Reduction in HPV 16/18-associated high grade cervical lesions following HPV vaccine introduction in the United States – 2008–2012

Hariri, Susan; Bennett, Nancy M.; Niccolai, Linda M.; Schafer, Sean; Park, Ina U.; Bloch, Karen C.; Unger, Elizabeth R.; Whitney, Erin; Julian, Pamela J.; Scahill, Mary; Abdullah, Nasreen; Levine, Diane; Johnson, Margaret; Steinau, Martin; Markowitz, Lauri E.

doi:10.1016/j.vaccine.2015.01.084

Cited by 112 publications

(91 citation statements)

References 20 publications

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“…[1][2][3][4][5][6][7][8][9][10] Consistent with health benefits estimated by these models, evaluations of vaccination programs have provided a growing body of evidence that documents the initial effects of HPV vaccination on the prevalence of HPV vaccine types, genital warts, and cervical precancers in the US and around the world. [11][12][13][14][15][16][17][18] In the future, more substantial reductions in these outcomes are expected, along with reductions in cervical cancer and other HPV-associated cancers. [5][6][7][8][9][10]13,19 The first 2 HPV vaccines licensed in the US were the bivalent vaccine (2vHPV, which targets HPV types 16 and 18) and the quadrivalent vaccine (4vHPV, which targets HPV types 6, 11, 16, and 18).…”

Section: Introductionmentioning

confidence: 99%

The impact and cost-effectiveness of nonavalent HPV vaccination in the United States: Estimates from a simplified transmission model

Chesson

Markowitz

Hariri

et al. 2016

Human Vaccines & Immunotherapeutics

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Introduction: The objective of this study was to assess the incremental costs and benefits of the 9-valent HPV vaccine (9vHPV) compared with the quadrivalent HPV vaccine (4vHPV). Like 4vHPV, 9vHPV protects against HPV types 6, 11, 16, and 18. 9vHPV also protects against 5 additional HPV types 31, 33, 45, 52, and 58. Methods: We adapted a previously published model of the impact and cost-effectiveness of 4vHPV to include the 5 additional HPV types in 9vHPV. The vaccine strategies we examined were (1) 4vHPV for males and females; (2) 9vHPV for females and 4vHPV for males; and (3) 9vHPV for males and females. In the base case, 9vHPV cost $13 more per dose than 4vHPV, based on available vaccine price information. Results: Providing 9vHPV to females compared with 4vHPV for females (assuming 4vHPV for males in both scenarios) was cost-saving regardless of whether or not cross-protection for 4vHPV was assumed. The cost per quality-adjusted life year (QALY) gained by 9vHPV for both sexes (compared with 4vHPV for both sexes) was < $0 (cost-saving) when assuming no cross-protection for 4vHPV and $8,600 when assuming cross-protection for 4vHPV. Conclusions: Compared with a vaccination program of 4vHPV for both sexes, a vaccination program of 9vHPV for both sexes can improve health outcomes and can be cost-saving.

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Section: Introductionmentioning

confidence: 99%

The impact and cost-effectiveness of nonavalent HPV vaccination in the United States: Estimates from a simplified transmission model

Chesson

Markowitz

Hariri

et al. 2016

Human Vaccines & Immunotherapeutics

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“…Reasons against changing screening policy in HPV-vaccinated women have include: 1) the low uptake of HPV vaccination in the United States, below 50% for completion of all three doses (8); 2) uncertain quality of documentation for an individual's vaccination history (ie, type of vaccine received, vaccination age, dosage timing); and 3) limited observations of real-world vaccine effectiveness in reducing prevalence of infection and precancer (9). However, as the initial cohorts of vaccinated women enter screening age and as we observe increasing empirical evidence of vaccine impact in the United States (10)(11)(12), the question of how to modify cervical cancer screening in HPV-vaccinated populations becomes critical.…”

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confidence: 99%

Optimal Cervical Cancer Screening in Women Vaccinated Against Human Papillomavirus

Kim

Burger

et al. 2016

JNCI J Natl Cancer Inst

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Background: Current US cervical cancer screening guidelines do not differentiate recommendations based on a woman's human papillomavirus (HPV) vaccination status. Changes to cervical cancer screening policies in HPV-vaccinated women should be evaluated. Methods: We utilized an individual-based mathematical model of HPV and cervical cancer in US women to project the health benefits, costs, and harms associated with screening strategies in women vaccinated with the bivalent, quadrivalent, or nonavalent vaccine. Strategies varied by the primary screening test, including cytology, HPV, and combined cytology and HPV "cotesting"; age of screening initiation and/or switching to a new test; and interval between routine screens. Cost-effectiveness analysis was conducted from the societal perspective to identify screening strategies that would be considered good value for money according to thresholds of $50 000 to $200 000 per quality-adjusted life-year (QALY) gained. Results: Among women fully vaccinated with the bivalent or quadrivalent vaccine, optimal screening strategies involved either cytology or HPV testing alone every five years starting at age 25 or 30 years, with cost-effectiveness ratios ranging from $34 680 to $138 560 per QALY gained. Screening earlier or more frequently was either not cost-effective or associated with exceedingly high cost-effectiveness ratios. In women vaccinated with the nonavalent vaccine, only primary HPV testing was efficient, involving decreased frequency (ie, every 10 years) starting at either age 35 years ($40 210 per QALY) or age 30 years ($127 010 per QALY); with lower nonavalent vaccine efficacy, 10-year HPV testing starting at earlier ages of 25 or 30 years was optimal. Importantly, current US guidelines for screening were inefficient in HPV-vaccinated women. Conclusions: This model-based analysis suggests screening can be modified to start at later ages, occur at decreased frequency, and involve primary HPV testing in HPV-vaccinated women, providing more health benefit at lower harms and costs than current screening guidelines.

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“…[5][6][7][8] Data are lacking on the association between Pap test results and HPV vaccination in the North American context. [9][10][11] The province of Alberta has a population-based program for cervical cancer screening and HPV vaccination, and is well positioned to address this knowledge gap.…”

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confidence: 99%

Effect of human papillomavirus vaccination on cervical cancer screening in Alberta

Kim

Bell

Sun

et al. 2016

CMAJ

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Background: A school-based program with quadrivalent human papillomavirus (HPV) vaccination was implemented in Alberta in 2008. We assessed the impact of this program on Pap test cytology results using databases of provincewide vaccination and cervical cancer screening. Methods:We conducted a nested case-control study involving a cohort of women in Alberta born between 1994 and 1997 who had at least 1 Pap test between 2012 and 2015. Women with negative cytology results were controls. Women with low-grade (atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion) and highgrade (atypical squamous cells, cannot rule out a high-grade lesion; or high-grade squamous intraepithelial lesion) cervical abnormalities were cases. Exposure status was assigned according to records of HPV vaccination. Odds ratios (ORs) for abnormal cytology results by vaccination status were adjusted for neighbourhood income, laboratory service, rural versus urban residency, and age. Results:The total study population was 10 204. Adjusting for age, vaccinated women had a higher screening rate than unvaccinated women (13.0% v. 11.4%, p < 0.001). Among women who received full vaccination (≥ 3 doses), the adjusted OR for cervical abnormalities was 0.72 (95% confidence interval [CI] 0.63-0.82). For high-grade lesions, the adjusted OR was 0.50 (95% CI 0.30-0.85). With 2-dose HPV vaccination, the adjusted OR for cervical abnormalities was 1.08 (95% CI 0.84-1.38).Interpretation: Quadrivalent HPV vaccination significantly reduced high-grade cervical abnormalities but required 3 doses. Vaccination against HPV was associated with screening uptake. Population-based vaccination and screening programs should work together to optimize cervical cancer prevention. AbstractResearch

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Reduction in HPV 16/18-associated high grade cervical lesions following HPV vaccine introduction in the United States – 2008–2012

Abstract: Population-based data from the United States indicate significant reductions in CIN2+ lesions attributable to types targeted by the vaccines and increasing HPV vaccine effectiveness with increasing interval between first vaccination and earliest detection of cervical disease.

Cited by 112 publications

References 20 publications

The impact and cost-effectiveness of nonavalent HPV vaccination in the United States: Estimates from a simplified transmission model

The impact and cost-effectiveness of nonavalent HPV vaccination in the United States: Estimates from a simplified transmission model

Optimal Cervical Cancer Screening in Women Vaccinated Against Human Papillomavirus

Effect of human papillomavirus vaccination on cervical cancer screening in Alberta

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