Evidence-based impact projections of single-dose human papillomavirus vaccination in India: a modelling study

Man, Irene; Georges, Damien; Carvalho, Tiago M. de; Saraswati, Lopamudra Ray; Bhandari, Prince; Kataria, Ishu; Siddiqui, Mariam; Muwonge, Richard; Lucas, Eric; Berkhof, Johannes; Sankaranarayanan, Rengaswamy; Bogaards, Johannes A.; Basu, Partha; Baussano, Iacopo

doi:10.1016/s1470-2045(22)00543-5

Cited by 23 publications

(33 citation statements)

References 26 publications

(48 reference statements)

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“…66 Although up-todate (three-dose) HPV vaccination coverage in the United States has lagged behind other countries, accumulating evidence suggests that a single dose offers substantial protection 67,68 and may even be preferable in low-income, high-burden populations. 69 In April, 2022, the World Health Organization's Strategic Advisory Group of Experts on Immunization endorsed single-dose vaccination among girls aged 9-14 years to address the global shortfall and optimize cancer prevention. 70 In 2021, 79% of adolescent girls in the United States had received at least one dose, and 64% were up to date.…”

Section: Trends In Cancer Incidencementioning

confidence: 99%

“…Shortly thereafter, an 87% reduction in cervical cancer and a 97% reduction in grade 3 cervical intraepithelial neoplasia was demonstrated among women aged 20–29 years who were vaccinated at ages 12 to 13 years in England 66 . Although up‐to‐date (three‐dose) HPV vaccination coverage in the United States has lagged behind other countries, accumulating evidence suggests that a single dose offers substantial protection 67,68 and may even be preferable in low‐income, high‐burden populations 69 . In April, 2022, the World Health Organization's Strategic Advisory Group of Experts on Immunization endorsed single‐dose vaccination among girls aged 9–14 years to address the global shortfall and optimize cancer prevention 70 .…”

Section: Selected Findingsmentioning

confidence: 99%

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Cancer statistics, 2023

Siegel

Miller

Wagle

et al. 2023

CA A Cancer J Clinicians

8,856

4,024

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Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population‐based cancer occurrence and outcomes using incidence data collected by central cancer registries and mortality data collected by the National Center for Health Statistics. In 2023, 1,958,310 new cancer cases and 609,820 cancer deaths are projected to occur in the United States. Cancer incidence increased for prostate cancer by 3% annually from 2014 through 2019 after two decades of decline, translating to an additional 99,000 new cases; otherwise, however, incidence trends were more favorable in men compared to women. For example, lung cancer in women decreased at one half the pace of men (1.1% vs. 2.6% annually) from 2015 through 2019, and breast and uterine corpus cancers continued to increase, as did liver cancer and melanoma, both of which stabilized in men aged 50 years and older and declined in younger men. However, a 65% drop in cervical cancer incidence during 2012 through 2019 among women in their early 20s, the first cohort to receive the human papillomavirus vaccine, foreshadows steep reductions in the burden of human papillomavirus‐associated cancers, the majority of which occur in women. Despite the pandemic, and in contrast with other leading causes of death, the cancer death rate continued to decline from 2019 to 2020 (by 1.5%), contributing to a 33% overall reduction since 1991 and an estimated 3.8 million deaths averted. This progress increasingly reflects advances in treatment, which are particularly evident in the rapid declines in mortality (approximately 2% annually during 2016 through 2020) for leukemia, melanoma, and kidney cancer, despite stable/increasing incidence, and accelerated declines for lung cancer. In summary, although cancer mortality rates continue to decline, future progress may be attenuated by rising incidence for breast, prostate, and uterine corpus cancers, which also happen to have the largest racial disparities in mortality.

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Section: Trends In Cancer Incidencementioning

confidence: 99%

Section: Selected Findingsmentioning

confidence: 99%

Cancer statistics, 2023

Siegel

Miller

Wagle

et al. 2023

CA A Cancer J Clinicians

8,856

4,024

View full text Add to dashboard Cite

show abstract

“…Action is especially needed in Asian, African and other countries where orphaning at young ages is more common. For cervical cancer, screening and treatment of cervical intra-epithelial neoplasia in adult women will greatly reduce cervical cancer mortality rates, whereas human papillomavirus (HPV) vaccination of young girls before the onset of sexual activity will protect the future generations of women from cancer and thus their children from orphanhood 21 . While this outlook is promising, the situation of averting breast cancer deaths is more complex.…”

Section: Discussionmentioning

confidence: 99%

Global and regional estimates of orphans attributed to maternal cancer mortality in 2020

Guida

Kidman

Ferlay

et al. 2022

Nat Med

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Despite women being disproportionally affected by cancer deaths at young ages, there are no global estimates of the resulting maternal orphans, who experience health and education disadvantages throughout their lives. We estimated the number of children who became maternal orphans in 2020 due to their mother dying from cancer in that year, for 185 countries worldwide and by cause of cancer-related death. Female cancer deaths—by country, cancer type and age (derived from GLOBOCAN estimates)—were multiplied by each woman’s estimated number of children under the age of 18 years at the time of her death (fertility data were derived from United Nations World Population Prospects for birth cohort), accounting for child mortality and parity-cancer risk associations. Globally, there were 1,047,000 such orphans. Over half of these were orphans due to maternal deaths from breast (258,000, 25%), cervix (210,000, 20%) and upper-gastrointestinal cancers (136,000, 13%), and most occurred in Asia (48%: India 15%, China 10%, rest of Asia 23%) and Africa (35%). Globally, there were 40 new maternal orphans due to cancer per 100,000 children, with a declining trend with a higher Human Development Index (range: 121 in Malawi to 15 in Malta). An estimated 7 million children were prevalent maternal orphans due to cancer in mid-2020. Accelerating the implementation of the World Health Organization’s cervical and breast cancer initiatives has the potential to avert not only millions of preventable female cancer deaths but also the associated, often-overlooked, intergenerational consequences of these deaths.

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“…The first model, EpiMetHeos, extends an open source framework (EpiModel) for the simulation of dynamic contact networks, 15 and describes transmission of 13 type-specific HPV infection types in India. This model is extensively described in Man et al 16 Using HPV incidence estimated from EpiMetHeos, the second model simulates the progression from HPV infection to cervical intraepithelial neoplasia (CIN), cervical cancer and death, and is described in the supplementary appendix.…”

Section: Modelling Approachmentioning

confidence: 99%

Health and economic effects of introducing single-dose human papillomavirus vaccination in India

Carvalho

Man

Georges

et al. 2023

Preprint

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Background Cervical cancer is a major public health problem in India, where access to prevention programmes is low. The World Health Organization-Strategic Advisory Group of Experts recently updated their recommendation for human papillomavirus (HPV) vaccination to include a single-dose option in addition to the two-dose option, which could make HPV vaccination programmes easier to implement and more affordable. Methods We combined projections from a type-specific HPV transmission model and a cancer progression model to assess the health and economic effects of HPV vaccination at national and state-level in India. The models used national and state-specific Indian demographic, epidemiological and cost data, and single-dose vaccine efficacy and immunogenicity data from the IARC India vaccine trial with 10-year follow-up. We compared single- and two-dose HPV vaccination for a range of plausible scenarios regarding single-dose vaccine protection, coverage and catch-up. Results Under the base-case scenario of life-long protection of single-dose vaccination in 10-year-old girls with 90% coverage, the incremental cost-effectiveness ratio (ICER) of nationwide vaccination relative to no vaccination was $405 per DALY averted and lay below an opportunity-cost based threshold of 30% Indian GDP per capita in each state (state-specific ICER range: $67 to $593 per DALY averted). The ICER of two-dose vaccination versus no vaccination and versus single-dose vaccination was $1403 and minimum $2279 per DALY averted, respectively. Conclusions Nationwide introduction of single-dose HPV vaccination in India is highly likely to be cost-effective whereas extending the number of doses from one to two would have a less favourable profile.

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Evidence-based impact projections of single-dose human papillomavirus vaccination in India: a modelling study

Cited by 23 publications

References 26 publications

Cancer statistics, 2023

Cancer statistics, 2023

Global and regional estimates of orphans attributed to maternal cancer mortality in 2020

Health and economic effects of introducing single-dose human papillomavirus vaccination in India

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