Global impact and cost-effectiveness of one-dose versus two-dose human papillomavirus vaccination schedules: a comparative modelling analysis

Abstract

Background To eliminate cervical cancer as a public health problem, the World Health Organization had recommended routine vaccination of adolescent girls with two doses of the human papillomavirus (HPV) vaccine before sexual initiation. However, many countries have yet to implement HPV vaccination because of financial or logistical barriers to delivering two doses outside the infant immunisation programme. Methods Using three independent HPV transmission models, we estimated the long-term health benefits and cost-effectiveness of one-dose versus two-dose HPV vaccination, in 188 countries, under scenarios in which one dose of the vaccine gives either a shorter duration of full protection (20 or 30 years) or lifelong protection but lower vaccine efficacy (e.g. 80%) compared to two doses. We simulated routine vaccination with the 9-valent HPV vaccine in 10-year-old girls at 80% coverage for the years 2021–2120, with a 1-year catch-up campaign up to age 14 at 80% coverage in the first year of the programme. Results Over the years 2021–2120, one-dose vaccination at 80% coverage was projected to avert 115.2 million (range of medians: 85.1–130.4) and 146.8 million (114.1–161.6) cervical cancers assuming one dose of the vaccine confers 20 and 30 years of protection, respectively. Should one dose of the vaccine provide lifelong protection at 80% vaccine efficacy, 147.8 million (140.6–169.7) cervical cancer cases could be prevented. If protection wanes after 20 years, 65 to 889 additional girls would need to be vaccinated with the second dose to prevent one cervical cancer, depending on the epidemiological profiles of the country. Across all income groups, the threshold cost for the second dose was low: from 1.59 (0.14–3.82) USD in low-income countries to 44.83 (3.75–85.64) USD in high-income countries, assuming one dose confers 30-year protection. Conclusions Results were consistent across the three independent models and suggest that one-dose vaccination has similar health benefits to a two-dose programme while simplifying vaccine delivery, reducing costs, and alleviating vaccine supply constraints. The second dose may become cost-effective if there is a shorter duration of protection from one dose, cheaper vaccine and vaccination delivery strategies, and high burden of cervical cancer.

Modeling the Health Impact and Cost-Effectiveness of a Combined Schoolgirl HPV Vaccination and Cervical Cancer Screening Program in Guangdong Province, China

“…We also found that irrespective of the screening coverage, the single-dose 9vHPV vaccination is likely to be more cost-effective compared to the two-dose 9vHPV vaccination under pessimistic assumptions of one-dose 30-year duration of protection, which is generally consistent with previous modeling studies [50,57,58]. Evidence from immunogenicity trials and post-randomization studies has indicated that a single vaccine dose of vaccine may offer comparable long-lasting protection against infection and clinical endpoints as two or three doses [6,17].…”

“…Evidence from immunogenicity trials and post-randomization studies has indicated that a single vaccine dose of vaccine may offer comparable long-lasting protection against infection and clinical endpoints as two or three doses [6,17]. Routine single-dose HPV vaccination will release vaccine doses, enabling a faster expansion of the vaccination scale, and thus achieving the maximum health and economic benefits within the constrained supply in China [58]. In the meantime, it is worth noting that China's pricing for the 9vHPV vaccine is beyond the reach of most eligible women and government-funded programs, prompting future research related to optimal vaccine pricing and price negotiations with manufacturers.…”

The one-dose schedule opens the door to rapid scale-up of HPV vaccination

“…In BMC Medicine , Prem and colleagues compared the long-term health benefits and cost-effectiveness of one-dose versus two-dose HPV vaccination in 188 countries, under scenarios in which the one-dose schedule provides either a shorter duration of protection or lower vaccine efficacy compared to two doses [ 6 ]. Prem et al’s study revealed that if a single HPV vaccine dose confers ≥ 30 years of protection or lifelong protection but at 80% efficacy, the difference in population benefits of the one-dose versus two-dose vaccination schedule would be minimal [ 6 ]. Importantly, the study underscored that, in contrast to high-income countries (HICs), the one-dose schedule in LMICs would avert a greater number of cervical cancer cases and necessitate the vaccination of fewer girls per prevented case [ 6 ].…”

“…Prem et al’s study revealed that if a single HPV vaccine dose confers ≥ 30 years of protection or lifelong protection but at 80% efficacy, the difference in population benefits of the one-dose versus two-dose vaccination schedule would be minimal [ 6 ]. Importantly, the study underscored that, in contrast to high-income countries (HICs), the one-dose schedule in LMICs would avert a greater number of cervical cancer cases and necessitate the vaccination of fewer girls per prevented case [ 6 ]. This highlights the value of the one-dose program for cervical cancer prevention in LMICs.…”

“…Prem et al calculated the threshold cost of the second dose of the 9-valent HPV vaccine at which the two-dose schedule would remain cost-effective compared to a one-dose schedule. The study showed that the threshold cost for a second dose was only US$1.59 (median range: 0.14 − 3.82) in low-income countries (LICs) if one dose provides > 30 years of protection [ 6 ]. Remarkably, this cost threshold even falls below the lowest prices (US$4.50) established by the United Nations Children’s Fund Supply Division/Gavi [ 7 ].…”