Cost-effectiveness Of Human Papillomavirus Vaccination Research Articles

Cost-Effectiveness of Human Papillomavirus Vaccination in the UK: Two Versus Single-Dose of Nonavalent HPV Vaccination

IntroductionThe UK implemented a single-dose HPV vaccination policy in September 2023, aiming for sustained protection, better vaccine coverage, and reduced healthcare costs. This research assesses the cost-effectiveness of both one-dose and two-dose schedules from a healthcare perspective. MethodsUsing an age-structured dynamic model, the study analyzed long-term health and economic outcomes of these two different vaccination approaches. It focused on the effects of vaccinating 12- to 13-year-olds with the 9-valent HPV vaccine in either single-dose or two-dose regimens from 2023 to 2093. The analysis, conducted in 2023–2024, explored different immunity durations (10, 30 years, or lifetime) and efficacy levels for the single-dose strategy. ResultsThe study indicated that in the UK, vaccinating 12- to 13-year-olds with a two-dose regimen is not considered cost-effective compared to the single-dose option, assumed to be 90% as effective for ten years. The incremental cost-effectiveness ratios (ICERs) for two doses ranged from £230,903 to £1,082,916 per quality-adjusted life year (QALY), significantly exceeding the UK's £20,000/QALY willingness-to-pay threshold. Over 70 years, a switch from a two-dose to a single-dose vaccination schedule could potentially lead to savings of over £1,073 million in the healthcare system. Furthermore, the single-dose regimen was cost-effective compared to no vaccination, with an ICER below £2,040/QALY. ConclusionsThe study affirms the cost-effectiveness of the UK's single-dose HPV vaccine, in sync with its September 2023 policy shift. The shift not only provides financial benefits but also simplifies vaccine administration, strategically reducing HPV's epidemiological and economic impacts.

Cost-effectiveness of human papillomavirus (HPV) vaccination in Burkina Faso: a modelling study

BackgroundAfrica has some of the highest cervical cancer incidence and mortality rates globally. Burkina Faso launched a human papillomavirus (HPV) vaccination programme for 9-year-old girls in 2022 with support from Gavi, the Vaccine Alliance (Gavi). An economic evaluation of HPV vaccination is required to help sustain investment and inform decisions about optimal HPV vaccine choices.MethodsWe used a proportionate outcomes static cohort model to evaluate the potential impact and cost-effectiveness of HPV vaccination for 9-year-old girls over a ten-year period (2022–2031) in Burkina Faso. The primary outcome measure was the cost (2022 US$) per disability-adjusted life year (DALY) averted from a limited societal perspective (including all vaccine costs borne by the government and Gavi, radiation therapy costs borne by the government, and all other direct medical costs borne by patients and their families). We evaluated four vaccines (CERVARIX®, CECOLIN®, GARDASIL-4®, GARDASIL-9®), comparing each to no vaccination (and no change in existing cervical cancer screening and treatment strategies) and to each other. We combined local estimates of HPV type distribution, healthcare costs, vaccine coverage and costs with GLOBOCAN 2020 disease burden data and clinical trial efficacy data. We ran deterministic and probabilistic uncertainty analyses.ResultsHPV vaccination could prevent 37–72% of cervical cancer cases and deaths. CECOLIN® had the most favourable cost-effectiveness (cost per DALY averted < 0.27 times the national gross domestic product [GDP] per capita). When cross-protection was included, CECOLIN® remained the most cost-effective (cost per DALY averted < 0.20 times the national GDP per capita), but CERVARIX® provided greater health benefits (66% vs. 48% reduction in cervical cancer cases and deaths) with similar cost-effectiveness (cost per DALY averted < 0.28 times the national GDP per capita, with CECOLIN® as the comparator). We estimated the annual cost of the vaccination programme at US$ 2.9, 4.1, 4.4 and 19.8 million for CECOLIN®, GARDASIL-4®, CERVARIX® and GARDASIL-9®, respectively. A single dose strategy reduced costs and improved cost-effectiveness by more than half.ConclusionHPV vaccination is cost-effective in Burkina Faso from a limited societal perspective. A single dose strategy and/or alternative Gavi-supported HPV vaccines could further improve cost-effectiveness.

Cost-effectiveness analysis of human papillomavirus vaccines for the prevention of cervical cancer in India.

Human papillomavirus (HPV) vaccines represent an important strategic opportunity to prevent cervical cancer in low-middle income countries, such as India. The economic evaluation of HPV vaccines is crucial to inform public-health decisions; however, the scarce economic evaluations from India have focused on the value for money of bivalent vaccines and took a healthcare perspective. The aim of this study is to conduct a cost-effectiveness analysis of all available HPV vaccines in India. The Papillomavirus Rapid Interface for Modelling and Economics (PRIME) model was used to evaluate the cost-effectiveness of HPV vaccination of 12-year-old girls in India, from both healthcare and societal perspectives. Cervical cancer cases, deaths averted and the incremental cost per Disability Adjusted Life Years (DALY) averted were reported as primary outcomes. Sensitivity analysis was undertaken to handle any uncertainty or variability in the results. Compared with no vaccination, the incremental cost per DALY averted was USD 362.78 for nonavalent vaccine, USD 393.16 for quadrivalent vaccine and USD 432.24 for bivalent vaccine from a healthcare perspective. From a societal perspective, the incremental cost per DALY averted was USD 334.28 for nonavalent vaccine, USD 364.67 for quadrivalent vaccine and USD 403.75 for bivalent vaccine. Assuming constant prices per dose for all vaccines, the nonavalent vaccine dominated both quadrivalent and bivalent vaccines, indicating that it is the more cost-effective strategy. Vaccinating girls against HPV is a cost-effective strategy to reduce the incidence of cervical cancer and mortality due to cervical cancer in India.

Vaccinating women previously treated for human papillomavirus-related cervical precancerous lesions is highly cost-effective in China.

The 2021 Chinese Expert Consensus on the Clinical Application of the Human Papillomavirus (HPV) Vaccine recommended vaccination for women who previously received ablative or excisional treatment for high-grade squamous intraepithelial lesion (HSIL). This study evaluates the cost-effectiveness of HPV vaccination in women previously treated for cervical precancerous lesions. We used a Markov model to simulate the disease progression of both low- and high-risk HPV subtypes. We followed a cohort of 100,000 women aged 18-45 years who received treatment for cervical precancerous lesions for a lifetime (80 years). We used the Incremental Cost-Effectiveness Ratios (ICER) with a 5% discount rate to measure the cost-effectiveness of nine vaccination strategies, including a combination of HPV bivalent (HPV-2), quadrivalent (HPV-4) and nonavalent vaccine (HPV-9), each with three vaccination doses (one-, two- and three-dose). We conducted one-way sensitivity analysis and probabilistic sensitivity analysis. We followed the CHEERS 2022 guidelines. Compared to the status quo, the nine vaccination strategies would result in $3.057-33.124 million incremental cost and 94-1,211 incremental quality-adjusted life-years (QALYs) in 100,000 women previously treated for cervical precancerous lesions. Three vaccination strategies were identified on the cost-effectiveness frontier. In particular, ICER for one-dose HPV-4 vaccination was US$10,025/QALY compared to the status quo (no vaccination); ICER for two-dose HPV-4 vaccination was US$17,641//QALY gained compared to one-dose HPV-4 vaccination; ICER for three-dose HPV-4 vaccination was US$27,785/QALY gained compared with two-dose HPV-4 vaccination. With a willingness-to-pay of three times gross domestic product per capita (US$37655), three-dose HPV-4 vaccination was the most cost-effective vaccination strategy compared with the lower-cost non-dominated strategy on the cost-effectiveness frontier. A probabilistic sensitivity analysis confirmed a 99.1% probability of being cost-effective. If the cost of the HPV-9 is reduced to 50% of the current price, three-dose HPV-9 vaccination would become the most cost-effective strategy. Three-dose HPV-4 vaccination is the most cost-effective vaccination strategy for women treated for precancerous cervical lesions in the Chinese setting.

HPV vaccination following loop electrical excision procedure (LEEP) for cervical intraepithelial neoplasia: A cost-effectiveness analysis (134)

Objectives: Excisional cervical procedures, such as a Cold Knife Cone (CKC) or a loop electrical excision procedure (LEEP), are standard treatments for moderate to severe cervical intraepithelial neoplasia (CIN). Human papillomavirus (HPV) is the causal agent for CIN and can persist or recur; thus, patients can be susceptible to recurrent CIN following excision. Some data suggest that CIN recurrence rates decrease with HPV vaccination after LEEP. Here, we aimed to examine the cost-effectiveness of HPV vaccination following LEEP procedures compared with no vaccination. Methods: We constructed a decision-analytic model (TreeAge Pro 2021) to compare outcomes between patients who underwent LEEP followed by HPV vaccination with those who underwent LEEP without HPV vaccination. Our theoretical cohort contained 250,000 patients, the approximate number of patients who had LEEPs per year in the United States. Our outcomes were costs, quality-adjusted life-years (QALYs), any recurrence, recurrence of CIN 1, recurrence of CIN 2/3, number of pap smears, colposcopy, and second LEEP. We assumed that all individuals with any recurrence underwent a colposcopy and that all individuals who had a recurrence of CIN 2/3 would undergo a second LEEP. Probabilities of recurrence were based on a recently-published meta-analysis. All values were derived from the literature and discounted QALYs at a rate of 3%. Utilities were applied for four years after the initial LEEP procedure. Our cost-effectiveness threshold was $100,000/QALY. Univariate sensitivity analyses were performed to evaluate the robustness of the model. Results: In our one-year theoretical cohort of 250,000 patients who had undergone LEEP, the HPV vaccination strategy was associated with 17,281 fewer recurrences of CIN (8,360 cases of CIN 1 and 8,921 cases of CIN 2/3), 26,203 fewer pap smears (1,025,368 vs 1,051,570), 17,281 fewer colposcopies (20,588 vs 37,869), and 8,921 fewer second LEEP procedures (4,779 vs 13,701) (Table 1). The vaccination strategy was associated with a higher cost of $135 million. However, HPV vaccination was the cost-effective strategy with an incremental cost-effectiveness ratio (ICER) of $29,180.81. In our sensitivity analyses, the HPV vaccination strategy remained cost-effective until the cost of the 3-dose HPV vaccine series reached $1,899.56, or the baseline (non-vaccinated) probability of recurrence was less than 4.8%. Objectives: Excisional cervical procedures, such as a Cold Knife Cone (CKC) or a loop electrical excision procedure (LEEP), are standard treatments for moderate to severe cervical intraepithelial neoplasia (CIN). Human papillomavirus (HPV) is the causal agent for CIN and can persist or recur; thus, patients can be susceptible to recurrent CIN following excision. Some data suggest that CIN recurrence rates decrease with HPV vaccination after LEEP. Here, we aimed to examine the cost-effectiveness of HPV vaccination following LEEP procedures compared with no vaccination. Methods: We constructed a decision-analytic model (TreeAge Pro 2021) to compare outcomes between patients who underwent LEEP followed by HPV vaccination with those who underwent LEEP without HPV vaccination. Our theoretical cohort contained 250,000 patients, the approximate number of patients who had LEEPs per year in the United States. Our outcomes were costs, quality-adjusted life-years (QALYs), any recurrence, recurrence of CIN 1, recurrence of CIN 2/3, number of pap smears, colposcopy, and second LEEP. We assumed that all individuals with any recurrence underwent a colposcopy and that all individuals who had a recurrence of CIN 2/3 would undergo a second LEEP. Probabilities of recurrence were based on a recently-published meta-analysis. All values were derived from the literature and discounted QALYs at a rate of 3%. Utilities were applied for four years after the initial LEEP procedure. Our cost-effectiveness threshold was $100,000/QALY. Univariate sensitivity analyses were performed to evaluate the robustness of the model. Results: In our one-year theoretical cohort of 250,000 patients who had undergone LEEP, the HPV vaccination strategy was associated with 17,281 fewer recurrences of CIN (8,360 cases of CIN 1 and 8,921 cases of CIN 2/3), 26,203 fewer pap smears (1,025,368 vs 1,051,570), 17,281 fewer colposcopies (20,588 vs 37,869), and 8,921 fewer second LEEP procedures (4,779 vs 13,701) (Table 1). The vaccination strategy was associated with a higher cost of $135 million. However, HPV vaccination was the cost-effective strategy with an incremental cost-effectiveness ratio (ICER) of $29,180.81. In our sensitivity analyses, the HPV vaccination strategy remained cost-effective until the cost of the 3-dose HPV vaccine series reached $1,899.56, or the baseline (non-vaccinated) probability of recurrence was less than 4.8%.

Prognosis of incidence and mortality from cervical cancer in Russia depending on vaccination against HPV

Human papilloma virus (HPV) is carcinogenic to humans and causes cervical cancer, as well as cancers of the vagina, vulva, penis, anus and oropharynx both in men and women. Based on this evidence the vaccines against HPV have been developed, registered and a recommended for use. These include bivalent vaccine (CERVARIX), quadrivalent vaccine (GARDASIL) and nonavalent vaccine (GARDASIL9). The effectiveness and safety of these vaccines were shown in the randomized clinical trials as well as in the real life in the countries where vaccination of girls aged 12–13 years was started in 2007–8. Vaccination prevents: a) HPV infection among vaccinated, b) cervical intraepithelial neoplasia (CIN) and c) invasive cervical cancer.World health organization (WHO) strategy to eliminate cervical cancer proposes the following targets that must be met by 2030: 90% of girls fully vaccinated by age 15; 70% women screened by 35 and again in 45 years of age. The goal of WHO is the decrease cervical cancer incidence to 4 cases per 100 000 population.In Russia the incidence of cervical cancer is on increase since early 1990 s and further rise is predicted. Mortality from cervical cancer has slightly increased in early 1990 s and since has stabilized. In 2019 the incidence (age standardized rates) of cervical cancer was 15,4 and mortality 5,6 per 100 000 population. The number of newly diagnosed cases was 17 500 and amount of dearth from cervical cancer – 6300.In this paper we assess the number of the preventable cervical cancer cases and death from this disease in women aged 15–79 years during the forthcoming years of 21 century as a result of the HPV vaccination of girls born in 2009–2018, 2019–28, 2029–2038. The prognosis is based on the incidence and mortality from cervical cancer in 2018 and predicted rates for 2032. Our assumption was that of 90% of girls under 15 years will be covered by vaccination and the effectiveness of vaccination will be 79,80% in decrease of the HPV prevalence.The estimates based on 2018 statistics suggest that among women born in 2009–2038 years – 348 850 will be diagnosed with cervical cancer and 117 862 will die from it. The timely vaccination of 90% of girls will prevent 250544 cases and 84648 deaths from cervical cancer. Based on the estimated incidence and mortality for 2032 among these cohorts of women 470 729 will be diagnosed with and 130 811will die from cervical cancer. vaccination will prevent 338 078 cases of disease and save 93 948 lives.We have shown that vaccination results in the decrease in incidence and mortality from cervical cancer and will save hundred thousands of lives. This is the strongest argument for urgent implementation of vaccination program in Russia. An additional important task is the assessment of economic impact of vaccination in comparison with the heavy burden imposed by disease and deaths from cervical cancer. The financial losses due to high incidence and mortality from cervical cancer or any other disease in addition to the costs of treatment include demographic and social factors. The latter will have largest impact on the economy and wellbeing of the country.Therefore the next step of our study will be the analyses of the cost-effectiveness of HPV vaccination in the cohort of 24 million women born in 2009–2038 based on the predicted in this paper incidence and mortality of cervical cancer and number of disease and deaths that will be prevented by vaccination.

The cost-effectiveness of human papillomavirus vaccination in the Philippines

Cervical cancer is the second most common cancer among women in the Philippines. Human papillomavirus (HPV) vaccination provides protection from the most common cancer-causing HPV types. This analysis used a proportionate outcomes model to estimate the potential cost-effectiveness of four different HPV vaccine products—Cervarix™, Cecolin®, GARDASIL®, and GARDASIL®9—for routine HPV vaccination of 10 cohorts of 9-year-old girls from the government and societal perspectives. Model parameters included cervical cancer burden, healthcare and program costs, vaccine efficacy with and without potential cross-protection, and vaccination coverage. Univariate and probabilistic sensitivity analyses evaluated the impact of uncertainty on model results. Compared to no vaccination, HPV programs with Cecolin®, Cervarix™, and GARDASIL® are projected to be cost-effective at US$1,210, US$1,300, and US$2,043 per DALY averted, respectively, from the government perspective, and at US$173, US$263, and US$1,006 per DALY averted, respectively, from the societal perspective when cross-protection was considered. When direct comparisons were made across vaccines, GARDASIL® was dominated by Cervarix™ and Cecolin®. In a scenario where cross-protection was not considered, results were similar except that Cervarix™ and GARDASIL® were both dominated by Cecolin®. GARDASIL®9 was not cost-effective under any of the modeled scenarios.

The Impact of Broader Value Elements on Cost-Effectiveness Analysis: Two Case Studies

ObjectivesThis study aimed to explore the impact of including broader value elements in cost-effectiveness analyses by presenting 2 case studies, one on human papillomavirus (HPV) infection and one on early-stage Hodgkin’s lymphoma (ESHL). MethodsWe identified broader value elements (eg, patient and caregiver time, spillover health effects, productivity) from the Second Panel’s Impact Inventory and the ISPOR Special Task Force’s value flower. We then evaluated the cost-effectiveness of HPV vaccination versus no vaccination (case 1) and combined modality therapy (CMT) versus chemotherapy alone for treatment of adult ESHL (case 2) using published simulation models. For each case study, we compared incremental cost-effectiveness ratios considering health sector impacts only (the “base-case” scenario) with incremental cost-effectiveness ratios incorporating broader value elements. ResultsFor vaccination of US girls against HPV before sexual debut versus no vaccination, the base-case result was $38 334 per disability-adjusted life-year averted. Including each broader value element made cost-effectiveness progressively more favorable, with HPV vaccination becoming cost-saving (ie, reducing costs and averting more disability-adjusted life-years) when the analysis incorporated productivity costs. For CMT versus chemotherapy alone in patients with ESHL, the base-case result indicated that CMT was cost-saving. Including all elements made this treatment’s net monetary benefits (the sum of its averted resource costs and the net value of its health impacts) less favorable, even as the contribution from CMT’s near-term health benefits grew. ConclusionsIncluding broader value elements can substantially influence cost-effectiveness ratios, although the direction and the magnitude of their impact can differ across interventions and disease context.

Cost-effectiveness of HPV vaccination in 195 countries: A meta-regression analysis

Cost-effectiveness analysis (CEA) is a well-known, but resource intensive, method for comparing the costs and health outcomes of health interventions. To build on available evidence, researchers are developing methods to transfer CEA across settings; previous methods do not use all available results nor quantify differences across settings. We conducted a meta-regression analysis of published CEAs of human papillomavirus (HPV) vaccination to quantify the effects of factors at the country, intervention, and method-level, and predict incremental cost-effectiveness ratios (ICERs) for HPV vaccination in 195 countries. We used 613 ICERs reported in 75 studies from the Tufts University's Cost-Effectiveness Analysis (CEA) Registry and the Global Health CEA Registry, and extracted an additional 1,215 one-way sensitivity analyses. A five-stage, mixed-effects meta-regression framework was used to predict country-specific ICERs. The probability that HPV vaccination is cost-saving in each country was predicted using a logistic regression model. Covariates for both models included methods and intervention characteristics, and each country's cervical cancer burden and gross domestic product per capita. ICERs are positively related to vaccine cost, and negatively related to cervical cancer burden. The mean predicted ICER for HPV vaccination is 2017 US$4,217 per DALY averted (95% uncertainty interval (UI): US$773-13,448) globally, and below US$800 per DALY averted in 64 countries. Predicted ICERs are lowest in Sub-Saharan Africa and South Asia, with a population-weighted mean ICER across 46 countries of US$706 per DALY averted (95% UI: $130-2,245), and across five countries of US$489 per DALY averted (95% UI: $90-1,557), respectively. Meta-regression analyses can be conducted on CEA, where one-way sensitivity analyses are used to quantify the effects of factors at the intervention and method-level. Building on all published results, our predictions support introducing and expanding HPV vaccination, especially in countries that are eligible for subsidized vaccines from GAVI, the Vaccine Alliance, and Pan American Health Organization.

Cost-effectiveness of human papillomavirus vaccine in China: a systematic review of modelling studies

ObjectivesChina suffers from high burdens of human papillomavirus (HPV) and cervical cancer, whereas the uptake of HPV vaccine remains low. The first Chinese domestic HPV vaccine was released in 2019....

Human papillomavirus prevalence among men who have sex with men in China: a systematic review and meta-analysis.

Human papillomavirus (HPV) infection among men who have sex with men (MSM) in China is underreported. We performed a systematic review and meta-analysis to clarify site-specific HPV prevalence among MSM in China. We searched both English and Chinese databases for all studies published before April 1, 2020, that reported HPV prevalence among MSM in China. Random-effects meta-analysis was used to calculate summary estimates. Thirty-four articles were eligible, where 32, 5, and 2 articles reported HPV prevalence at the anus, penis, and oral cavity, respectively. The estimated prevalence of anal HPV among MSM in China was 85.1% (HIV-positive), 53.6% (HIV-negative), and 59.2% (unknown HIV status), with HPV genotypes being predominated by HPV 6, 11, 16, 18, 52, and 58. Any HPV and high-risk (HR) HPV was more common in northern China, while low-risk HPV was more common in southern China. HPV prevalence increased with age among HIV-negative MSM, from 40.5% (aged < 20 years) to 57.2% (aged ≥ 40 years). High prevalence of any HPV (HIV+: 95.1%; HIV-: 97.7%) and multiple infections (HIV+: 75.9%; HIV-: 41.7%) was found in anogenital warts among MSM. HPV is common among MSM in China. MSM living with HIV and/or anogenital warts were at disproportionate risk for HR HPV. Younger MSM were found to have a lower HPV prevalence. HPV vaccines would have prevented the majority of infections if given before sex debut. HPV at anatomical sites other than the anus, incident HPV infection, and the cost-effectiveness of HPV vaccination in this population are worth further investigation.

Human papillomavirus vaccination for adults aged 30 to 45 years in the United States: A cost-effectiveness analysis.

BackgroundA nonavalent human papillomavirus (HPV) vaccine has been licensed for use in women and men up to age 45 years in the United States. The cost-effectiveness of HPV vaccination for women and men aged 30 to 45 years in the context of cervical cancer screening practice was evaluated to inform national guidelines.Methods and findingsWe utilized 2 independent HPV microsimulation models to evaluate the cost-effectiveness of extending the upper age limit of HPV vaccination in women (from age 26 years) and men (from age 21 years) up to age 30, 35, 40, or 45 years. The models were empirically calibrated to reflect the burden of HPV and related cancers in the US population and used standardized inputs regarding historical and future vaccination uptake, vaccine efficacy, cervical cancer screening, and costs. Disease outcomes included cervical, anal, oropharyngeal, vulvar, vaginal, and penile cancers, as well as genital warts. Both models projected higher costs and greater health benefits as the upper age limit of HPV vaccination increased. Strategies of vaccinating females and males up to ages 30, 35, and 40 years were found to be less cost-effective than vaccinating up to age 45 years, which had an incremental cost-effectiveness ratio (ICER) greater than a commonly accepted upper threshold of $200,000 per quality-adjusted life year (QALY) gained. When including all HPV-related outcomes, the ICER for vaccinating up to age 45 years ranged from $315,700 to $440,600 per QALY gained. Assumptions regarding cervical screening compliance, vaccine costs, and the natural history of noncervical HPV-related cancers had major impacts on the cost-effectiveness of the vaccination strategies. Key limitations of the study were related to uncertainties in the data used to inform the models, including the timing of vaccine impact on noncervical cancers and vaccine efficacy at older ages.ConclusionsOur results from 2 independent models suggest that HPV vaccination for adult women and men aged 30 to 45 years is unlikely to represent good value for money in the US.

A comprehensive Cervical Cancer Control Plan in a low-middle income country: Bangladesh perspective

Carcinoma cervix is one of the most important preventable and curable diseases of women of reproductive age. Human Papilloma Virus (HPV), especially the oncogenic HPV are the main culprit of this disease. Effective vaccination of HPV can prevent Carcinoma cervix and it is the preferred method for long-term reduction of Cervical neoplasia. Developed countries have established comprehensive HPV vaccination programs, but it is not established in the low-middle income countries yet. The objective of our paper is to evaluate the efficacy and cost-effectiveness of HPV vaccination for the prevention of Ca Cervix and make a comprehensive cancer control plan for Ca Cervix in a low-middle income country setting. We used narrative analysis to evaluate the cost-effectiveness of HPV vaccination for a low resource low-middle income country and propose a comprehensive cancer control plan appropriate for them. Primary prevention (HPV vaccination) along with Secondary prevention (Screening by Visual Inspection with Acetic Acid-VIA or Pap smear or HPV DNA detection) and early treatment of precancerous lesions are very much cost-effective for the prevention of Cervical cancer. Carcinoma cervix is a preventable and curable disease despite rapidly growing cancer with high mortality and morbidity. A comprehensive cancer control plan with effective screening and HPV vaccination will make a difference by reducing the national and global burden of Cervical.

Cost-effectiveness of HPV vaccination for adults through age 45 years in the United States: Estimates from a simplified transmission model

IntroductionThe objective of this study was to assess incremental costs and benefits of a human papillomavirus (HPV) vaccination program expanded to include “mid-adults” (adults aged 27 through 45 years) in the United States. MethodsWe adapted a previously published, dynamic mathematical model of HPV transmission and HPV-associated disease to estimate the incremental costs and benefits of a 9-valent HPV vaccine (9vHPV) program for people aged 12 through 45 years compared to a 9vHPV program for females aged 12 through 26 years and males aged 12 through 21 years. ResultsA 9vHPV program for females aged 12 through 26 years and males aged 12 through 21 years was estimated to cost < $10,000 quality-adjusted life year (QALY) gained, compared to no vaccination. Expanding the 9vHPV program to include mid-adults was estimated to cost $587,600 per additional QALY gained when including adults through age 30 years, and $653,300 per additional QALY gained when including adults through age 45 years. Results were most sensitive to assumptions about HPV incidence among mid-adults, current and historical vaccination coverage, vaccine price, and the impact of HPV diseases on quality of life. ConclusionsMid-adult vaccination is much less cost-effective than the comparison strategy of routine vaccination for all adolescents at ages 11 to 12 years and catch-up vaccination for women through age 26 years and men through age 21 years.

Annals On Call - HPV Vaccination 2020

In this episode of Annals On Call, Dr. Centor discusses the appropriate use and cost-effectiveness of human papillomavirus vaccination with Dr. Sandra Adamson Fryhofer.

Potential health impact and cost-effectiveness of bivalent human papillomavirus (HPV) vaccination in Afghanistan

IntroductionHuman papillomavirus (HPV) vaccination has not been introduced in many countries in South-Central Asia, including Afghanistan, despite the sub-region having the highest incidence rate of cervical cancer in Asia. This study estimates the potential health impact and cost-effectiveness of HPV vaccination in Afghanistan to inform national decision-making. MethodAn Excel-based static cohort model was used to estimate the lifetime costs and health outcomes of vaccinating a single cohort of 9-year-old girls in the year 2018 with the bivalent HPV vaccine, compared to no vaccination. We also explored a scenario with a catch-up campaign for girls aged 10–14 years. Input parameters were based on local sources, published literature, or assumptions when no data was available. The primary outcome measure was the discounted cost per disability-adjusted life-year (DALY) averted, evaluated from both government and societal perspectives. ResultsVaccinating a single cohort of 9-year-old girls against HPV in Afghanistan could avert 1718 cervical cancer cases, 125 hospitalizations, and 1612 deaths over the lifetime of the cohort. The incremental cost-effectiveness ratio was US$426 per DALY averted from the government perspective and US$400 per DALY averted from the societal perspective. The estimated annual cost of the HPV vaccination program (US$3,343,311) represents approximately 3.53% of the country′s total immunization budget for 2018 or 0.13% of total health expenditures. ConclusionIn Afghanistan, HPV vaccine introduction targeting a single cohort is potentially cost-effective (0.7 times the GDP per capita of $586) from both the government and societal perspective with additional health benefits generated by a catch-up campaign, depending on the government′s willingness to pay for the projected health outcomes.

Effectiveness and Cost-Effectiveness of Human Papillomavirus Vaccination Through Age 45 Years in the United States.

In the United States, the routine age for human papillomavirus (HPV) vaccination is 11 to 12 years, with catch-up vaccination through age 26 years for women and 21 years for men. U.S. vaccination policy on use of the 9-valent HPV vaccine in adult women and men is being reviewed. To evaluate the added population-level effectiveness and cost-effectiveness of extending the current U.S. HPV vaccination program to women aged 27 to 45 years and men aged 22 to 45 years. The analysis used HPV-ADVISE (Agent-based Dynamic model for VaccInation and Screening Evaluation), an individual-based transmission dynamic model of HPV infection and associated diseases, calibrated to age-specific U.S. data. Published data. Women aged 27 to 45 years and men aged 22 to 45 years in the United States. 100 years. Health care sector. 9-valent HPV vaccination. HPV-associated outcomes prevented and cost-effectiveness ratios. The model predicts that the current U.S. HPV vaccination program will reduce the number of diagnoses of anogenital warts and cervical intraepithelial neoplasia of grade 2 or 3 and cases of cervical cancer and noncervical HPV-associated cancer by 82%, 80%, 59%, and 39%, respectively, over 100 years and is cost saving (vs. no vaccination). In contrast, extending vaccination to women and men aged 45 years is predicted to reduce these outcomes by an additional 0.4, 0.4, 0.2, and 0.2 percentage points, respectively. Vaccinating women and men up to age 30, 40, and 45 years is predicted to cost $830000, $1843000, and $1471000, respectively, per quality-adjusted life-year gained (vs. current vaccination). Results were most sensitive to assumptions about natural immunity and progression rates after infection, historical vaccination coverage, and vaccine efficacy. Uncertainty about the proportion of HPV-associated disease due to infections after age 26 years and about the level of herd effects from the current HPV vaccination program. The current HPV vaccination program is predicted to be cost saving. Extending vaccination to older ages is predicted to produce small additional health benefits and result in substantially higher incremental cost-effectiveness ratios than the current recommendation. Centers for Disease Control and Prevention.

Analysis of the Economic and Socio-Demographic Burden of HPV-Associated Diseases and the Cost-Effectiveness of HPV Vaccination in Russia

Background .The human papillomavirus (HPV) is one of the most common sexually transmitted viruses and, according to WHO, the cause of 7.5% of all women deaths from cancer. Every year, more than 500.000 new cases of HPV-associated cancer are registered in the world, approximately 90% of which fall into cervical cancer category. Aim . The aim of the work was to determine the economic and socio-demographic burden of HPV-associated diseases in Russia by analyzing the following indicators: fertility, life expectancy and cost of vaccines, as well as the impact of HPV vaccination. Methods . Mathematical modeling was performed using epidemiological data on prevalence and mortality of HPV-associated diseases in Russia, taking into account current data on the types of HPV-related diseases, the effectiveness of vaccination, statistics by sex and age structure of diseases, and age-specific birth rates. The calculations were based on 50% and 70% vaccination coverage, and the average life expectancy of 12-year-old girls. Treatment cost was calculated based on the fees charged by mandatory health insurance system. The weighted average cost of 1 dose of quadrivalent vaccine in 2018, and average cost of visiting a pediatrician before each vaccination were taken into account. To estimate the cost, a discount rate of 3.5% per year was used. The economic burden of HPV-associated diseases, direct and indirect medical costs were calculated. Results . The economic burden of HPV-associated diseases is estimated at 63.638 billion rubles. 70% vaccination rate would reduce the economic burden by 41.792 billion rubles, prevent 4,841 deaths from malignant neoplasms and reduce losses associated with a fall in the birth rate by 1,100 children per year. The estimated economic effect of vaccination per vaccinated girl will be 13,327 rubles, and the total economic effect over the entire simulation period will be 31.653 billion rubles. Conclusion . Taking into account the results of modeling, vaccination of 12-year-old girls against HPV in Russia is a cost-effective measure in the prevention of HPV-associated diseases.

Updated medical care cost estimates for HPV-associated cancers: implications for cost-effectiveness analyses of HPV vaccination in the United States

ABSTRACT Estimates of medical care costs for cervical and other cancers associated with human papillomavirus (HPV) are higher in studies published in recent years than in studies published before 2012. The purpose of this report is (1) to review and summarize the recent cancer cost estimates and (2) to illustrate how the estimated cost-effectiveness of HPV vaccination might change when these recent cost estimates are applied. Our literature search yielded 6 studies that provided updated medical care cost estimates for 5 HPV-associated cancers. We found that applying the current cancer cost estimates had a notable impact on the estimated medical costs averted by HPV vaccination over an extended time frame (100 years), and a moderate impact on the estimated cost per quality-adjusted life year (QALY) gained by HPV vaccination. For example, for catch-up vaccination of teenagers and young adults, applying the more recent cancer costs reduced the estimated cost per QALY gained by about $12,400. The cost studies we identified in our literature review are up-to-date and based on reliable data sources from United States settings, and can inform future studies of HPV vaccination cost-effectiveness in the United States. However, careful consideration is warranted to determine the most appropriate cost values to apply.

Cost-effectiveness of Human Papilloma Virus (HPV) vaccination in Nigeria: a decision analysis using pragmatic parameter estimates for cost and programme coverage

BackgroundWorld Health Organisation recommends routine Human Papilloma Virus (HPV) vaccination for girls when its cost-effectiveness in the country or region has been duly considered. We therefore aimed to evaluate cost-effectiveness of HPV vaccination in Nigeria using pragmatic parameter estimates for cost and programme coverage, i.e. realistically achievable in the studied context.MethodsA microsimulation frame-work was used. The natural history for cervical cancer disease was remodelled from a previous Nigerian model-based study. Costing was based on health providers’ perspective. Disability adjusted life years attributable to cervical cancer mortality served as benefit estimate. Suitable policy option was obtained by calculating the incremental costs-effectiveness ratio. Probabilistic sensitivity analysis was used to assess parameter uncertainty. One-way sensitivity analysis was used to explore the robustness of the policy recommendation to key parameters alteration. Expected value of perfect information (EVPI) was calculated to determine the expected opportunity cost associated with choosing the optimal scenario or strategy at the maximum cost-effectiveness threshold.ResultsCombination of the current scenario of opportunistic screening and national HPV vaccination programme (CS + NV) was the only cost-effective and robust policy option. However, CS + NV scenario was only cost-effective so far the unit cost of HPV vaccine did not exceed $5. EVPI analysis showed that it may be worthwhile to conduct additional research to inform the decision to adopt CS + NV.ConclusionsNational HPV vaccination combined with opportunist cervical cancer screening is cost-effective in Nigeria. However, adoption of this strategy should depend on its relative efficiency when compared to other competing new vaccines and health interventions.