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Vacunas contra Papillomavirus , Humanos , Vacunas contra Papillomavirus/economía , Femenino , Adolescente , Alemania , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/legislación & jurisprudencia , Infecciones por Papillomavirus/prevención & control , Infecciones por Papillomavirus/economía , Mecanismo de Reembolso/economía , Mecanismo de Reembolso/legislación & jurisprudencia , Neoplasias del Cuello Uterino/prevención & control , Neoplasias del Cuello Uterino/economía , Adulto JovenRESUMEN
BACKGROUND: The vaccine coverage rate (VCR) for human papillomavirus (HPV) in France is one of the lowest in Europe, well below the target of 80% announced in the French Cancer Plan 2021-2030. The extension of vaccination competencies (prescription and administration) to new health care providers, such as community pharmacists (CPs), was a decisive step by the French Health Authority (HAS) in 2022 to simplify access to vaccination and improve the VCR. This research assessed the economic and organizational impacts (OIs) of the extension of vaccination competencies in France. METHODS: A model was developed in Excel® to compare the current HPV vaccination pathway focused on general practitioners (GPs) to a mix of pathways (new and current) that extends pharmacists' competencies (prescription and/or injection). The simulated population corresponded to girls and boys targeted by the French recommendations. The model was run from 2023 to 2030. HAS guidelines were used to identify OIs related to these new pathways. Model inputs were collected from national data sources and an acceptability study. The results focused on three OIs (HPV vaccination ability [defined as the number of adolescents who could be vaccinated in each pathway], the VCR projection, and flows of activity between health care professionals]). The economic impact was evaluated from the National Health Insurance (NHI) perspective in 2022. RESULTS: With a mix of vaccination pathways, including an increasing role of pharmacists, the target of an 80% VCR could be reached in 2030 (versus 2032 with the current pathway) with lower investment than the current situation, resulting in cost savings for the NHI of 212 million. Expanding vaccination competencies will provide pharmacists with additional revenue (an average of 755,000/month for all vaccinating pharmacies) and will free up medical time for GPs (average of 603,000 consultations/year for all GPs). CONCLUSIONS: Expanding vaccination competencies to pharmacists has a positive impact on the entire ecosystem. From a public health perspective, the national VCR target can be achieved and better access to care can be provided, freeing up medical time. From an economic perspective, this approach can provide savings for the NHI and additional revenue for pharmacists.
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Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Farmacéuticos , Humanos , Francia , Vacunas contra Papillomavirus/economía , Vacunas contra Papillomavirus/administración & dosificación , Femenino , Masculino , Infecciones por Papillomavirus/prevención & control , Adolescente , Vacunación/economía , Servicios Comunitarios de Farmacia/organización & administración , Servicios Comunitarios de Farmacia/economía , Competencia Clínica , Virus del Papiloma HumanoRESUMEN
Multiple studies have documented low human papillomavirus (HPV) vaccine uptake among Chinese girls. It remains crucial to determine the parental willingness to pay (WTP) HPV vaccine for girls. We conducted a cross-sectional study recruiting 3904 parents with girls aged 9-14 in Shanghai, China, employing an online questionnaire with a convenience sampling strategy. Parental WTP, both range of payment and estimated point value, were determined for themselves (or wives) and daughters. HPV vaccine uptake was 22.44% in mothers and 3.21% in daughters. Respondents favored WTP ≤ 1000 CNY/138 USD for themselves (or wives), whereas showed increasing WTP along with valency of HPV vaccine for daughters (2-valent: 68.62% ≤1000 CNY/138 USD; 4-valent: 56.27% 1001-2000 CNY/138-277 USD; 9-valent: 65.37% ≥2001 CNY/277 USD). Overall, respondents showed higher WTP for daughters (median 2000 CNY/277 USD; IQR 1000-3600 CNY/138-498 USD) than for themselves (2000 CNY/277 USD; 1000-3500 CNY/138-483 USD) or wives (2000 CNY/277 USD; 800-3000 CNY/110-414 USD) (each p < .05). Furthermore, parental WTP was higher for international vaccine and 9-valent vaccine (each p < 0.05). Between two assumed government subsidy scenarios, parental preference for 9-valent vaccine remained consistently high for daughters (approximately 24% in each scenario), whereas preference for themselves (or wives) was sensitive to payment change between the subsidy scenarios. Using a discrete choice experiment, we found domestic vaccine was commonly preferred; however, certain sociodemographic groups preferred multivalent HPV vaccines. In conclusion, the valency of HPV vaccine may influence parental decision-making for daughters, in addition to vaccine price. Our findings would facilitate tailoring the HPV immunization program in China.
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Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Padres , Humanos , Vacunas contra Papillomavirus/administración & dosificación , Vacunas contra Papillomavirus/economía , Vacunas contra Papillomavirus/inmunología , Femenino , China , Estudios Transversales , Niño , Adolescente , Infecciones por Papillomavirus/prevención & control , Adulto , Padres/psicología , Encuestas y Cuestionarios , Aceptación de la Atención de Salud/estadística & datos numéricos , Vacunación/economía , Vacunación/psicología , Vacunación/estadística & datos numéricos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Infections are responsible for â¼13% of cancer cases worldwide, with human papillomavirus (HPV) and hepatitis B (HBV) among the infections associated with cancer for which vaccines are available. The aim of this study was to estimate the indirect cost of premature mortality related to cancers caused by HPV and HBV in Middle East and North Africa (MENA) countries. METHODS: The number of deaths and years of life lost (YLL) in 2019 from four HPV-related cancers: cervical cancer, oral cavity cancer, laryngeal cancer, and oropharynx cancer, as well as HBV-related liver cancer were sourced from the Institute for Health Metrics Evaluation (IHME) Global Burden of Disease database. HPV-attributable fractions were applied to deaths and YLL. The human capital approach was used to measure productivity loss, through value of YLL (VYLL), and estimated using gross domestic product per capita (World Bank; in USD). Seventeen countries in the MENA region were included. Four countries in the region were not included due to data availability. RESULTS: In 2019, there were 11,645 potentially vaccine-preventable cancer-related deaths across the MENA region. This resulted in an indirect cost of $1,688,821,605, with 76.1% of this accrued in the Middle East ($1,284,923,633). The number of deaths in the Middle East (5,986) were similar to Northern Africa (5,659) but YLL were higher in Northern Africa (179,425) compared to the Middle East (169,207). The highest indirect cost per death occurred in Qatar ($1,378,991), compared to $14,962 in Sudan. Oral cavity cancer had the highest VYLL per death ($186,084). CONCLUSIONS: There is a high burden of premature mortality and indirect costs of potentially vaccine-preventable cancer-related deaths in the MENA region. Improved vaccination program implementation, increased vaccine coverage of HPV and HBV vaccinations, and continued prioritization of public health measures, such as screening, could effectively reduce premature mortality and associated costs.
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Neoplasias , Humanos , Medio Oriente/epidemiología , África del Norte/epidemiología , Femenino , Masculino , Neoplasias/mortalidad , Neoplasias/economía , Persona de Mediana Edad , Infecciones por Papillomavirus/prevención & control , Adulto , Costo de Enfermedad , Hepatitis B/prevención & control , Hepatitis B/economía , Vacunas contra Papillomavirus/economía , Vacunas contra Papillomavirus/administración & dosificación , Anciano , Mortalidad Prematura , Modelos EconométricosRESUMEN
BACKGROUND: The economic and mortality burden of cancer is high worldwide. In Europe, cancer was responsible for 1.3 million deaths in 2020 and incurred an estimated cost of 50 billion from premature mortality. Human papillomavirus (HPV) and hepatitis B virus (HBV) are among the leading causes of infection-related cancers despite the availability of effective vaccines against these infections. This analysis estimated the mortality and productivity loss of HBV- and HPV-associated cancers that could be preventable through vaccination across European regions. MATERIALS AND METHODS: Institute for Health Metrics Evaluation (IHME) data were used to estimate mortality, years of life lost (YLL), and the value of years of life lost (VYLL) from five HBV- and HPV-related cancers (oral cavity, oropharynx, larynx, cervical, and liver cancers) across 40 European countries in 2019. Preventable deaths and YLL were estimated based on fractions attributable to infections. Data from the World Bank on GDP per capita were used to estimate the VYLL. The robustness of these results was explored with sensitivity and scenario analyses. RESULTS: In 2019, 31,906 cancer deaths resulted in an economic burden of 18,521,614,725 due to productivity losses across Europe. HPV-related cervical cancer had the highest mortality (19,473 deaths) and economic burden (10,706,253,185). HBV-related liver cancer and HPV-related larynx, oral cavity, and oropharynx cancers also had a substantial burden, particularly in males. Eastern Europe had the highest YLL (308,179; 39%) and Western Europe was responsible for the greatest VYLL (8,281,306,504; 45%), although the highest VYLL per death was in Northern Europe (923,638). HPV-related oropharynx cancer had the highest VYLL per death (656,607). CONCLUSION: HPV- and HBV-related cancer deaths are associated with substantial mortality and productivity losses in Europe, which could be reduced by the continued prioritization and implementation of prophylactic public health measures including systematic awareness, vaccination, and screening efforts.
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Costo de Enfermedad , Infecciones por Papillomavirus , Humanos , Europa (Continente)/epidemiología , Femenino , Masculino , Infecciones por Papillomavirus/prevención & control , Infecciones por Papillomavirus/complicaciones , Persona de Mediana Edad , Hepatitis B/prevención & control , Hepatitis B/economía , Neoplasias/mortalidad , Neoplasias/economía , Adulto , Anciano , Vacunas contra Hepatitis B/economía , Vacunas contra Hepatitis B/administración & dosificación , Modelos Econométricos , Adulto Joven , Vacunas contra Papillomavirus/economía , Vacunas contra Papillomavirus/administración & dosificaciónRESUMEN
BACKGROUND: Human papillomavirus (HPV) causes several cancers such as cervical cancer and some head and neck (oral cavity, pharynx, and larynx), vulval, vaginal, anal, and penile cancers. As HPV vaccination is available, there is potential to prevent these cancers attributed to HPV and consequently the burden associated with them. The aim of this analysis was to estimate the number of HPV-related cancer deaths and the productivity costs due to years of life lost (YLL) in the United Kingdom (UK). METHOD: A model was developed utilizing UK 2019 mortality data sourced from country-specific databases for England, Scotland, Wales, and Northern Ireland for the following HPV-related cancers: head and neck (ICD-10 C00-14 and C32), cervix uteri (C53), vaginal (C51), vulval (C52), anal (C21), and penile (C60). The proportion of deaths and years of life lost (YLL) due to HPV were estimated using HPV attributable fractions for each anatomic location from the published literature. Labor force participation, retirement ages, and mean annual earnings, discounted at 3.5% annually, were applied to YLL to calculate the present value of future lost productivity (PVFLP). RESULTS: A total of 1817 deaths due to HPV-related cancers were reported in the UK in 2019 resulting in 31,804 YLL. Restricting to only YLL that occurred prior to retirement age yielded a total YPLL of 11,765 and a total PVFLP of £187,764,978. CONCLUSIONS: There is a high disease burden in the UK for HPV-related cancers, with a large economic impact on the wider economy due to productivity losses. Implementing and reinforcing public health measures to maintain high HPV vaccination coverage in both males and females may further facilitate reduction of this burden.
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Infecciones por Papillomavirus , Humanos , Reino Unido/epidemiología , Femenino , Masculino , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/economía , Infecciones por Papillomavirus/mortalidad , Persona de Mediana Edad , Neoplasias/mortalidad , Neoplasias/economía , Adulto , Anciano , Eficiencia , Costo de Enfermedad , Modelos Econométricos , Vacunas contra Papillomavirus/economía , Vacunas contra Papillomavirus/administración & dosificación , Neoplasias del Cuello Uterino/mortalidad , Neoplasias del Cuello Uterino/economía , Neoplasias del Cuello Uterino/virología , Virus del Papiloma HumanoRESUMEN
INTRODUCTION: The 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. METHODS: Using 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. RESULTS: The 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 10 years. The incremental cost-effectiveness ratios 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 incremental cost-effectiveness ratio below £2,040/QALY. CONCLUSIONS: The 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.
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Análisis Costo-Beneficio , Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Humanos , Vacunas contra Papillomavirus/administración & dosificación , Vacunas contra Papillomavirus/economía , Reino Unido , Adolescente , Femenino , Infecciones por Papillomavirus/prevención & control , Infecciones por Papillomavirus/economía , Niño , Años de Vida Ajustados por Calidad de Vida , Vacunación/economía , Esquemas de Inmunización , Adulto Joven , Adulto , Virus del Papiloma HumanoRESUMEN
Vaccines to protect against human papillomavirus (HPV) infection are recommended for all adolescents by the World Health Organization (WHO) and are primarily delivered in school-based settings. This systematic review aims to summarize the available evidence on the cost of HPV vaccine delivery in low- and middle-income countries (LMICs). This updated evidence is eminent given recent global efforts to revitalize HPV vaccine delivery following the COVID-19 pandemic and can be used to inform planning for program sustainability. We carried out a systematic review of published literature reporting the costs of HPV vaccine delivery in LMICs published between 2005 and 2023. Eligibility criteria were developed using the Population, Intervention, Comparator, Outcome (PICO) framework, and studies that reported primary costing data and unit costs of HPV vaccine delivery were included. From the included studies, we extracted data such as phase of HPV vaccine implementation when costing was done, delivery strategy, and unit costs. Unit costs were converted into 2022 US$ for comparability. All included studies underwent critical appraisal using an adapted framework including Consolidated Health Economics Evaluation Reporting Standards criteria, the WHO-led consensus statement on vaccine delivery costing, and other frameworks. Our research identified 226 records, of which 15 met our inclusion criteria. Most studies (64 %) were carried out in African countries and during HPV vaccine pilots or demonstrations (60 %). Vaccine delivery cost ranged from $0.31 to $24.07 per dose for financial costs and $1.48 to $48.70 per dose for economic costs. The critical appraisal showed that most studies did not describe the uncertainty of reported delivery cost. Our systematic review evidence suggests that HPV vaccine delivery costs vary widely depending on country and stage of implementation when costing was done. Areas for further research include costing when programs are beyond the introduction phase and in LMICs outside of Africa.
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Países en Desarrollo , Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Humanos , Vacunas contra Papillomavirus/economía , Vacunas contra Papillomavirus/administración & dosificación , Infecciones por Papillomavirus/prevención & control , Infecciones por Papillomavirus/economía , COVID-19/prevención & control , COVID-19/economía , Femenino , Vacunación/economía , Adolescente , Programas de Inmunización/economía , Análisis Costo-BeneficioRESUMEN
Human papilloma virus (HPV) vaccine for adolescents was recommended as an effective prevention strategy of HPV-related cancers. In Vietnam, HPV vaccination has not been introduced to male adolescent. This study was conducted to examine the acceptance of having boys vaccinated against HPV and its underlying reasoning, and to identify their parent's willingness to pay (WTP) for HPV vaccination in central Vietnam. 785 parents of boys were directly interviewed based on a structured questionnaire. Parent's acceptability of HPV vaccine for their sons was identified by one question with response on 3-point scale (agree, don't know, and disagree). Multivariate logistic regression model was used to determine contributing factors to participant's acceptance. Bidding game method was applied to elicit WTP values for HPV vaccination with initial bid of 161.2 USD. The results showed that 49.2% of parents agreed to have their sons vaccinated against HPV. Factors that influenced parent's acceptance including son's age older than 12 years (OR = 1.5; 95% CI: 1.08-1.98); being eldest son (OR = 1.6; 95% CI: 1.13-2.19), being mother (OR = 1.4; 95% CI: 1.01-1.91), parents with high educational level (OR = 1.7; 95% CI: 1.11-2.47) and their knowledge of HPV and HPV vaccine (OR = 1.8; 95% CI: 1.23-2.65). Average WTP value for full doses of HPV vaccine was 137.5 USD, ranging between 9 USD and 188.3 USD. Parents' knowledge of HPV and HPV vaccine was the only factor affecting WTP value (Rho: 0.11; p-value: 0.030). The findings suggest a strategy be introduced for HPV vaccination to male adolescents in Vietnam.
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Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Vacunación , Adolescente , Alphapapillomavirus , Niño , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Papillomaviridae , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/economía , Vacunas contra Papillomavirus/uso terapéutico , Padres , Vacunación/economía , Vacunación/psicología , VietnamRESUMEN
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.
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Vacunación Masiva/economía , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/economía , Análisis Costo-Beneficio , Femenino , Salud Global , Promoción de la Salud , Humanos , Análisis de RegresiónRESUMEN
Cervical cancer is the second leading cause of cancer and one of the leading causes of cancer-related death in women in India. Human papillomavirus (HPV) vaccine uptake in India is low due to cost, low awareness of HPV, social stigma, and other factors. We assessed the awareness, attitudes, and beliefs regarding HPV and HPV vaccination and explored the barriers and challenges to HPV vaccine intent among women in Mangalore, India. An exploratory study was conducted using two focus group discussions (FGDs) and six in-depth one-on-one interviews. FGD-1 comprised nine women aged 18 to 26 years, and FGD-2 comprised seven women aged 27 to 45 years. The FGDs were recorded, transcribed, and analyzed using thematic content analysis. Themes identified were limited knowledge of HPV and vaccine, stigma associated with receiving HPV vaccine, vaccine safety concerns, and cost as a barrier to receiving vaccine. Participants expressed desire for physician and government recommendation of the HPV vaccine to validate vaccine intent. Contrasting themes between the two FGDs include support for vaccination at a younger age and lower perception of stigma and judgment in the 18- to 26-year-old group; however, participants in the 27- to 45-year-old group support vaccination at an older age and endorse greater fear of stigma and judgment associated with obtaining vaccination. Education regarding HPV-associated diseases and the HPV vaccine for the general public, physicians, and government officials in conjunction with lowering vaccine cost, improving vaccine access, and encouraging strong physician recommendations are key strategies to scale up HPV vaccine implementation in India.
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Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/inmunología , Aceptación de la Atención de Salud , Adulto , Femenino , Humanos , India/epidemiología , Infecciones por Papillomavirus/epidemiología , Vacunas contra Papillomavirus/economía , Factores de Riesgo , Adulto JovenRESUMEN
BACKGROUND: Introduction of human papillomavirus (HPV) vaccination has been slow in low-income and middle-income countries (LMICs) because of resource constraints and worldwide shortage of vaccine supplies. To help inform WHO recommendations, we modelled various HPV vaccination strategies to examine the optimal use of limited vaccine supplies and best allocation of scarce resources in LMICs in the context of the WHO global call to eliminate cervical cancer as a public health problem. METHODS: In this mathematical modelling analysis, we developed HPV-ADVISE LMIC, a transmission-dynamic model of HPV infection and diseases calibrated to four LMICs: India, Vietnam, Uganda, and Nigeria. For different vaccination strategies that encompassed use of a nine-valent vaccine (or a two-valent or four-valent vaccine assuming high cross-protection), we estimated three outcomes: reduction in the age-standardised rate of cervical cancer, number of doses needed to prevent one case of cervical cancer (NNV; as a measure of efficiency), and the incremental cost-effectiveness ratio (ICER; in 2017 international $ per disability-adjusted life-year [DALY] averted). We examined different vaccination strategies by varying the ages of routine HPV vaccination and number of age cohorts vaccinated, the population targeted, and the number of doses used. In our base case, we assumed 100% lifetime protection against HPV-16, HPV-18, HPV-31, HPV-33, HPV-45, HPV-52, and HPV-58; vaccination coverage of 80%; and a time horizon of 100 years. For the cost-effectiveness analysis, we used a 3% discount rate. Elimination of cervical cancer was defined as an age-standardised incidence of less than four cases per 100 000 woman-years. FINDINGS: We predicted that HPV vaccination could lead to cervical cancer elimination in Vietnam, India, and Nigeria, but not in Uganda. Compared with no vaccination, strategies that involved vaccinating girls aged 9-14 years with two doses were predicted to be the most efficient and cost-effective in all four LMICs. NNV ranged from 78 to 381 and ICER ranged from $28 per DALY averted to $1406 per DALY averted depending on the country. The most efficient and cost-effective strategies were routine vaccination of girls aged 14 years, with or without a later switch to routine vaccination of girls aged 9 years, and routine vaccination of girls aged 9 years with a 5-year extended interval between doses and a catch-up programme at age 14 years. Vaccinating boys (aged 9-14 years) or women aged 18 years or older resulted in substantially higher NNVs and ICERs. INTERPRETATION: We identified two strategies that could maximise efforts to prevent cervical cancer in LMICs given constraints on vaccine supplies and costs and that would allow a maximum of LMICs to introduce HPV vaccination. FUNDING: World Health Organization, Canadian Institute of Health Research, Fonds de recherche du Québec-Santé, Compute Canada, PATH, and The Bill & Melinda Gates Foundation. TRANSLATIONS: For the French and Spanish translations of the abstract see Supplementary Materials section.
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Países en Desarrollo , Esquemas de Inmunización , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/administración & dosificación , Vacunas contra Papillomavirus/inmunología , Neoplasias del Cuello Uterino/prevención & control , Adolescente , Adulto , Niño , Análisis Costo-Beneficio , Femenino , Humanos , Masculino , Modelos Biológicos , Vacunas contra Papillomavirus/economía , Años de Vida Ajustados por Calidad de Vida , Vacunación , Adulto JovenRESUMEN
BACKGROUND: Cervical cancer imposes considerable economic burden on societies and individuals. There is lack of evidence regarding this from the developing world and particularly from sub-Saharan Africa. Therefore, the study aimed to estimate the societal costs of cervical cancer in Eswatini. MATERIALS AND METHODS: The cost of illness study (CoI) was applied using national specific clinical and registry data from hospitals, registries and reports to determine the prevalence of cervical intraepithelial neoplasia (CIN) and cervical cancer in Eswatini in 2018. Cost data included direct medical costs (health care utilization in inpatient and outpatient care), direct non-medical costs (patient costs for traveling) and indirect costs based on productivity loss due to morbidity (patient time during diagnosis and treatment) and premature mortality. RESULTS: The estimated total annual cost for cervical cancer was $19 million (ranging between $14 million and $24 million estimated with lower and upper bounds). Direct cost represented the majority of the costs at 72% ($13.7 million) out of which total pre-cancerous treatment costs accounted for 0.7% ($94,161). The management of invasive cervical cancer was the main cost driver with costs attributable to treatment for FIGO III and FIGO IV representing $1.7 million and $8.7 million respectively. Indirect costs contributed 27% ($5.3 million) out of which productivity loss due to premature mortality represented the majority at 67% ($3.5 million). CONCLUSION: The economic burden of cervical cancer in Eswatini is substantial. National public health prevention strategies with prophylactic HPV vaccine and screening for cervical lesions should therefore be prioritized to limit the extensive costs associated with cervical cancer.
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Costo de Enfermedad , Vacunas contra Papillomavirus/economía , Displasia del Cuello del Útero/complicaciones , Neoplasias del Cuello Uterino/economía , Esuatini , Femenino , Costos de la Atención en Salud , Humanos , Neoplasias del Cuello Uterino/prevención & control , Displasia del Cuello del Útero/prevención & controlRESUMEN
BACKGROUND: A 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 FINDINGS: We 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. CONCLUSIONS: Our 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.
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Análisis Costo-Beneficio , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/uso terapéutico , Vacunación/economía , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Vacunas contra Papillomavirus/economía , Estados UnidosRESUMEN
BACKGROUND: The human papillomavirus (HPV) vaccine was introduced into Thailand's national immunization program in 2017 for 11-12 year old school girls. The objectives of this study were to examine the epidemiological consequences and cost-effectiveness of a routine quadrivalent HPV (4vHPV) vaccination and the routine 4vHPV vaccination plus 5-year catch-up vaccination by comparing with cervical cancer screening only (no vaccination) in Thailand. METHOD: A transmission dynamic model was used to assess the cost-effectiveness of the routine 4vHPV vaccination and the routine 4vHPV vaccination plus catch-up vaccination, compared with no vaccination (screening only) in Thai population. The vaccination coverage rate assumptions were 95% in 11-12-year-old girls for the routine vaccination and 70% in 13-24 year-old females for the 5-year catch-up vaccination. Vaccination costs, direct medical costs of HPV-related diseases, and the number of quality of life years (QALYs) gained were calculated for over a 100-year time horizon with discount rate of 3%. RESULT: The model indicated that the routine 4vHPV vaccination and the routine plus catch-up 4vHPV vaccination strategies could prevent approximately 434,130 and 472,502 cumulative cases of cervical cancer, 182,234 and 199,068 cumulative deaths from cervical cancer and 12,708,349 and 13,641,398 cumulative cases of HPV 6/11 related genital warts, respectively, when compared with no vaccination over 100 years. The estimated cost per QALY gained (ICER) when compared to no vaccination in Thailand was 8,370 THB/QALY for the routine vaccination and 9,650 THB/QALY for the routine with catch-up vaccination strategy. CONCLUSION: Considering the recommended threshold of 160,000 THB/QALY for Thailand, the implementation of the routine 4vHPV vaccination either alone or plus the catch-up vaccination was cost-effective as compared to the cervical cancer screening only.
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Vacunas contra Papillomavirus/economía , Vacunas contra Papillomavirus/farmacología , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/prevención & control , Niño , Análisis Costo-Beneficio , Femenino , Humanos , Tamizaje Masivo/economía , Modelos Económicos , Tailandia/epidemiologíaRESUMEN
Human papillomavirus (HPV) is responsible for almost all of the 570,000 new cases of cervical cancer and approximately 311,000 deaths per year. HPV vaccination is an integral component of the World Health Organization's (WHO) global strategy to fight the disease. However, high vaccine prices enforced through patent protection are limiting vaccine expansion, particularly in low- and middle-income countries. By limiting market power, patent buyouts could reduce vaccine prices and raise HPV vaccination rates while keeping innovation incentives. We estimate the global patent buyout price as the present discounted value (PDV) of the future profit stream over the remaining patent length for Merck's HPV vaccines (Gardasil-4 and 9), which hold 87% of the global HPV vaccine market, in the range of US$ 15.6-27.7 billion (in 2018 US$). The estimated PDV of the profit stream since market introduction amounts to US$ 17.8-42.8 billion and the estimated R&D cost to US$ 1.05-1.21 billion. Thus, we arrive at a ratio of R&D costs to the patent value of the order of 2.5-6.8%. We relate this figure to typical estimates of the probability of success (POS) for clinical trials of vaccines to discuss if patent protection provides Merck with extraordinarily strong price setting power.
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Vacunas contra Papillomavirus/economía , Análisis Costo-Beneficio , Femenino , Humanos , Programas de Inmunización/economía , Infecciones por Papillomavirus/economía , Infecciones por Papillomavirus/prevención & control , Infecciones por Papillomavirus/virología , Patentes como Asunto , Neoplasias del Cuello Uterino/economía , Neoplasias del Cuello Uterino/prevención & control , Neoplasias del Cuello Uterino/virología , Vacunación/economíaAsunto(s)
Vacunas/economía , Adyuvantes Inmunológicos , Factores de Edad , Vacuna contra la Varicela/economía , Análisis Costo-Beneficio , Economía Médica , Humanos , Vacunas contra la Influenza/economía , Vacunas contra la Influenza/inmunología , Vacunas contra Papillomavirus/economía , Vacunas/inmunologíaRESUMEN
OBJECTIVES: Cost-effectiveness analysis can guide decision making about health interventions, but the appropriate cost-effectiveness threshold to use is unclear in most countries. The World Health Organization (WHO) recommends vaccinating girls 9 to 14 years against human papillomavirus (HPV), but over half the world's countries have not introduced it. This study aimed to investigate whether country-level decisions about HPV vaccine introduction are consistent with a particular cost-effectiveness threshold, and to estimate what that threshold may be. METHODS: The cost-effectiveness of vaccinating 12-year-old girls was estimated in 179 countries using the Papillomavirus Rapid Interface for Modelling and Economics (PRIME) model, together with vaccine price data from World Health Organization's Market Information for Access to Vaccines database. In each year from 2006 to 2018, countries were categorized based on (1) whether they had introduced HPV vaccination, and (2) whether the incremental cost-effectiveness ratio for HPV vaccine introduction fell below a certain cost-effectiveness threshold. RESULTS: A cost-effectiveness threshold of 60% to 65% of GDP per capita has the best ability to discriminate countries that introduced vaccination, with a diagnostic odds ratio of about 7. For low-income countries the optimal threshold was lower, at 30% to 40% of GDP per capita. CONCLUSIONS: A cost-effectiveness threshold has some ability to discriminate between HPV vaccine introducer and non-introducer countries, although the average threshold is below the widely used threshold of 1 GDP per capita. These results help explain the current pattern of HPV vaccine use globally. They also inform the extent to which cost-effectiveness thresholds proposed in the literature reflect countries' actual investment decisions.
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Análisis Costo-Beneficio/estadística & datos numéricos , Países en Desarrollo/estadística & datos numéricos , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/administración & dosificación , Vacunas contra Papillomavirus/economía , Países en Desarrollo/economía , Salud Global , Humanos , Programas de Inmunización/economía , Programas de Inmunización/estadística & datos numéricos , Modelos Económicos , Infecciones por Papillomavirus/economía , Infecciones por Papillomavirus/epidemiología , Años de Vida Ajustados por Calidad de VidaRESUMEN
The human papillomavirus (HPV) vaccines may provide some level of cross-protection against high-risk HPV genotypes not directly targeted by the vaccines. We evaluated the long-term health and economic impacts of routine HPV vaccination using either the nonavalent HPV vaccine or the bivalent HPV vaccine in the context of 48 Gavi-eligible countries. We used a multi-modeling approach to compare the bivalent with or without cross-protection and the nonavalent HPV vaccine. The optimal, that is, most cost-effective, vaccine was the vaccine with an incremental cost-effectiveness ratio below the per-capita gross domestic product (GDP) for each country. By 2100 and assuming 70% HPV vaccination coverage, a bivalent vaccine without cross-protection, a bivalent vaccine with favorable cross-protection and the nonavalent vaccine were projected to avert 14.9, 17.2 and 18.5 million cumulative cases of cervical cancer across all 48 Gavi-eligible countries, respectively. The relative value of the bivalent vaccine compared to the nonavalent vaccine increased assuming a bivalent vaccine conferred high cross-protection. For example, assuming a cost-effectiveness threshold of per-capita GDP, the nonavalent vaccine was optimal in 83% (n = 40) of countries if the bivalent vaccine did not confer cross-protection; however, the proportion of countries decreased to 63% (n = 30) if the bivalent vaccine conferred high cross-protection. For lower cost-effectiveness thresholds, the bivalent vaccine was optimal in a greater proportion of countries, under both cross-protection assumptions. Although the nonavalent vaccine is projected to avert more cases of cervical cancer, the bivalent vaccine with favorable cross-protection can prevent a considerable number of cases and would be considered a high-value vaccine for many Gavi-eligible countries.
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Papillomavirus Humano 16/inmunología , Papillomavirus Humano 18/inmunología , Infecciones por Papillomavirus/inmunología , Vacunas contra Papillomavirus/inmunología , Neoplasias del Cuello Uterino/inmunología , Análisis Costo-Beneficio , Países Desarrollados , Países en Desarrollo , Femenino , Genotipo , Geografía , Salud Global/economía , Papillomavirus Humano 16/genética , Papillomavirus Humano 16/fisiología , Papillomavirus Humano 18/genética , Papillomavirus Humano 18/fisiología , Humanos , Infecciones por Papillomavirus/prevención & control , Infecciones por Papillomavirus/virología , Vacunas contra Papillomavirus/administración & dosificación , Vacunas contra Papillomavirus/economía , Neoplasias del Cuello Uterino/prevención & control , Neoplasias del Cuello Uterino/virología , Vacunación/economía , Vacunación/métodosRESUMEN
Background: There is a need to better understand HPV vaccination (HPVv) implementation in WHO Europe Region (WHO/ER), including recommendations, funding, and vaccination coverage rates (VCR). Methods: A targeted literature review (up to 31 January 2020) was conducted using national health ministry websites, WHO database, and published studies from WHO/ER countries (n = 53). HPVv recommendations and funding data (target age, gender, schedule, setting, target and monitored VCR) for primary and catch-up cohorts were collected. Results: National recommendations for HPVv exist in 46/53 (87%) countries, of which 38 (83%), 2 (4%), and 6 (13%) countries provided full, partial, or no funding, respectively, for the primary cohort. Fully or partially funded HPVv was provided for girls only in 25/53 (47%) countries and for both boys and girls in 15/53 (28%) countries. HPVv catch-up was fully or partially funded in 14/53 (26%) countries. Among 40 countries with a national immunization program (NIP), monitored VCRs ranged from 4.3% to 99% (n = 30). Of the 10 countries reporting VCR targets, only Portugal exceeded its target. Conclusion: Of the 53 WHO/ER countries, 40 have funded HPVv NIPs, among which 30 report VCRs. Additional efforts are required to ensure HPVv NIPs are fully funded and high VCRs maintained.