Challenges in Cost-Effectiveness Analysis Modelling of HPV Vaccines in Low- and Middle-Income Countries: A Systematic Review and Practice Recommendations

Abstract

BackgroundLow- and middle-income countries (LMICs) face a number of challenges in implementing cervical cancer prevention programmes that do not apply in high-income countries.ObjectiveThis review assessed how context-specific challenges of implementing cervical cancer prevention strategies in LMICs were accounted for in existing cost-effectiveness analysis (CEA) models of human papillomavirus (HPV) vaccination.MethodsThe databases of MEDLINE, EMBASE, NHS Economic Evaluation Database, EconLit, Web of Science, and the Center for the Evaluation of Value and Risk in Health (CEA) Registry were searched for studies published from 2006 to 2015. A descriptive, narrative, and interpretative synthesis of data was undertaken.ResultsOf the 33 studies included in the review, the majority acknowledged cost per vaccinated girl (CVG) (26 studies) and vaccine coverage rate (21 studies) as particular challenges for LMICs, while nine studies identified screening coverage rate as a challenge. Most of the studies estimated CVG as a composite of different cost items. However, the basis for the items within this composite cost was unclear. The majority used an assumption rather than an observed rate to represent screening and vaccination coverage rates. CVG, vaccine coverage and screening coverage were shown by some studies through sensitivity analyses to reverse the conclusions regarding cost-effectiveness, thereby significantly affecting policy recommendations.ConclusionsWhile many studies recognized aspects of the particular challenges of HPV vaccination in LMICs, greater efforts need to be made in adapting models to account for these challenges. These include adapting costings of HPV vaccine delivery from other countries, learning from the outcomes of cervical cancer screening programmes in the same geographical region, and taking into account the country’s previous experience with other vaccination programmes.

Verteporfin Is a Promising Anti-Tumor Agent for Cervical Carcinoma by Targeting Endoplasmic Reticulum Stress Pathway

“…An annual mortality of 266,000 with 528,000 incidence cases worldwide made cervical cancer the most common carcinoma in female reproductive system ( 1 ). The data showed that approximately 90% of cervical cancer deaths were from developing countries ( 2 ), and the incidence rate of cervical cancer in China, the biggest developing country, has showed an upward and younger trend ( 3 ). Currently, cisplatin-based sequential chemo-radiation therapy is the standard approach for patients in FIGO stage IIB to IVA ( 4 ).…”

Cost-Effectiveness Analysis for HPV Mitigation Strategies Implemented in 2018 in the Republic of Moldova Based on Infectious Disease Modelling

“…Vaccination in a single action a single cohort has not been considered from health economic perspective for Moldova yet. Moldova case cost-effectiveness analysis is also important to be disseminated worldwide [13], due to similar externally founded projects in other Low and Middle Income countries (e.g. GAVI-the Vaccine Alliance).…”

Anogenital HPV

“…Low-risk HPV types include HPV 6 and 11 that have been associated with benign anogenital warts. At least 12 HR-HPV types, HPV 16,18,31,33,35,39,45,51,52,56, 58 and 59, have been associated with anogenital cancers as well as precursor neoplastic lesions [8]. It is now established that HPV 16 and 18 are the major papillomavirus types responsible for cervical cancer.…”