Projected Clinical Benefits and Cost-effectiveness of a Human Papillomavirus 16/18 Vaccine

Goldie, Sue J.; Kohli, Michele; Grima, Daniel; Weinstein, Milton C.; Wright, Thomas; Bosch, F. Xavier; Franco, Eduardo L.

doi:10.1093/jnci/djh104

Cited by 478 publications

(310 citation statements)

References 91 publications

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“…[1][2][3][4][5][6][7][8][9][10] Consistent with health benefits estimated by these models, evaluations of vaccination programs have provided a growing body of evidence that documents the initial effects of HPV vaccination on the prevalence of HPV vaccine types, genital warts, and cervical precancers in the US and around the world. [11][12][13][14][15][16][17][18] In the future, more substantial reductions in these outcomes are expected, along with reductions in cervical cancer and other HPV-associated cancers.…”

Section: Introductionmentioning

confidence: 81%

The impact and cost-effectiveness of nonavalent HPV vaccination in the United States: Estimates from a simplified transmission model

Chesson

Markowitz

Hariri

et al. 2016

Human Vaccines & Immunotherapeutics

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Introduction: The objective of this study was to assess the incremental costs and benefits of the 9-valent HPV vaccine (9vHPV) compared with the quadrivalent HPV vaccine (4vHPV). Like 4vHPV, 9vHPV protects against HPV types 6, 11, 16, and 18. 9vHPV also protects against 5 additional HPV types 31, 33, 45, 52, and 58. Methods: We adapted a previously published model of the impact and cost-effectiveness of 4vHPV to include the 5 additional HPV types in 9vHPV. The vaccine strategies we examined were (1) 4vHPV for males and females; (2) 9vHPV for females and 4vHPV for males; and (3) 9vHPV for males and females. In the base case, 9vHPV cost $13 more per dose than 4vHPV, based on available vaccine price information. Results: Providing 9vHPV to females compared with 4vHPV for females (assuming 4vHPV for males in both scenarios) was cost-saving regardless of whether or not cross-protection for 4vHPV was assumed. The cost per quality-adjusted life year (QALY) gained by 9vHPV for both sexes (compared with 4vHPV for both sexes) was < $0 (cost-saving) when assuming no cross-protection for 4vHPV and $8,600 when assuming cross-protection for 4vHPV. Conclusions: Compared with a vaccination program of 4vHPV for both sexes, a vaccination program of 9vHPV for both sexes can improve health outcomes and can be cost-saving.

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Section: Introductionmentioning

confidence: 81%

The impact and cost-effectiveness of nonavalent HPV vaccination in the United States: Estimates from a simplified transmission model

Chesson

Markowitz

Hariri

et al. 2016

Human Vaccines & Immunotherapeutics

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“…So far the cost-effectiveness of HPV vaccination has not really been considered in relation to implementing HPV into the national vaccination programme (Goldie et al, 2004;Taira et al, 2004). The logical extension of this analysis would be to attach costs to both disease and vaccination.…”

Section: Discussionmentioning

confidence: 99%

Strategies for the introduction of human papillomavirus vaccination: modelling the optimum age- and sex-specific pattern of vaccination in Finland

et al. 2007

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Phase III trials have demonstrated the efficacy of human papillomavirus (HPV) vaccines in preventing transient and persistent high-risk (hr) HPV infection and precancerous lesions. A mathematical model of HPV type 16 infection and progression to cervical cancer, parameterised to represent the infection in Finland, was used to explore the optimal age at vaccination and pattern of vaccine introduction. In the long term, the annual proportion of cervical cancer cases prevented is much higher when early adolescents are targeted. Vaccinating against hr HPV generates greater long-term benefits if vaccine is delivered before the age at first sexual intercourse. However, vaccinating 12 year olds delays the predicted decrease in cervical cancer, compared to vaccinating older adolescents or young adults. Vaccinating males as well as females has more impact on the proportion of cases prevented when vaccinating at younger ages. Implementing catch-up vaccination at the start of a vaccination programme would increase the speed with which a decrease in HPV and cervical cancer incidence is observed. Human papillomavirus (HPV) is a common sexually transmitted agent (Trottier and Franco, 2006) and persistent infection with high risk (hr) types of HPV, most notably types 16 and 18, is the most important risk factor for cervical cancer (Ho et al, 1998). Rates of invasive cervical cancer (ICC) in fertile aged women in Finland declined significantly from 1960 to 1990 (Figure 1), mostly as a result of the national screening programme. However, cervical cancer incidence in Finnish women aged 30 -39 years is now four times higher than 15 years ago (2.9/100 000 in 1986 -1990; 9.8/ 100 000 in 2000: Finnish Cancer Registry, 2006. This is probably due to an increase in incidence and prevalence of hr HPV types in young (23 -28 year old) Finnish women (Laukkanen et al, 2003;Lehtinen et al, 2006).In phase III trials, two HPV virus-like particle vaccines have been shown effective in preventing incident and persistent HPV16 and 18 infection and associated precancerous lesions, with reported efficacies in the region of 90 -100% (Koutsky et al, 2002;Harper et al, 2004Harper et al, , 2006Villa et al, 2005;Mao et al, 2006). The vaccines could prevent around 70% of all cervical cancer (Munoz et al, 2003). One vaccine has recently been licensed for use in the US and in Europe. However, there remain important questions about how a HPV vaccine should be used at a population level (Lowndes and Gill, 2005). These include: the age chosen for vaccination, whether the vaccine is given to female subjects only or to female and male subjects and whether a catch-up vaccination campaign should accompany the introduction of routine vaccination. As mathematical models provide a framework for exploring these questions (Garnett, 2002), we have examined these questions with a model of single-type HPV using the observed epidemiology of HPV in Finland (Barnabas et al, 2006). MATERIALS AND METHODSIn earlier work, we used sexual behaviour data along with HPV seroprevalenc...

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“…36,37 Provision of prophylactic HPV vaccine, in conjunction with continued emphasis on cervical cancer screening among vaccinated and unvaccinated women, is expected to reduce the prevalence of precursor lesions and cervical cancer and to be cost effective. [36][37][38][39] In addition, HPV vaccination could reduce the psychosocial burden and healthcare costs associated with abnormal Pap test results while also decreasing the number of women who require follow-up care like colposcopy, biopsy, and other treatment for precancerous cervical lesions. 40,41 Sanders et al 42 estimated a 21% reduction in the incidence of low-grade Pap test abnormalities over the lifetime of a vaccinated cohort of females aged 12 years.…”

Section: Economic Benefitsmentioning

confidence: 99%

Preventing cervical cancer

Khan

Curtis

Ekwueme

et al. 2008

Cancer

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Projected Clinical Benefits and Cost-effectiveness of a Human Papillomavirus 16/18 Vaccine

Cited by 478 publications

References 91 publications

The impact and cost-effectiveness of nonavalent HPV vaccination in the United States: Estimates from a simplified transmission model

The impact and cost-effectiveness of nonavalent HPV vaccination in the United States: Estimates from a simplified transmission model

Strategies for the introduction of human papillomavirus vaccination: modelling the optimum age- and sex-specific pattern of vaccination in Finland

Preventing cervical cancer

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