PCN98 Estimating the Potential Cost-Effectiveness of Human Papillomavirus (HPV) Vaccination in Germany Using A Dynamic Transmission Model

Objectives: The objective of this study was to simulate human papillomavirus (HPV) infection in a heterosexual population and subsequently analyze the incremental costs and effects of introducing a vaccination program against HPV types 6, 11, 16, and 18 in Denmark compared with screening alone.Methods: The analysis was performed in two phases. First, an agent-based transmission model was developed that described the HPV transmission without and with HPV vaccination. Second, an analysis of the incremental costs and effects was performed. The results of prevalence estimates of HPV, genital warts, cervical intraepithelial neoplasia (CIN1–3), and cervical cancer in the model simulations before and after introduction of HPV vaccination were extrapolated to the Danish population figures. Incremental costs and effects were then estimated. Future costs and effects were discounted.Results: Cost-effectiveness ratios for annual vaccination of 12-year-old girls, with a vaccination rate of 70 percent without a catch-up program, were estimated at approximately €1,917 per quality-adjusted life-year (QALY, 3 percent discount rate) and €10,846/QALY (5 percent discount rate), given a 62-year time horizon.Conclusions: A vaccination program would incur extra vaccination costs but would save treatment costs and improve both quality of life and survival.

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PIN44 Cost-Effectiveness of Quadrivalent HPV Vaccination in Germany Using A Dynamic Transmission Model

Value in Health ◽

10.1016/j.jval.2011.08.231 ◽

2011 ◽

Vol 14 (7) ◽

pp. A273

Author(s):

D. Schobert ◽

V. Remy ◽

O. Schöffski

Keyword(s):

Cost Effectiveness ◽

Hpv Vaccination ◽

Transmission Model ◽

Dynamic Transmission Model

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Impact and cost-effectiveness of nonavalent human papillomavirus vaccination in Switzerland: insights from a dynamic transmission model

10.1101/19012674 ◽

2019 ◽

Author(s):

Maurane Riesen ◽

Johannes A. Bogaards ◽

Nicola Low ◽

Christian L. Althaus

Keyword(s):

Cervical Cancer ◽

Sensitivity Analysis ◽

Cost Effectiveness ◽

Hpv Vaccination ◽

Quadrivalent Vaccine ◽

Transmission Model ◽

Price Difference ◽

Dynamic Transmission Model ◽

Hpv Types ◽

The Impact

ABSTRACTAIMIn Switzerland, human papillomavirus (HPV) vaccination has been implemented using a quadrivalent vaccine that covers HPV types 16 and 18, responsible for about 70% of cervical cancer. The average national uptake was 56% in girls by the age of 16 years in 2014–2016. A nonavalent vaccine, covering five additional oncogenic HPV types was recommended at the end of 2018. The primary aim of this study was to assess the impact and cost-effectiveness of introducing the nonavalent HPV vaccine in Switzerland compared with the quadrivalent vaccine.METHODSWe developed a dynamic transmission model that describes the spread of 10 high risk HPV types. We informed the model with Swiss data about sexual behaviour and cervical cancer screening, and calibrated the model to cervical cancer incidence in Switzerland. We modelled the impact of quadrivalent and nonavalent vaccines at the achieved (56%) and national recommended uptake (80%) in girls. We calculated the incremental cost-effectiveness ratio (ICER) between the nonavalent vaccine, the quadrivalent vaccine and no vaccination. We evaluated costs linked to cervical cancer screening, treatment of different disease stages and vaccination in a sensitivity analysis.RESULTSCompared with quadrivalent HPV vaccination in Switzerland at 56% uptake, vaccinating with the nonavalent vaccine would avert 1,175 cervical cancer deaths, 3,641 cases of cervical cancer and 106,898 CIN treatments over 100 years at 56% uptake. Compared with the quadrivalent vaccine, which would prevent an estimated 67% and 72% of cervical cancer cases at 56% and 80% coverage, the nonavalent vaccine would prevent 83% and 89% of all cervical cancers at the same coverage rates. The sensitivity analysis shows that introducing the nonavalent vaccination should improve health outcomes and offers a cost-saving alternative to the quadrivalent vaccine under the current price difference.CONCLUSIONSAll scenarios with quadrivalent and nonavalent vaccination are likely to be cost-effective compared with no vaccination. Switching to the nonavalent vaccine at current and improved vaccination uptake is likely to be cost-saving under the investigated price difference.

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Prevalence and risk factors of anogenital human papillomavirus infection in a community sample of men who have sex with men in Taiwan: baseline findings from a cohort study

Sexually Transmitted Infections ◽

10.1136/sextrans-2018-053629 ◽

2019 ◽

Vol 96 (1) ◽

pp. 62-66

Author(s):

Carol Strong ◽

Huachun Zou ◽

Nai-Ying Ko ◽

Ya-Lun Liang ◽

Wen-Wei Ku ◽

...

Keyword(s):

Risk Factors ◽

Human Papillomavirus ◽

Cost Effectiveness ◽

Community Sample ◽

Hpv Vaccination ◽

Hpv Infection ◽

Sex Partners ◽

Anal Sex ◽

The Past ◽

Sex With Men

ObjectivesMen who have sex with men (MSM) are a highly neglected population in the current recommendation of girls-only human papillomavirus (HPV) vaccination programmes in many countries. To better assess the cost effectiveness of HPV vaccination among men requires data on the prevalence of HPV infection in MSM using a community sample, which is still sparse in several regions. We examined the prevalence of and factors associated with anogenital HPV infection among MSM in Taiwan.MethodsMSM 20 years of age and older were recruited from the community and social media in Taiwan in 2015–2016 and screened for HPV infection to detect 37 genotypes. MSM were seen at baseline and were/will be seen at 6, 12, 24 and 36 months. Men completed a questionnaire regarding their sexual experiences. Multivariable regression analyses were conducted to identify associated behavioural risk factors using the baseline data.ResultsA total of 253 MSM were recruited; 87 % were below 35 years of age. Diagnosis of HIV was reported in 4% of men; just over 20% had three or more anal sex partners in the past year. The prevalence of any tested HPV type was 29.4% at the anal site and 11% at the penile site. One quarter of MSM were infected with any of the 9-valent vaccine HPV types. Anal HPV detection was associated with having three or more receptive anal sex partners in the past year (adjusted odds ratio (aOR)=2.92, 95% CI 1.29 to 6.61) and having older sex partners (aOR=2.51, 95% CI 1.07 to 5.90).ConclusionsOur data provide the base to calculate the reproductive rate for HPV transmission in a low-risk community sample and cost-effectiveness to include men in HPV vaccination policies. Adding evidence from a community sample adds comprehensiveness for future estimates of disease transmission and vaccine effectiveness.

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

Vaccine ◽

10.1016/j.vaccine.2020.10.019 ◽

2020 ◽

Vol 38 (50) ◽

pp. 8032-8039 ◽

Cited By ~ 1

Author(s):

Harrell W. Chesson ◽

Elissa Meites ◽

Donatus U. Ekwueme ◽

Mona Saraiya ◽

Lauri E. Markowitz

Keyword(s):

United States ◽

Cost Effectiveness ◽

Hpv Vaccination ◽

The United States ◽

Transmission Model

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Human Papillomavirus Genotype Replacement: Still Too Early to Tell?

The Journal of Infectious Diseases ◽

10.1093/infdis/jiaa032 ◽

2020 ◽

Cited By ~ 4

Author(s):

Irene Man ◽

Simopekka Vänskä ◽

Matti Lehtinen ◽

Johannes A Bogaards

Keyword(s):

Human Papillomavirus ◽

Hpv Vaccination ◽

Population Level ◽

Cross Protection ◽

Transmission Model ◽

Trade Off ◽

Long Run ◽

Vaccine Type ◽

Cross Immunity ◽

Different Levels

Abstract Background Although human papillomavirus (HPV) vaccines are highly efficacious in protecting against HPV infections and related diseases, vaccination may trigger replacement by nontargeted genotypes if these compete with the vaccine-targeted types. HPV genotype replacement has been deemed unlikely, based on the lack of systematic increases in the prevalence of nonvaccine-type (NVT) infection in the first decade after vaccination, and on the presence of cross-protection for some NVTs. Methods To investigate whether type replacement can be inferred from early postvaccination surveillance, we constructed a transmission model in which a vaccine type and an NVT compete through infection-induced cross-immunity. We simulated scenarios of different levels of cross-immunity and vaccine-induced cross-protection to the NVT. We validated whether commonly used measures correctly indicate type replacement in the long run. Results Type replacement is a trade-off between cross-immunity and cross-protection; cross-immunity leads to type replacement unless cross-protection is strong enough. With weak cross-protection, NVT prevalence may initially decrease before rebounding into type replacement, exhibiting a honeymoon period. Importantly, vaccine effectiveness for NVTs is inadequate for indicating type replacement. Conclusions Although postvaccination surveillance thus far is reassuring, it is still too early to preclude type replacement. Monitoring of NVTs remains pivotal in gauging population-level impacts of HPV vaccination.

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Cost-effectiveness of a bivalent human papillomavirus vaccination program in Japan

Sexual Health ◽

10.1071/sh14241 ◽

2015 ◽

Vol 12 (6) ◽

pp. 520 ◽

Cited By ~ 5

Author(s):

Luke B. Connelly ◽

Ha N. D. Le

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Cost Effectiveness ◽

Screening Program ◽

Vaccine Coverage ◽

Precancerous Lesions ◽

Hpv Vaccination ◽

Vaccination Program ◽

Human Papillomavirus Vaccination ◽

The Cost

Background Human papillomavirus (HPV) vaccines and their widespread adoption have the potential to relieve a large part of the burden of cervical cancer morbidity and mortality, particularly in countries that have low screening rates or, like Japan, lack a cohesive universal screening program. An economic evaluation was conducted to assess the cost-effectiveness of introducing a bivalent HPV vaccination program in Japan from a healthcare perspective. Methods: A Markov model of the natural history of HPV infection that incorporates both vaccination and screening was developed for Japan. The modelled intervention, a bivalent HPV vaccine with a 100% lifetime vaccine efficacy and 80% vaccine coverage, given to a cohort of 12-year-old Japanese girls in conjunction with the current screening program, was compared with screening alone in terms of costs and effectiveness. A discount rate of 5% was applied to both costs and utilities where relevant. Results: Vaccination alongside screening compared with screening alone is associated with an incremental cost-effectiveness ratio (ICER) of US$20 315 per quality-adjusted-life-year gained if 80% coverage is assumed. The ICER at 5% coverage with the vaccine plus screening, compared with screening alone, is US$1158. Conclusion: The cost-effectiveness results suggest that the addition of a HPV vaccination program to Japan’s cervical cancer screening program is highly likely to prove a cost-effective way to reduce the burden of cervical cancer, precancerous lesions and HPV16/18-related diseases.

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Cost-effectiveness of influenza control measures: a dynamic transmission model-based analysis

Epidemiology and Infection ◽

10.1017/s0950268813000423 ◽

2013 ◽

Vol 141 (12) ◽

pp. 2581-2594 ◽

Cited By ~ 7

Author(s):

S.-C. CHEN ◽

C.-M. LIAO

Keyword(s):

Cost Effectiveness ◽

Natural Ventilation ◽

Seasonal Influenza ◽

School Setting ◽

Control Measures ◽

Transmission Model ◽

Model Based ◽

Dynamic Transmission Model ◽

Influenza Transmission ◽

The Cost

SUMMARYWe investigated the cost-effectiveness of different influenza control strategies in a school setting in Taiwan. A susceptible-exposure-infected-recovery (SEIR) model was used to simulate influenza transmission and we used a basic reproduction number (R0)–asymptomatic proportion (θ) control scheme to develop a cost-effectiveness model. Based on our dynamic transmission model and economic evaluation, this study indicated that the optimal cost-effective strategy for all modelling scenarios was a combination of natural ventilation and respiratory masking. The estimated costs were US$10/year per person in winter for one kindergarten student. The cost for hand washing was estimated to be US$32/year per person, which was much lower than that of isolation (US$55/year per person) and vaccination (US$86/year per person) in containing seasonal influenza. Transmission model-based, cost-effectiveness analysis can be a useful tool for providing insight into the impacts of economic factors and health benefits on certain strategies for controlling seasonal influenza.

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