Optimal human papillomavirus vaccination strategies to prevent cervical cancer in low-income and middle-income countries in the context of limited resources: a mathematical modelling analysis

Cervical cancer incidence and mortality have decreased in high-income countries, but low- and middle-income countries continue to bear a significant burden from the disease. Human papillomavirus (HPV) vaccines are a promising alternative for disease control; however, their introduction is slow in settings with greater need. We conducted a review of HPV vaccine efficacy and effectiveness reported in clinical trials and population-based studies. Efficacy of HPV vaccines is close to 100% when using a three-dose schedule in HPV-negative young women (<25 years old) for protection against persistent infection and HPV vaccine-type associated pre-cancerous lesions. Furthermore, sustained protection for up to 12 years of follow-up has been demonstrated; cross-protection against non-vaccine types is particularly observed for the bivalent vaccine, and preliminary data regarding impact on invasive cancer have emerged. Given its lower efficacy, catch-up vaccination beyond 19 years of age and proposals for vaccinating adult women deserve careful evaluation in accurately designed studies and economic analyses. Despite positive results regarding immunogenicity and post-hoc analysis for cervical intra-epithelial neoplasia in clinical trials, population-based data for prime and booster two-dose schedules are not available. Evaluation of vaccine safety from surveillance systems in immunization programs that have already distributed more than 270 million doses found no association of HPV vaccination with serious side effects. The introduction of HPV vaccination in national immunization programs remains the main challenge in tackling the burden of cervical cancer (up to 2018, only 89 countries have introduced vaccination worldwide, and most of these are high-income countries). Access models and technical capacity require further development to help low- and middle-income countries to increase the pace of vaccine delivery. Alternative approaches such as one-dose schedules and vaccination at younger ages may help reduce the programmatic and economic challenges to adolescent vaccination.

Download Full-text

Assessing the value of human papillomavirus vaccination in Gavi-eligible low-income and middle-income countries

BMJ Global Health ◽

10.1136/bmjgh-2020-003006 ◽

2020 ◽

Vol 5 (10) ◽

pp. e003006

Author(s):

Jessica Ochalek ◽

Kaja Abbas ◽

Karl Claxton ◽

Mark Jit ◽

James Lomas

Keyword(s):

Human Papillomavirus ◽

Low Income ◽

Hpv Vaccination ◽

Cost Effective ◽

Health Impact ◽

Healthcare Intervention ◽

Human Papillomavirus Vaccination ◽

Middle Income ◽

Maximum Price ◽

Healthcare Interventions

IntroductionEstimating the value of providing effective healthcare interventions in a country requires an assessment of whether the improvement in health outcomes they offer exceeds the improvement in health that would have been possible if the resources required had, instead, been made available for other healthcare activities in that country. This potential alternative use of the same resources represents the health opportunity cost of providing the intervention. Without such assessments, there is a danger that blanket recommendations made by international organisations will lead to the adoption of healthcare interventions that are not cost effective in some countries, even given existing donor mechanisms intended to support their affordability.MethodsWe assessed the net health impact to 46 Gavi-eligible countries of achieving one of the WHO’s proposed 90-70-90 targets for cervical cancer elimination, which includes 90% coverage of human papillomavirus (HPV) vaccination among girls by 15 years of age, using published estimates of the expected additional benefits and costs in each country and estimates of the marginal productivity of each healthcare system. We calculated the maximum price each country could afford to pay for HPV vaccination to be cost effective by assessing the net health impact that would be expected to be generated at different potential prices.ResultsAt Gavi negotiated prices, HPV vaccination offers net health benefits across most Gavi-eligible countries included in this study. However, if Gavi-eligible countries faced the average price faced by non-Gavi eligible countries, providing HPV vaccination would result in reduced overall population health in most countries.ConclusionEstimates of the net health impact of providing a healthcare intervention can be used to assess the benefit (or lack of) to countries of adhering to global guidance, inform negotiations with donors, as well as pricing negotiations and the value of developing new healthcare interventions.

Download Full-text

Burden of enterotoxigenic Escherichia coli and shigella non-fatal diarrhoeal infections in 79 low-income and lower middle-income countries: a modelling analysis

The Lancet Global Health ◽

10.1016/s2214-109x(18)30483-2 ◽

2019 ◽

Vol 7 (3) ◽

pp. e321-e330 ◽

Cited By ~ 19

Author(s):

John D Anderson ◽

Karoun H Bagamian ◽

Farzana Muhib ◽

Mirna P Amaya ◽

Lindsey A Laytner ◽

...

Keyword(s):

Escherichia Coli ◽

Low Income ◽

Enterotoxigenic Escherichia Coli ◽

Middle Income ◽

Middle Income Countries ◽

Modelling Analysis

Download Full-text

Comparative effectiveness and cost-effectiveness of treat-to-target versus benefit-based tailored treatment of type 2 diabetes in low-income and middle-income countries: a modelling analysis

The Lancet Diabetes & Endocrinology ◽

10.1016/s2213-8587(16)30270-4 ◽

2016 ◽

Vol 4 (11) ◽

pp. 922-932 ◽

Cited By ~ 15

Author(s):

Sanjay Basu ◽

Vishnu Shankar ◽

John S Yudkin

Keyword(s):

Type 2 Diabetes ◽

Cost Effectiveness ◽

Low Income ◽

Comparative Effectiveness ◽

Treat To Target ◽

Middle Income ◽

Middle Income Countries ◽

Tailored Treatment ◽

Modelling Analysis

Download Full-text

Modern possibilities of using immunotherapy in the treatment of cervical cancer

Tumors of female reproductive system ◽

10.17650/1994-4098-2021-17-2-104-111 ◽

2021 ◽

Vol 17 (2) ◽

pp. 104-111

Author(s):

A. V. Tarasova ◽

K. A. Ganina ◽

M. A. Meshkova ◽

Yu. V. Solovyeva ◽

E. E. Ivanova ◽

...

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Clinical Case ◽

Control Points ◽

Special Group ◽

Middle Income ◽

Vaccination Programs ◽

Middle Income Countries ◽

Common Cancer ◽

Preventive Vaccination

Cervical cancer (CC) is the fourth most common cancer in women worldwide. Every year, more than 500,000 women are diagnosed with CC, and the disease leads to more than 300,000 deaths worldwide. Infection with the human papillomavirus is the cause of CC in most cases. The disease is largely preventable through preventive vaccination. Approximately 90 % of CC cases are diagnosed in low-and middle-income countries where there are no organized human papillomavirus screening and vaccination programs. A special group in this disease consists of patients who develop recurrent / metastatic CC. To date, the most promising direction of drug treatment for this pathology is drugs that act on the control points of immunity – the PD-1 receptor / PD-L1 ligand, which are used by the tumor to block the immune system. The article presents a clinical case demonstrating the efficacy of the PD-1 inhibitor pembrolizumab for the treatment of recurrent / metastatic CC.

Download Full-text