between €5367-21,711, €5142-21,800 and €4563-18,142, respectively, in sensitivity analysis. The results were most sensitive to changes in discount rate, vaccination regimen, vaccine prices and cervical cancer screening coverage. Vaccination of 12-year-old girls alongside current cervical cancer screening can be considered a cost-effective intervention in Estonia. Adding HPV vaccination to the national immunisation schedule is expected to prevent a considerable number of HPV infections, genital warts, premalignant lesions, HPV related cancers and deaths. Although in our model ICERs varied slightly depending on the vaccine used, they generally fell within the same range. Cost-effectiveness of HPV vaccination was found to be most dependent on vaccine cost and duration of vaccine immunity, but not on the type of vaccine used.

The Cost-Effectiveness of Quadrivalent Human Papillomavirus Vaccination in Indonesia

Objective:National cervical cancer prevention program has been initiated in Indonesia since April 2015 and the ministry of health has started efforts to integrate the HPV Vaccine in the national immunization program since Q4 2015. Thus, it becomes important to analyze the cost-effectiveness of HPV vaccine. The objective of this model is to examine the potential long-term epidemiologic and economic impact of quadrivalent HPV(qHPV;6/11/16/18) vaccination program in Indonesia.Methods:A previously validated transmission dynamic model was used to estimate the long-term epidemiologic and economic consequences of quadrivalent HPV vaccination by comparing cost-effectiveness of 2 dose qHPV vaccination strategy for girls 11-12 years old (with or without catch up; catch up dose for 12–26 years) versus Screening Only (Pap Smear) for reducing cost related to HPV type 6,11,16,18 (cervical cancer, CIN 1, CIN 2/3, and genital warts). Costs of an HPV disease episode-of-care (diagnosis and treatment) were calculated for base case analysis using local Indonesian cost.Result:2-dose qHPV vaccination strategies without catch up reduce the overall incidence of HPV 16/18–related cervical cancer relative to screening by 54.4% over the 100 year following vaccine introduction. Likewise, vaccination strategies reduce the incidence of HPV type 16/18 CIN 2/3, CIN 1 by 69.1% and 71.8% respectively, also reducing HPV type 6/11 CIN 1, genital warts in female, genital warts in male by 82.9%,84.2%,82.1% respectively, at this time point. From total reduction of health care cost, 67.1% attributable for diseases caused by HPV type 16/18 and 32.9% attributable for diseases caused by HPV type 6/11. Without catch up, cost/QALY would be $450/year. However catch-up strategy is more cost effective versus vaccinates 12-year-old girls only; with cost/QALYs would be $390/year.Conclusion:HPV 6/11/16/18 vaccination of females in Indonesia are 1) substantially reduce genital warts, CIN, and cervical cancer; 2) improve quality of life, and 3) with the Indonesia GDP of USD 3,531.80 in 2014, Cost/QALYs result with or without catch up is considered very cost-effective when implemented; however with catch up, the cost/QALY can be better.

PIN56 - Beyond Cervical Cancer: The Cost-Effectiveness Of Hpv Vaccination In The Netherlands

PIN56 - Beyond Cervical Cancer: The Cost-Effectiveness Of Hpv Vaccination In The Netherlands

Applying a Simple Model of Cost Effectiveness Study of HPV Vaccine for Iran.

HPV vaccine has been recently added to the Iran Drug List, so decision makers need information beyond that available from RCTs to recommend funding for this vaccination. Modeling and economic studies have addressed some of those information needs. We reviewed cost effectiveness studies to find a suitable model for Iranian population to determine the potential cost effectiveness of HPV vaccine program based on domestic available epidemiologic data. Articles were obtained from an extensive literature search to determine the cost effectiveness of implementing an HPV vaccination program with routine cervical cancer screening. A total of 64 studies were included in this review. Although the studies used different model structures, baseline parameters and assumptions (either a Markov, Hybrid, or Dynamic model). Most of the proposed cost effectiveness models need to model the probability of HPV acquisition, the possible progression from HPV infection to CIN I, CIN II, CIN III and cervical cancer, the probability of HPV transmission which are not available in Iranian epidemiologic data. Based on the available epidemiologic data in Iran, the simplified and it requires substantially fewer assumptions than the other more complex Markov and hybrid models, therefore we decided to use this model for the evaluation of cost effectiveness of HPV vaccine in Iran.

Cost-Effectiveness of HPV-Vaccination in Medium or Low Income Countries with High Cervical Cancer Incidence – A Systematic Review

Background: Prophylactic human papilloma virus (HPV) vaccines represent a promising option for cervical cancer (CC) prevention in countries where screening, diagnostics and treatment have difficulties in producing significant reductions in CC incidence/mortality. Numerous studies have evaluated the cost-effectiveness of HPV vaccination strategies including female vaccination alone, female vaccination combined with different screening strategies, or female and male vaccination. Countries with the highest CC incidences, however, have the least resources to implement any CC prevention programs. To understand priorities in low vs. middle income countries with high CC incidence pertinent cost-efficacy studies on CC interventions were compared. Methods: We conducted a systematic review of cost-effectiveness studies including only countries with high CC incidence (>14.5) and GDP per capita below the high income group (<37,162 2010 international $). Results: We identified 16 cost-effectiveness studies (with the bivalent 16/18 or the quadrivalent 6/11/16/18 vaccine) including 25 countries from Europe, Africa, Latin America, and Asia. CC incidence ratios vary from 14.8 (Kenya) to 38.3 (Mozambique) and GDP per capita from 913 (Mozambique) I$ to 27063 I$ (Slovenia). High income countries that met the high CC incidence criteria included Ireland (14.7) and Denmark (18.4). Sub-Saharan African countries excluded, the CC incidence rates were comparable in the middle- and low-income countries (median 18.5 vs. 22). All of the studies concluded that HPV vaccination of females is very effective, especially combined with a screening, and cost-effective assuming a low to moderate vaccine price at the same time underlining that the commonly used cost-effectiveness thresholds do not always equal affordability. Conclusion: Our systematic review showed that HVP vaccination alone or combined with screening strategies is cost-effective in countries with high CC incidence and moderate to low GDP per capita. Affordability of the vaccination program is a crucial determinant for the success of cervical cancer prevention by country, and determines whether rapidly increasing differences between the middle-and low-income countries in HPV disease burden are imminent in the future.

The cost efficiency of HPV vaccines is significantly underestimated due to omission of conisation-associated prematurity with neonatal mortality and morbidity

Introduction: Cervical intraepithelial neoplasia (CIN) represents the precursor of invasive cervical cancer and is associated with human papillomavirus infection (HPV) against which two vaccines have been approved in the last years. Standard treatments of high-grade CIN are conisation procedures, which are associated with an increased risk of subsequent pregnancy complications like premature delivery and possible subsequent life-long disability. HPV vaccination has therefore the potential to decrease neonatal morbidity and mortality. This has not been taken into account in published cost-effectiveness models. Material and Methods: We calculated the possible reduction rate of conisations for different vaccination strategies for Germany. Using this rate, we computed the reduction of conisation-associated preterm deliveries, life-long disability and neonatal death due to prematurity. The number of life-years saved (LYS) and gain in quality-adjusted life-years (QALYs) was estimated. The incremental costs per LYS / additional QALY were calculated. Results: The reduction of conisation procedures was highest in scenario I (vaccination coverage 90% prior to HPV exposition) with about 50%. The costs per LYS or additional QALY were lowest in scenario I, II and III with 45,101 € or 43,505–47,855 € and rose up to 60,544 € or 58,401–64,240 € in scenario V (50% vaccinated prior to sexual activity + additional 20% catch-up at a mean age of 20 y). Conclusion: Regarding the HPV 16 / 18 vaccines as “vaccines against conisation-related neonatal morbidity and mortality” alone, they already have the potential to be cost-effective. This effect adds up to reduction of cervical cancer cases and decreased costs of screening for CIN. Further studies on cost-effectiveness of HPV vaccination should take the significant amount of neonatal morbidity and mortality into account.

Until Which Age Should Women Be Vaccinated Against HPV Infection? Recommendation Based on Cost-effectiveness Analyses

Cervical cancer is caused by infection with human papillomavirus (HPV). Several countries have implemented vaccination programs against HPV for teenage girls before sexual debut. However, recent clinical trials have demonstrated that vaccination of older women is highly effective as well. Accordingly, it has been suggested that these older women should also be offered vaccination. Here, the cost-effectiveness of HPV vaccination for older women was assessed. A Markov model was used to estimate age-specific health benefits and cost savings of HPV vaccination for women 12-50 years of age, in the Netherlands. Sensitivity analyses were performed to test the robustness of the outcomes. State-of-the-art health-economic methods were used, and international health-economic guidelines were followed. HPV vaccination is highly cost-effective for girls aged 12-16 years. Remarkably, cost-effectiveness only slowly declines with increasing age of the vaccinees up to 25 years. Indeed, substantial health benefits can be obtained by vaccinating women in this age group at acceptable costs. Beyond this age, cost-effectiveness of HPV-vaccination rapidly declines. Not only HPV vaccination of girls before sexual debut is a highly effective and cost-effective strategy for prevention of cervical cancer, but also vaccination of women until the age of 25 years is generally cost-effective.

Commentary on: Economic evaluation of human papilloma virus vaccination in the European Union: a critical review

The article by Koleva et al. [1] in current issue is unusual reading for the public of IEM. First, systematic reviews of economic evaluations are still uncommon in general medical journals. Second, this review on HPV vaccination deals with a very important public health topic, which, on the other hand, is not a typical theme for this journal. There are good reasons for the Clinical Evidence and HTA section of IEM to present such articles. Cost effectiveness reviews represent a methodological challenge and, as such, are relevant and intriguing regardless of their object. Furthermore, cost-issues are by their nature a general medical issue, because the cost of resources spent in one field of health care compete with the money spent in others. Finally, an economic publication on a vaccine in a general medical journal is a chance for readers to be challenged by the diverse methodological problems which are encountered in the complex area of screening and vaccines [2]. Coming to Koleva et al.’s message [1], we notice that the authors are critical regarding cost-effectiveness of HPV vaccination as measured in the reviewed studies, despite the fact that all but one concluded in favour of vaccination. However, they mention other reviews of economic evaluations which reach similar conservative conclusions [3, 4].They finally observe that vaccination cost-effectiveness was sensitive to the assumptions made in sensitivity analyses and that non-sponsored evaluations were somehow more cautious and restrictive. Koleva et al. [1] are particularly dubious about the validity of life-long modelling of the effects of screening vaccination campaigns, based on a few years follow-up of RCTs and on assumptions borrowed from current data. The comments raised by Koleva et al. [1] are reasonable. Nevertheless, we have to deal with the limits that we face in performing EEs. In particular, everybody would agree that, for clinical and health policy decisions, it would be desirable to have long term data to work on, rather than referring to assumptions in statistical models. Conditions under which decisions are made are very often different from the desired ones. Models allow to ‘‘rationalize future uncertainty’’, framing uncertainty within probabilistic models. This is an imperfect method, with large margins of subjectivity, but on the other hand it makes possible—based on more or less optimistic scenarios—to generate forecasts based on epidemiological and clinical data available today, using such predictions to inform decision making. Furthermore, the process is dynamic and it allows to update the estimates by including the evidence provided by new studies. Regarding the level of subjectivity associated with the selection of model components, if the hypotheses are not ‘‘specious’’, but ‘‘reasonable’’ and ‘‘standard/coherent’’ with the literature [5, 6], then the emerging scenario will present a few levels of ‘‘controlled and conscious subjectivity’’. In other words, the limits of the results and the G. Virgili (&) Department of Specialized Surgical Sciences, University of Florence and Azienda Ospedaliero-Universitaria Careggi, V.le Morgagni 85, 50134 Florence, Italy e-mail: gianni.virgili@unifi.it

Prevention of cervical cancer in rural China: Evaluation of HPV vaccination and primary HPV screening strategies

Comprehensive evaluation of the cost-effectiveness of HPV vaccination in China has not previously been performed. The objective of this study was to evaluate vaccination as an alternative or addition to primary HPV screening with careHPV (Qiagen, Gaithersburg, USA), and to assess the threshold total cost per vaccinated girl (CVG) at which strategies involving vaccination would become viable compared to screening-only strategies in rural China. We used data from field studies in Shanxi Province to support modelling of HPV vaccination and screening, including local information on sexual behaviour, HPV prevalence, test accuracy, treatment protocols and costs. We evaluated several strategies involving screening once or twice per lifetime or at regular 5-yearly intervals, with or without vaccination of young females at age 15 years, assuming 70% coverage for both screening and vaccination. We also predicted cross-sectional cancer incidence each year to the year 2050 for a range of strategies. We found that strategies involving vaccination would be cost-effective at CVGs of US$50–54 or less, but at CVGs >$54, screening-only strategies would be more cost-effective. If vaccination of young cohorts is combined with two rounds of careHPV screening for women aged 30–59 years in 2012 and 2027, a predicted indicative 33% reduction in cervical cancer incidence by 2030 would be sustained until 2050, with incidence rates decreasing thereafter. In conclusion, taking into account estimated vaccine delivery costs (for 3 doses), a per-dose HPV vaccine cost of approximately <$9–14 would be required for strategies involving vaccination to be cost-effective. Overall, combined screening and vaccination approaches are required to maximise outcomes in rural China.

P926 Modelling the impact of different vaccine profiles on the cost-effectiveness of HPV vaccination in the Chilean setting

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S673-S674 Poster presentations P926 Modelling the impact of different vaccine profiles on the cost-effectiveness of HPV vaccination in the Chilean setting N. Demarteau, N. DemarteauSearch for more papers by this authorE. Suarez, E. SuarezSearch for more papers by this authorJ. Gomez, J. GomezSearch for more papers by this authorB. Standaert, B. StandaertSearch for more papers by this author N. Demarteau, N. DemarteauSearch for more papers by this authorE. Suarez, E. SuarezSearch for more papers by this authorJ. Gomez, J. GomezSearch for more papers by this authorB. Standaert, B. StandaertSearch for more papers by this author First published: 20 November 2009 https://doi.org/10.1016/S0020-7292(09)62413-9AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S673-S674 RelatedInformation

Catch-up programmes boost cost effectiveness of HPV vaccination

Catch-up programmes boost cost effectiveness of HPV vaccination