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

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.

scholarly journals Estimating health opportunity costs in low-income and middle-income countries: a novel approach and evidence from cross-country data

2018 ◽  
Vol 3 (6) ◽  
pp. e000964 ◽  
Author(s):  
Jessica Ochalek ◽  
James Lomas ◽  
Karl Claxton
Keyword(s):  
Health Outcomes ◽  
Low Income ◽  
Health Expenditure ◽  
Cost Effective ◽  
Opportunity Costs ◽  
Donor Funding ◽  
Middle Income ◽  
Novel Approach ◽  
Healthcare Interventions ◽  
Country Specific

The economic evaluation of healthcare interventions requires an assessment of whether the improvement in health outcomes they offer exceeds the improvement in health that would have been possible if the additional resources required had, instead, been made available for other healthcare activities. Therefore, some assessment of these health opportunity costs is required if the best use is to be made of the resources available for healthcare. This paper provides a framework for generating country-specific estimates of cost per disability-adjusted life year (DALY) averted ‘thresholds’ that reflect health opportunity costs. We apply estimated elasticities on mortality, survival, morbidity and a generic measure of health, DALYs, that take account of measures of a country’s infrastructure and changes in donor funding to country-specific data on health expenditure, epidemiology and demographics to determine the likely DALYs averted from a 1% change in expenditure on health. The resulting range of cost per DALY averted ‘threshold’ estimates for each country that represent likely health opportunity costs tend to fall below the range previously suggested by WHO of 1–3× gross domestic product (GDP) per capita. The 1–3× GDP range and many other previous and existing recommendations about which interventions are cost-effective are not based on an empirical assessment of the likely health opportunity costs, and as a consequence, the health effects of changes in health expenditure have tended to be underestimated, and there is a risk that interventions regarded as cost-effective reduce rather than improve health outcomes overall.

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 A Long-Term Observation on the Possible Adverse Effects in Japanese Adolescent Girls after Human Papillomavirus Vaccination

Vaccines ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 856
Author(s):  
Akiyo Hineno ◽  
Shu-Ihi Ikeda
Keyword(s):  
Human Papillomavirus ◽  
Adverse Effects ◽  
Orthostatic Intolerance ◽  
Hpv Vaccination ◽  
Pain Syndrome ◽  
Causal Link ◽  
Human Papillomavirus Vaccination ◽  
Chronic Regional Pain Syndrome ◽  
Laboratory Test Results ◽  
Long Term Observation

In Japan, a significant number of adolescent females noted unusual symptoms after receiving the human papillomavirus (HPV) vaccination, of which the vast majority of them were initially diagnosed with psychiatric illnesses because of the absence of pathologic radiological images and specific abnormalities in laboratory test results. Later these symptoms were thought to be adverse effects of HPV vaccination. However, a causal link between HPV vaccination and the development of these symptoms has not been demonstrated. Between June 2013 and March 2021, we examined 200 patients who noted various symptoms after HPV vaccination. In total, 87 were diagnosed with HPV vaccination-related symptoms based on our proposed diagnostic criteria. The clinical histories of these 87 patients were analyzed. The age at initial vaccination ranged from 11 to 19 years old (mean ± SD: 13.5 ± 1.5 years old), and the age at the first appearance of symptoms ranged from 12 to 20 years old (mean ± SD: 14.3 ± 1.6 years old). The patients received an initial HPV vaccine injection between May 2010 and May 2013, but the first affected patient developed symptoms in October 2010, and the last affected developed symptoms in October 2015. A cluster of patients with a post-HPV vaccination disorder has not appeared in Japan during the last five years. Our study shows that, in Japan, the period of HPV vaccination considerably overlapped with that of a unique post-HPV vaccination disorder development. This disorder appears as a combination of orthostatic intolerance, chronic regional pain syndrome, and cognitive dysfunction, but its exact pathogenesis remains unclear.

scholarly journals Estimating the health impact of vaccination against ten pathogens in 98 low-income and middle-income countries from 2000 to 2030: a modelling study

The Lancet ◽  
2021 ◽  
Vol 397 (10272) ◽  
pp. 398-408 ◽  
Author(s):  
Xiang Li ◽  
Christinah Mukandavire ◽  
Zulma M Cucunubá ◽  
Susy Echeverria Londono ◽  
Kaja Abbas ◽  
...  
Keyword(s):  
Low Income ◽  
Health Impact ◽  
Middle Income ◽  
Middle Income Countries ◽  
Modelling Study

scholarly journals Lack of school requirements and clinician recommendations for human papillomavirus vaccination

2018 ◽  
Author(s):  
Linda M. Niccolai ◽  
Anna L. North ◽  
Alison Footman ◽  
Caitlin E. Hansen
Keyword(s):  
Human Papillomavirus ◽  
Hpv Vaccination ◽  
School Entry ◽  
Structured Interviews ◽  
Human Papillomavirus Vaccination ◽  
Strong Recommendation ◽  
Entry Requirements ◽  
Design And Methods ◽  
Purposive Sample

Background: A strong recommendation from a clinician is one of the best predictors of human papillomavirus (HPV) vaccination among adolescents, yet many clinicians do not provide effective recommendations. The objective of this study was to understand how the lack of school entry requirements for HPV vaccination influences clinicians’ recommendations. Design and Methods: Semi-structured interviews with a purposive sample of 32 clinicians were conducted in 2015 in Connecticut USA. Data were analysed using an iterative thematic approach in 2016-2017. Results: Many clinicians described presenting HPV vaccination as optional or non-urgent because it is not required for school entry. This was noted to be different from how other required vaccines were discussed. Even strong recommendations were often qualified by statements about the lack of requirements. Furthermore, lack of requirements was often raised initially by clinicians and not by parents. Many clinicians agreed that requirements would simplify the recommendation, but that parents may not agree with requirements. Personal opinions about school entry requirements were mixed. Conclusions: The current lack of school entry requirements for HPV vaccination is an important influence on clinicians’ recommendations that are often framed as optional or non-urgent. Efforts are needed to strengthen the quality of clinicians’ recommendations in a way that remains strong and focused on disease prevention yet uncoupled from the lack of requirements that may encourage delays. Additionally, greater support for requirements among clinicians may be needed to successfully enact requirements in the future.

scholarly journals Awareness and knowledge of human papillomavirus vaccination and their influential factors among Chinese women: a systematic review

2019 ◽  
Vol 6 (4) ◽  
pp. 317-326
Author(s):  
Gui-Dan Tang ◽  
Gu-Qing Zeng ◽  
Bi-Xia Zhao ◽  
Yun-Li Li ◽  
Rong Wang ◽  
...  
Keyword(s):  
Public Health ◽  
Human Papillomavirus ◽  
Hpv Vaccine ◽  
Chinese Women ◽  
Hpv Vaccination ◽  
Influential Factors ◽  
Perceived Behavioral Control ◽  
Human Papillomavirus Vaccination ◽  
Female Population ◽  
Multi Level

Abstract Objectives To systematically review the knowledge attitudes and the influential factors on human papillomavirus (HPV) vaccination among Chinese women. Methods Published studies on knowledge and attitudes of HPV vaccination for preventing cervical cancer among Chinese female population were retrieved using the major Chinese and English databases. Meanwhile, handwork retrieval was also conducted and the references including in the literature were retrieved. The quality of the literature was rigorously evaluated and extracted independently by two researchers and the data were analyzed and described by review manager 5.3 (RevMan5.3) software. Results In all, 19 articles including 8 articles in Chinese and 11 in English were chosen. A total of 30,176 participants were included and the sample size ranged from 64 to 6,024. The overall awareness of HPV and HPV vaccine among Chinese women was at a low level. Chinese women generally showed poor knowledge about HPV and HPV vaccine. Acceptance of HPV vaccination among Chinese women was at a high level. Vaccination intentions were influenced by the theory of planned behavior (TPB) and measured by attitudes subjective norms and perceived behavioral control. Conclusions The health authorities may evaluate and develop TPB-based interventions to increase HPV vaccination intentions of Chinese women. HPV vaccination programs should focus on carrying out multi-level and targeted health education and developing effective public health strategies after balancing the cost and benefit of HPV vaccine program. Medical staff should play the positive role in promoting the use of HPV vaccines in China. Integration of policy and community perspectives and multi-level interventions are essential to maximize the public health benefits of HPV vaccination.

scholarly journals Acceptability and feasibility of human papillomavirus vaccination for adolescents in school environments in Libreville

2020 ◽  
Vol 9 (9) ◽  
pp. 3541
Author(s):  
Nathalie L. Ambounda ◽  
Sylvain H. Woromogo ◽  
Olive M. Kenmogne ◽  
Felicite E. Yagata Moussa ◽  
Vicky N. Simo Tekem ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
High Risk ◽  
Precancerous Lesions ◽  
Hpv Vaccination ◽  
Immunization Coverage ◽  
Human Papillomaviruses ◽  
Professional Status ◽  
Human Papillomavirus Vaccination ◽  
Cross Sectional

Background: High-risk oncogenic human papillomaviruses (HPV) are the cause of sexually transmitted viral infection. Its persistence is a risk factor for precancerous lesions of the cervix, which will constitute the base of cervical cancer. In the world, the prevalence of high-risk oncogenic HPV is 66.7%, which is higher among women starting their sexual activity.Methods: An analytical cross-sectional study was conducted in high schools in Gabon regarding parents. The variables selected were the socio-cultural and demographic characteristics of the parents, their knowledge of human papillomavirus vaccination and their acceptability of HPV vaccination and finally the feasibility of HPV vaccination. The statistical test used was Pearson's Chi-square, and a difference was considered significant for p<0.05.Results: The majority of parents, 89%, were informed of the existence of cervical cancer. However, 73.4% of them were unaware of the existence of vaccination against cervical cancer. Only 2.4% of parents had vaccinated their daughters against cervical cancer at the time of the study. These parents only 53.4% expressed an interest in vaccinating their daughters in 53.4% of cases. The ability to vaccinate children is associated with the socio-professional status of parents (p˂0.000).Conclusions: The majority of parents approved school-based vaccination against human papillomavirus infections despite its reported cost and lack of information. The integration of anti-HPV vaccination into the expanded programme on immunization in Gabon will improve immunization coverage.

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