A brief history of economic evaluation for human papillomavirus vaccination policy

Sexual Health ◽  
2010 ◽  
Vol 7 (3) ◽  
pp. 352 ◽  
Author(s):  
Philippe Beutels ◽  
Mark Jit
Keyword(s):  
Human Papillomavirus ◽  
Economic Evaluation ◽  
Policy Making ◽  
Cervical Screening ◽  
Hpv Vaccination ◽  
Health Economic Evaluation ◽  
Developed Countries ◽  
Economic Evaluations ◽  
Human Papillomavirus Vaccination ◽  
Screening Programs

Background: This commentary discusses key issues for health economic evaluation and modelling, applied to human papillomavirus (HPV) vaccine programs. Methods: We outline some of the specific features of HPV disease and vaccination, and associated policy questions in light of a literature search for economic evaluations on HPV vaccination. Results: We observe that some policy questions could not be reliably addressed by many of the 43 published economic evaluations we found. Despite this, policy making on universal HPV vaccination followed shortly after vaccine licensure in many developed countries, so the role economic evaluation played in informing these decisions (pre-dating 2008) seems to have been fairly limited. For more recent decisions, however, economic evaluation is likely to have been used more widely and more intensively. Conclusions: We expect future cost-effectiveness analyses to be more instrumental in policy making regarding vaccines covering more HPV types, therapeutic HPV vaccines, and novel diagnostic tests for biomarkers of HPV infection and disease integrated with cervical screening programs.

scholarly journals Human papillomavirus vaccination: the population impact

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 866 ◽  
Author(s):  
Lai-yang Lee ◽  
Suzanne M. Garland
Keyword(s):  
Human Papillomavirus ◽  
Vaccine Coverage ◽  
Cervical Screening ◽  
Hpv Vaccination ◽  
National Guidelines ◽  
Human Papillomavirus Vaccination ◽  
Vaccination Programs ◽  
Screening Programs ◽  
National Immunisation ◽  
The Impact

We currently have the knowledge and experience to prevent much of human papillomavirus (HPV)-related disease burden globally. In many countries where prophylactic HPV vaccination programs have been adopted as highly effective public health programs with good vaccine coverage, we are already seeing, in real-world settings, reduction of vaccine-related HPV-type infections, genital warts and cervical pre-cancers with potential reductions in vulvar, vaginal and anal pre-cancers. Moreover, we are seeing a change in cervical screening paradigms, as HPV-based screening programs now have strong evidence to support their use as more sensitive ways to detect underlying cervical abnormalities, as compared with conventional cervical cytology. This article describes the impact of prophylactic vaccination on these outcomes and in settings where these vaccines have been implemented in national immunisation programs. Given the successes seen to date and the availability of essential tools, there has been a global push to ensure that every woman has access to effective cervical screening and every girl has the opportunity for primary prevention through vaccination. A gender-neutral approach by offering vaccination to young boys has also been adopted by some countries and is worthy of consideration given that HPV-related cancers also affect males. Furthermore, vaccination of young boys has the advantage of reducing the risk of HPV transmission to sexual partners, lowering the infectious pool of HPV in the general population and ultimately HPV-related diseases for both genders. Therefore, it is appropriate that all countries consider and promote national guidelines and programs to prevent HPV-related diseases.

Economic Evaluation of Human Papillomavirus Vaccination in Developed Countries

2009 ◽  
Vol 12 (5-6) ◽  
pp. 343-351 ◽  
Author(s):  
Marc Brisson ◽  
Nicolas van de Velde ◽  
Marie-Claude Boily
Keyword(s):  
Human Papillomavirus ◽  
Economic Evaluation ◽  
Developed Countries ◽  
Human Papillomavirus Vaccination

Human Papillomavirus Vaccination in the Prevention of Cervical Neoplasia

2009 ◽  
Vol 19 (9) ◽  
pp. 1610-1613 ◽  
Author(s):  
Katharine Astbury ◽  
Michael J. Turner
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Disease Incidence ◽  
Developed Countries ◽  
Cervical Neoplasia ◽  
Human Papillomavirus Vaccination ◽  
Vaccination Programs ◽  
Screening Programs ◽  
Hpv 18

Cervical cancer remains a major cause of morbidity and mortality for women worldwide. Although the introduction of comprehensive screening programs has reduced the disease incidence in developed countries, it remains a major problem in the developing world. The recent licensing of 2 vaccines against human papillomavirus (HPV) type 16 and HPV-18, the viruses responsible for 70% of cervical cancer cases, offers the hope of disease prevention. In this article, we review the role of HPV in the etiology of cervical cancer and the evidence to support the introduction of vaccination programs in young women and discus the potential obstacles to widespread vaccination. In addition, we discuss the issues that remain to be elucidated, including the potential need for booster doses of the vaccine and the role of concomitant vaccination in men.

Promising strategies for cervical cancer screening in the post-human papillomavirus vaccination era

Sexual Health ◽  
2010 ◽  
Vol 7 (3) ◽  
pp. 376 ◽  
Author(s):  
Joseph Tota ◽  
Salaheddin M. Mahmud ◽  
Alex Ferenczy ◽  
François Coutlée ◽  
Eduardo L. Franco
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Human Error ◽  
Pap Smear ◽  
Cervical Screening ◽  
Screening Tests ◽  
Hpv Testing ◽  
Human Papillomavirus Vaccination ◽  
Screening Programs

Human papillomavirus (HPV) vaccination is expected to reduce the burden of cervical cancer in most settings; however, it is also expected to interfere with the effectiveness of screening. In the future, maintaining Pap cytology as the primary cervical screening test may become too costly. As the prevalence of cervical dysplasias decreases, the positive predictive value of the Pap test will also decrease, and, as a result, more women will be referred for unnecessary diagnostic procedures and follow-up. HPV DNA testing has recently emerged as the most likely candidate to replace cytology for primary screening. It is less prone to human error and much more sensitive than the Pap smear in detecting high-grade cervical lesions. Incorporating this test would improve the overall quality of screening programs and allow spacing out screening tests, while maintaining safety and lowering costs. Although HPV testing is less specific than Pap cytology, this issue could be resolved by reserving the latter for the more labour-efficient task of triaging HPV-positive cases. Because most HPV-positive smears would contain relevant abnormalities, Pap cytology would be expected to perform with sufficient accuracy under these circumstances. HPV Pap triage would also provide a low-cost strategy to monitor long-term vaccine efficacy. Although demonstration projects could start implementing HPV testing as a population screening tool, more research is needed to determine the optimal age to initiate screening, the role of HPV typing and other markers of disease progression, and appropriate follow-up algorithms for HPV-positive and Pap-negative women.

Human papillomavirus prevalence to age 60 years among Australian women prevaccination

Sexual Health ◽  
2015 ◽  
Vol 12 (4) ◽  
pp. 353 ◽  
Author(s):  
Julia M. L. Brotherton ◽  
John R. Condon ◽  
Peter B. McIntyre ◽  
Sepehr N. Tabrizi ◽  
Michael Malloy ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
High Risk ◽  
Sexual Debut ◽  
Cervical Screening ◽  
Hpv Vaccination ◽  
Normal Cytology ◽  
Screening Programs ◽  
Hpv Types ◽  
High Risk Hpv ◽  
Second Peak

Background The prevalence of human papillomavirus (HPV) at the cervix varies with age, peaking following sexual debut and declining thereafter in most populations. In some populations, a second peak is observed. Here we describe the prevalence of HPV at the cervix among Australian women before the commencement of the HPV vaccination program. Methods: Women aged 15 to 60 years attending health services for cervical screening between 2005 and 2008 were invited to participate. Liquid based cervical specimens were tested for 37 types of HPV using linear array. The percentage and 95% confidence interval of women with any type of HPV, any of 13 high risk HPV types, and with vaccine-preventable HPV types (types 6, 11, 16 and 18) were estimated in 5-year age bands. Results: Among 1929 women aged 15–60 years, HPV prevalence peaked at 64% at age 15–20 years, then declined gradually to 12% at age 41–45 years, whereafter it rose to 19% in women 51–55 years then returned to 14% in 56–60 year olds. Prevalence curves were similar for high-risk HPV types and vaccine-targeted HPV types 6, 11, 16 and 18 and when results were restricted to women with only normal cytology. Conclusions: The shape of the prevalence curve we observed is similar to those from other Western populations. Variation in prevalence curves is likely due to differences in sexual behaviour between populations and over time, reactivation of HPV during perimenopause, and possibly the presence of cervical screening programs. These data are the first such data from the Oceania region.

National survey of general practitioners' experience of delivering the National Human Papillomavirus Vaccination Program

Sexual Health ◽  
2010 ◽  
Vol 7 (3) ◽  
pp. 291 ◽  
Author(s):  
Julia M. L. Brotherton ◽  
Julie Leask ◽  
Cath Jackson ◽  
Kirsten McCaffery ◽  
Lyndal J. Trevena
Keyword(s):  
Human Papillomavirus ◽  
General Practitioners ◽  
Hpv Vaccine ◽  
Cervical Screening ◽  
Hpv Vaccination ◽  
Vaccine Safety ◽  
Population Based ◽  
Vaccination Program ◽  
Routine Practice ◽  
Human Papillomavirus Vaccination

Background: Between 2007 and 2009, Australian general practitioners (GPs) were involved in implementing a population-based human papillomavirus (HPV) vaccination program. We investigated GPs’ experiences of delivering the HPV vaccine to women aged 18–26. Methods: We posted a survey to 1000 GPs. The survey was informed by 12 domains incorporating constructs from psychological theories that focus on individual and environmental barriers and facilitators to effective implementation of evidence-based practice by health professionals. Results: The response rate was 32%. The 298 vaccinating GPs were positive about HPV vaccine implementation as part of their professional role as a worthwhile initiative within existing general practice infrastructure. They had more negative views about some aspects of program organisation, such as the timelines and potential adverse impacts on cervical screening rates. Vaccine safety was not a key concern. Actual levels of knowledge about HPV were moderate (mean score 3.41 out of 6 (s.d. 0.99)) and contrasted with self-rated knowledge, which was high (93% perceived their knowledge to be adequate). Notably, there were unrealistic expectations about the likely reduction in Pap abnormalities due to vaccination, which is important to clarify to avoid loss of confidence in the vaccine when this reduction does not eventuate. Conclusions: Australian GPs viewed HPV vaccination of women aged 18–26 years as an integrated part of their routine practice, with positive attitudes regarding its benefits and achievability. GPs are well placed to implement mass immunisation programs as long as they are supported by effective and timely communication strategies and resources.

scholarly journals Increasing Human Papillomavirus Vaccination and Cervical Cancer Screening in Nigeria: An Assessment of Community-Based Educational Interventions

2020 ◽  
Vol 41 (1) ◽  
pp. 89-99
Author(s):  
Chigozie Anastacia Nkwonta ◽  
DeAnne K. Hilfinger Messias ◽  
Tisha Felder ◽  
Kathryn Luchok
Keyword(s):  
Human Papillomavirus ◽  
Hpv Vaccine ◽  
Cervical Screening ◽  
Hpv Vaccination ◽  
Educational Interventions ◽  
Urban Setting ◽  
Sub Saharan Africa ◽  
Community Based ◽  
Human Papillomavirus Vaccination ◽  
The Impact

We explored the impact of two community-based educational interventions on Nigerian adults’ knowledge and intention to take or encourage human papillomavirus (HPV) vaccine and cervical screenings. Face-to-face presentation and printed pamphlet intervention were delivered to 266 men and women aged 18 to 65 years in 12 locations in urban setting. At baseline, the majority (80%) had poor knowledge of HPV, and less than 12% had ever received or have a family member who had received HPV vaccine or cervical screening. Postintervention, there was significant increase (>70%) in the participants knowledge and intention to take or encourage HPV vaccination and cervical screening. In addition, more than half were willing to pay for HPV vaccine and screening even when expensive. Gender-focused and context-specific low-cost community-based educational interventions are effective in increasing HPV vaccine and cervical screening in sub-Saharan Africa.

scholarly journals Is human papillomavirus vaccination likely to be a useful strategy in India?

2013 ◽  
Vol 02 (04) ◽  
pp. 193-197 ◽  
Author(s):  
Sudeep Gupta ◽  
Rajendra A. Kerkar ◽  
Rajesh Dikshit ◽  
Rajendra A. Badwe
Keyword(s):  
Public Health ◽  
Human Papillomavirus ◽  
Hpv Vaccination ◽  
Cost Effective ◽  
Population Based ◽  
Point Of View ◽  
Public Health Perspective ◽  
Human Papillomavirus Vaccination ◽  
Screening Programs ◽  
Vaccine Trials

AbstractTwo vaccines that protect against infection by some of the oncogenic human papillomavirus (HPV) subtypes have recently been licensed for use in population-based vaccination strategies in many countries. However, these products are being promoted as ‘cervical cancer vaccines’ based on inadequate data. Specifically, there remain several concerns about the duration of immunogenicity, length of follow-up of trial subjects, endpoints chosen in vaccine trials, applicability of trial results to real populations, the safety of these products, and their cost-effectiveness as public health interventions. Furthermore, it is unlikely that vaccination will obviate the need for setting up robust and cost-effective screening programs in countries like India. This article will discuss various aspects of HPV vaccination from a public health perspective, especially from the point of view of its relevance to India and other South Asian countries.

scholarly journals Genotype Distribution Change After Human Papillomavirus Vaccination in Two Autonomous Communities in Spain

2021 ◽  
Vol 11 ◽  
Author(s):  
Javier Freire-Salinas ◽  
Rafael Benito ◽  
Ainara Azueta ◽  
Joaquina Gil ◽  
Claudia Mendoza ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Cervical Screening ◽  
Hpv Vaccination ◽  
Uterine Cervical Cancer ◽  
Vaccination Program ◽  
Genotype Distribution ◽  
Human Papillomavirus Vaccination ◽  
Cross Sectional ◽  
Autonomous Communities ◽  
Hpv Dna

ContextIt has been more than 10 years since the human papillomavirus (HPV) vaccination program was initiated in most advanced countries. Thus, it seems necessary to change the uterine cervical cancer screening strategy. Molecular-based tests are considered essential in this scenario.ObjectiveWe aimed to review the distribution of the HPV genotypes after the introduction of the vaccination program with Cervarix® and Gardasil 4® in two autonomous communities in Spain, looking for possible changes in distribution and the occurrence of a herd effect.DesignA cross-sectional study was performed in 45,362 samples that were processed in the Cantabria and Aragon communities during the period from 2002 to 2016. We compared the genotype distribution before and after the vaccination program was initiated.ResultsGenotypes HPV6 and HPV11 have decreased significantly after the introduction of the vaccine. HPV16 has had a decrease, but not a significant one in the statistical analysis. However, HPV31, HPV52, and HPV45 have increased in percentage. A replacement phenomenon with other genotypes not included in the vaccine has been observed in our population.ConclusionsContinued surveillance is needed to provide further indication of any changes over time in the genotypes in circulation. This will be facilitated by monitoring the genotyping results from the new model of cervical screening using primary HPV DNA testing.

scholarly journals Toward universal human papillomavirus vaccination for adolescent girls in Hong Kong: a policy analysis

2020 ◽  
Vol 41 (2) ◽  
pp. 170-184 ◽  
Author(s):  
Ruirui Chen ◽  
Eliza Wong ◽  
Lijuan Wu ◽  
Yuanfang Zhu
Keyword(s):  
Hong Kong ◽  
Health Policy ◽  
Human Papillomavirus ◽  
Policy Analysis ◽  
Adolescent Girls ◽  
Policy Making ◽  
Hpv Vaccination ◽  
Policy Formation ◽  
Coalition Building ◽  
Human Papillomavirus Vaccination

Abstract Studies have assessed early population-level impact of human papillomavirus (HPV) vaccination programs for preventing cervical cancer. Through a case study in Hong Kong we examined stakeholder engagement and interactions to promote a universal HPV vaccination program using the Health Policy Triangle framework for structured health policy analysis. Using data from a document review and semi-structured in-depth interviews, we used thematic and stakeholder analyses to describe the process of policy formation. Given Hong Kong’s political and health system, and a mix of Chinese and Western values, stakeholders judged legitimacy of the process differently. We discuss their varied ethical stances and the role of research evidence for informing policy-making. For effective HPV vaccination policy and promotion of universal free HPV vaccination among adolescent girls, new strategies are needed to broaden acceptance of the process, to frame policies in terms of facts and values, and to connect research to policy-making and improve coalition-building.

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