HPV vaccination could reduce the burden of CC and precancerous lesions in countries worldwide, part of disease burden reduction being related to protection against non HPV-16/18 related types.

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Background: Despite the fact that approximately 70% of Canadian women undergo cervical cancer screening at least once every 3 years, approximately 1,300 women were diagnosed with cervical cancer and approximately 380 died from it in 2008. This study estimates the effectiveness and cost-effectiveness of vaccinating 12-year old Canadian females with an AS04-adjuvanted cervical cancer vaccine. The indirect effect of vaccination, via herd immunity, is also estimated.

Both vaccines have a different epidemiological impact with an increased number of CC-related lesions potentially prevented for the BV because of additional cross-protection. In the Taiwanese setting, HPV mass vaccination using the BV was estimated to dominate vaccination using the QV.

Extending HPV vaccination to females post-sexual debut could lead to a substantial reduction in CC-related burden and would be cost-effective in Belgium.

BackgroundThis study aims at evaluating the cost-effectiveness of a 2-dose schedule human papillomavirus (HPV) vaccination programme of HPV and human immunodeficiency virus (HIV) naïve 12-year-old girls, in addition to cervical cancer (CC) screening alone, in South Africa. The study aims to account for both the impact of the vaccine among girls who are HIV-positive (HIV+) as well as HIV-negative (HIV-) population.MethodsA previously published Markov cohort model was adapted to assess the impact and cost-effectiveness of a HPV vaccination programme in girls aged 12 years (N = 527 900) using the AS04-adjuvanted HPV-16/18 vaccine from a public payer perspective. Two subpopulations were considered: HIV- and HIV+ women. Each population followed the HPV natural history with different transition probabilities. Model input data were obtained from the literature, local databases and Delphi panel. Costs and outcomes were discounted at 5 %. Extensive sensitivity analyses were conducted to assess the robustness of the evaluation.ResultsImplementation of the AS04-adjuvanted HPV-16/18 vaccine in combination with current cytological screening in South African girls could prevent up to 8 869 CC cases and 5 436 CC deaths over the lifetime of a single cohort. Without discounting, this HPV vaccine is dominant over screening alone; with discounting, the incremental cost-effectiveness ratio is ZAR 81 978 (South African Rand) per quality-adjusted life years (QALY) gained. HPV vaccination can be considered cost-effective based on World Health Organization (WHO) recommended threshold (3 x gross domestic product/capita = ZAR 200 293). In a scenario with a hypothetical targeted vaccination in a HIV+ subpopulation alone, the modelled outcomes suggest that HPV vaccination is still cost-effective, although the incremental cost-effectiveness ratio increases to ZAR 102 479. Results were sensitive to discount rate, vaccine efficacy, HIV incidence and mortality rates, and HPV-related disease transition probabilities.ConclusionsThe AS04-adjuvanted HPV-16/18 vaccine can be considered cost-effective in a South African context although the cost-effectiveness is expected to be lower in the HIV+ subpopulation than in the overall female population. With improved access to HIV treatment, the HIV mortality and incidence rates are likely to be reduced, which could improve cost-effectiveness of the vaccination programme in South Africa.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1295-z) contains supplementary material, which is available to authorized users.

Objectives:Human papillomavirus is the necessary cause of cervical cancer, in particular the human papillomavirus-16/18 strains, which have been detected in ~70% of all cervical cancer cases worldwide. This study aims to assess whether other cofactors, which might be specific for the Chinese population, are involved in the development of cervical cancer. These findings may support the future direction of cervical cancer prevention.Study Design:Systematic literature review.Methods:The following databases were searched: MEDLINE, MEDLINE-IN-PROCESS, EMBASE, China National Knowledge Infrastructure, Wanfang Data and Chongqing VIP Information. The target population were adolescents or adults from mainland China. All observational studies irrespective of intervention or comparator reporting risk factors for cervical cancer were included. The Newcastle-Ottawa Scale was used to assess study quality. The impact of each outcome was reported in numerical terms.Results:A total of 2,676 articles were screened. A total of 21 articles met the inclusion criteria. All studies were case-controlled designs mostly conducted in hospitals of South-Eastern China. A total of 18 studies reported lifestyle behaviours as significant influencing factors in the development of cervical cancer. Sexual behaviour, gestational factors, screening history, disease history and socio-demographics status were reported as significant risk factors for cervical cancer development.Conclusion:This review provides an up-to-date insight of current cervical cancer risk factors in China. Due to the heterogeneity of the results, further evaluation is recommended to determine the association of these risk factors to the overall risk of cervical cancer.

The implementation of a CC vaccination in Japan could reduce the CC burden in a very cost-effective manner for women up to 45 years.