Cost and effectiveness of HPV vaccine delivery strategies: A systematic review

Akumbom, Alvine; Lee, Jennifer J.; Reynolds, Nancy; Thayer, Winter M.; Wang, Jinglu; Slade, Eric P.

doi:10.1016/j.pmedr.2022.101734

Cited by 17 publications

(16 citation statements)

References 39 publications

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“…A vaccine's high price will raise the overall cost of vaccination programs, thus posing a barrier to the cost-effectiveness of HPV vaccination. 23 Similarly, Seto et al 11 found the addition of boys to a vaccination program to exceed traditional cost-effective thresholds. Reasons for the HPV vaccine not being cost-effective in some countries could be that the cost (.i.e.…”

Section: Discussionmentioning

confidence: 99%

A targeted literature review of health economic analyses of human papillomavirus vaccination from various countries

Segal

Rashid

2023

Int J STD AIDS

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Background Understanding the cost-effectiveness of the HPV vaccine from a global perspective is important to assess from a policy perspective and to support current and future HPV vaccination programs. Objectives The aim of this analysis was to conduct a targeted literature review of published pharmacoeconomic literature on the cost-effectiveness of the HPV vaccine to treat patients in various countries, with a focus on cost-savings and their impact on vaccine recommendations. Methods We searched cost-effectiveness studies in HPV published in peer-reviewed literature from 2012 to 2020 using MEDLINE via the PubMed database and Google Scholar. Results HPV vaccine cost-effectiveness was found to be greatest in low-income countries where screen programs were not yet in place, additionally, in adolescent males and females. The majority of the economic evaluations viewed the implementation of the HPV vaccine as cost-effective and recommended national HPV vaccination. Conclusion The majority of economic studies favored national HPV vaccination for adolescent males and females in various countries. Feasibility of this strategy and implementation remains an open question, in addition to screening coverage rate in countries with no vaccine programs or countries yet to introduce national HPV vaccination.

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Section: Discussionmentioning

confidence: 99%

A targeted literature review of health economic analyses of human papillomavirus vaccination from various countries

Segal

Rashid

2023

Int J STD AIDS

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“…Economic costs frame a bigger picture on the total monetary and non-monetary implications of implementing HPV vaccination strategies [ 72 ]. Statewide implementation of quality improvements visits, centralized reminder and recall, and school-located vaccination were each cost-effective at increasing HPV vaccine coverage, relative to no intervention [ 73 ]. Genital HPV infection is very common among men, with an ongoing international study estimating a prevalence of 65.2% in asymptomatic males aged 18–70 years [ 74 ].…”

Section: Discussionmentioning

confidence: 99%

HPV Vaccination Adherence in Working-Age Men: A Systematic Review and Meta-Analysis

et al. 2023

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Background: Human papillomavirus (HPV) infection is the most common sexually transmitted viral infection in the world. HPV vaccination adherence rates in men are generally lower than in women. The aim of this systematic review and meta-analysis was to assess adherence to HPV vaccination in young working-age males (18–30 years old). Methods: A systematic review was performed using three databases: PubMed, Scopus, and Web of Science, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: After duplicate removal, the initial search resulted in 478 eligible papers. With the exclusion of 425 papers after screening the abstracts, full texts of 53 articles were reviewed. Subsequently, 45 were excluded. Among the eight studies included, four (50%) examined the vaccination adherence in young adults through data registered in nationwide insurance or private companies’ databases, three (37.5%) in young adults in different settings through data collected from surveys and questionnaires, and one (12.5%) an HPV vaccination campaign in a family medicine residency practice. Conclusion: Adherence to HPV vaccination in men of working age (18–30 years) does not appear to be adequate (pooled prevalence 11%). In order to achieve a higher level of compliance, it is important to place an emphasis on vaccination campaigns in schools as well as in the workplace, after consultation with and approval from local, regional, and federal public health agencies.

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“…While data on the costs of implementing novel screening strategies and single-dose HPV vaccination for female adolescents are forthcoming from the PAVE consortium and single-dose vaccination studies, we crudely assumed a single vaccine dose cost US$4.50 2 with an average financial delivery cost per dose (i.e., per fully immunized girl) of US$7. 3 We assumed a bundled financial cost per woman screened of US$15, including a low-cost rapid HPV genotyping assay with triage and treatment of screen-positive women.…”

Section: Supplementary Materials To “Hpv-automated Visual Evaluation ...mentioning

confidence: 99%

Design of the HPV-Automated Visual Evaluation (PAVE) Study: Validating a Novel Cervical Screening Strategy

de Sanjosé,

Perkins,

Campos

et al. 2023

Preprint

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Objective: To describe the HPV-Automated Visual Evaluation (PAVE) Study, an international, multi-centric study designed to evaluate a novel cervical screen-triage-treat strategy for resource-limited settings as part of a global strategy to reduce cervical cancer burden. The PAVE strategy involves: 1) screening with self-sampled HPV testing; 2) triage of HPV-positive participants with a combination of extended genotyping and visual evaluation of the cervix assisted by deep-learning-based automated visual evaluation (AVE); and 3) treatment with thermal ablation or excision (Large Loop Excision of the Transformation Zone). The PAVE study has two phases: efficacy (2023-2024) and effectiveness (planned to begin in 2024-2025). The efficacy phase aims to refine and validate the screen-triage portion of the protocol. The effectiveness phase will examine implementation of the PAVE strategy into clinical practice, cost-effectiveness, and health communication. Study design: Phase 1 Efficacy: Nonpregnant women, aged 25-49 years, without prior hysterectomy, are being screened at nine study sites in resource-limited settings. Eligible and consenting participants perform self-collection of vaginal specimens for HPV testing using a FLOQSwab (Copan). Swabs are transported dry and undergo testing for HPV using a newly-redesigned isothermal DNA amplification HPV test (ScreenFire), which has been designed to provide HPV genotyping by hierarchical risk groups: HPV16, else HPV18/45, else HPV31/33/35/52/58, else HPV39/51/56/59/68. HPV-negative individuals are considered negative for precancer/cancer and do not undergo further testing. HPV-positive individuals undergo pelvic examination with collection of cervical images and targeted biopsies of all acetowhite areas or endocervical sampling in the absence of visible lesions. Cervical images are used to refine a deep learning AVE algorithm that classifies images as normal, indeterminate, or precancer+. AVE classifications are validated against the histologic endpoint of high-grade precancer determined by biopsy. The combination of HPV genotype and AVE classification is used to generate a risk score that corresponds to the risk of precancer (lower, medium, high, highest). During the efficacy phase, clinicians and patients will receive HPV testing results but not AVE results or risk scores. Treatment during the efficacy phase will be performed per local standard of care: positive Visual Inspection with Acetic Acid impression, high-grade colposcopic impression or CIN2+ on colposcopic biopsy, HPV positivity, or HPV 16,18/45 positivity. The sensitivity of the PAVE strategy for detection of precancer will be compared to current SOC at a given level of specificity. Phase 2 Effectiveness: The AVE software will be downloaded to the new dedicated image analysis and thermal ablation devices (Liger Iris) into which the HPV genotype information can be entered to provide risk HPV-AVE risk scores for precancer to clinicians in real time. The effectiveness phase will examine clinician use of the PAVE strategy in practice, including feasibility and acceptability for clinicians and patients, cost-effectiveness, and health communication. Conclusion: The goal of the PAVE study is to validate a screen-triage-treat protocol using novel biomarkers to provide an accurate, feasible, cost-effective strategy for cervical cancer prevention in resource-limited settings.

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Cost and effectiveness of HPV vaccine delivery strategies: A systematic review

Cited by 17 publications

References 39 publications

A targeted literature review of health economic analyses of human papillomavirus vaccination from various countries

A targeted literature review of health economic analyses of human papillomavirus vaccination from various countries

HPV Vaccination Adherence in Working-Age Men: A Systematic Review and Meta-Analysis

Design of the HPV-Automated Visual Evaluation (PAVE) Study: Validating a Novel Cervical Screening Strategy

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