Factors Influencing the Cost-Effectiveness Outcomes of HPV Vaccination and Screening Interventions in Low-to-Middle-Income Countries (LMICs): A Systematic Review

Abstract

Background: Cervical cancer ranks fourth amongst the commonest malignancies worldwide and the second most prevalent cancer afflicting women in low-to middle-income countries (LMICs), hence, of great public health importance. LMICs are the most affected regions as evidenced by their high prevalence of the disease. Mortality associated with cervical neoplasms is preventable through the implementation of recommended preventive approaches.Aims: This review aimed at appraising evidence on the cost-effectiveness of cervical cancer prevention interventions in LMICs involving cervical screening and HPV vaccination programmes.Methods: A search of CINAHL, MEDLINE, PubMed, and Web of Science was elicited and studies published between 1 st January 2008 and 31 st December 2018 were retrieved. Two authors independently undertook the screening, review, selection of studies, and data extraction with disagreements being resolved through discussion and consensus.Results: Twelve studies were selected. The cost-effectiveness outcomes of HPV vaccination and screening interventions are dependent on age, screening method used, intervention coverage, and the number of doses or visits required for vaccination and screening respectively. A combination of visual inspection with acetic acid (VIA) screening and HPV vaccination appears to be the most cost-effective approach in reducing the lifetime risk for HPV-linked cervical neoplasms. Similarly, vaccination as a stand-alone intervention is potentially cost effective provided the coverage is maintained between 70-100%.Conclusions: HPV vaccination and screening interventions may be cost-effective in LMICs and potentially reduce the lifetime risk, economic burden, and associated mortality. However, it is important to consider the factors that influence the cost-effectiveness of cervical cancer prevention interventions for better outcomes to be realised. Key points for decision makers▪ HPV vaccination and VIA screening appear to be cost-effective approaches for reducing the lifetime risks for cervical cancer in LMICs ▪ A high loss-to-follow-up for vaccination and screening is associated with increased mortality ▪ Early screening for HPV below the age of 30 years could potentially reduce cervical cancer associated morbidity and mortality ▪ Implementation of organised programmes improves coverage and has better outcomes compared to opportunistic programmes

Cost‐effectiveness analysis of human papillomavirus vaccines for the prevention of cervical cancer in India

“…A recent systematic review examined the cost-effectiveness of the HPV vaccination program in 11 LMICs namely Thailand, Colombia, Uganda, Laos, Malaysia, Iran, China, Honduras, India, South Africa, and Brazil. 32 The study estimated that HPV vaccination, with 70% or more coverage, was a cost-effective strategy with an ICER in the range This analysis has various strengths that should be highlighted.…”

“…These studies estimated that introducing nationwide HPV vaccination programs is likely to be cost‐effective if the vaccine is procured at GAVI‐negotiated prices. A recent systematic review examined the cost‐effectiveness of the HPV vaccination program in 11 LMICs namely Thailand, Colombia, Uganda, Laos, Malaysia, Iran, China, Honduras, India, South Africa, and Brazil 32 . The study estimated that HPV vaccination, with 70% or more coverage, was a cost‐effective strategy with an ICER in the range of I$3.19–821.85 per QALY/ DALY averted.…”

The potential cost-effectiveness of HPV vaccination among girls in Mongolia

“…In Mongolia, approximately 30% of women 15–49 have received screening at least once per lifetime [3] . The presence of an active national screening may interact with the value of vaccination and impact the potential cost-effectiveness results; however, economic models of comprehensive cervical cancer prevention programs that include both vaccination and screening and treatment for pre-cancerous lesions have shown that vaccination of girls is generally still highly cost-effective and can yield greater health impact when combined with screening for adult women [23] , [24] , [25] . This analysis also focuses on HPV vaccine types associated with cervical cancer so the benefits of preventing HPV-associated cancers at other anatomical sites as well as genital warts are excluded.…”

Ultrasound Microbubbles-mediated Microrna-505 Regulates Cervical Cancer Cell Growth via AKT2

“…Cervical cancer (CC) is an aggressive gynecological malignancy with a high risk of recurrence and death, mainly in women [1,2]. It is the 4th most prevalent female cancer and causes approximately 265,700 annual deaths worldwide [3][4][5]. The incidence varies across the world, with the highest incidence rate in Eastern Africa and lowest incidence in Western Asia [6].…”