Polycystic ovarian syndrome (PCOS), a common endocrinal disorder of reproductive age characterized by heterogeneous complications, is nowadays prevailing among females at adolescent stage. Infrequent or prolonged menstrual periods, excess hair growth, acne, and obesity can occur in women with PCOS. In adolescents, infrequent or absence of menstruation may raise chances for this condition. The increased prevalence of PCOS among general population throughout the world is found to be 5%–10% in the women of reproductive age, and about 40% women with PCOS experience depression, particularly young girls. The exact cause of PCOS is unknown. Early diagnosis and treatment along with weight loss may reduce the risk of long-term complications. Depression and anxiety are common in women with PCOS but are often overlooked and therefore left untreated. Along with the physical disturbances, many mental problems are also associated with PCOS. Therefore, PCOS not only has problems associated with reproduction but also has associated crucial metabolic and psychological health risks with increasing age of the patients. Because of the increased number of cases with PCOS around the world in present times, with prominent symptom of, specifically, depression at the adolescent stage, it is important to highlight the disease.
Methods: A Markov cohort model, populated using Netherlands epidemiological, cervical cancer screening, treatment pattern, and cost data was used to perform the analysis. Societal lifetime costs were included at 2006 prices. Initial vaccine efficacy of 95% against HPV-persistent infection with HPV-16/18 plus 30% efficacy against other oncogenic HPV types (''cross-protection'') was assumed in the base case.Reduction in cancer cases, associated quality-adjusted life years (QALYs) and costs for a vaccine against HPV-16/18, and other oncogenic HPV types with lifetime cervical cancer protection were compared with vaccine scenarios having less than lifetime protection. These scenarios included: 1) alternative combinations of HPV types that wane (HPV-18 alone, oncogenic non-vaccine HPV alone, HPV-18 + oncogenic non-vaccine HPV); 2) alternative durations of protection (range: 5-30 years); 3) alternative patterns representing the time of decline to 0% protection (linear 5-year, linear 10-year, other); 4) alternative rates of booster vaccine coverage (range 0% -100%) and protection (i.e. double original vaccine protection vs. lifetime protection)Results: In the hypothetical vaccine scenarios, overall duration of vaccine protection had the largest impact, followed by HPV-type-specific waning, then the pattern of waning decline. Waning impact depended on the relationship between age and HPV infection rate, as well as on HPV-type distribution in cervical cancer. Adding a booster increased the overall costs, but improved clinical outcomes and QALYs.Conclusion: Vaccine waning is an important characteristic to consider when assessing a vaccine's effectiveness against cervical disease related morbidity and mortality; a vaccine with more sustained protection is predicted to have better clinical outcomes at lower total costs.
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