The cost-effectiveness of bivalent, quadrivalent, and nine-valent HPV vaccination in Asia: a systematic review

Zhu, Ke; Tian, Ye; Dong, Xiaomei; Akinwunmi, Babatunde; Zhang, Casper J. P.; Huang, Jian; Ming, Wai‐Kit

doi:10.1007/s00404-021-06309-y

Cited by 4 publications

(5 citation statements)

References 37 publications

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“…For example, Gardasil ® 9 is not cost-effective under any modeling scenario in the Philippines [ 25 ]. Thus, cost remains a major barrier to vaccine implementation in LMICS, and there is a need for a new generation of simpler, cheaper, and broader-spectrum vaccines against mucosal and cutaneous HPVs [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Vaccination with a Human Papillomavirus L2 Multimer Provides Broad Protection against 17 Human Papillomavirus Types in the Mouse Cervicovaginal Challenge Model

Han,

Wang,

et al. 2024

Vaccines

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Human papillomavirus (HPV) is a prevalent cause of mucosal and cutaneous infections and underlying conditions ranging from benign warts to anogenital and oropharyngeal cancers affecting both males and females, notably cervical cancer. Cervical cancer is the fourth leading cause of cancer deaths among women globally and is the most impactful in low- and middle-income countries (LMICs), where the costs of screening and licensed L1-based HPV vaccines pose significant barriers to comprehensive administration. Additionally, the licensed L1-based HPV vaccines fail to protect against all oncogenic HPV types. This study generated three independent lots of an L2-based target antigen (LBTA), which was engineered from conserved linear L2-protective epitopes (aa11–88) from five human alphapapillomavirus genotypes in E. coli under cGMP conditions and adjuvanted with aluminum phosphate. Vaccination of rabbits with LBTA generated high neutralizing antibody titers against all 17 HPV types tested, surpassing the nine types covered by Gardasil®9. Passive transfer of naïve mice with LBTA antiserum revealed its capacity to confer protection against vaginal challenge with all 17 αHPV types tested. LBTA shows stability at room temperature over >1 month. Standard in vitro and in vivo toxicology studies suggest a promising safety profile. These findings suggest LBTA’s promise as a next-generation vaccine with comprehensive coverage aimed at reducing the economic and healthcare burden of cervical and other HPV+ cancers in LMICs, and it has received regulatory approval for a first-in-human clinical study (NCT05672966).

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Section: Discussionmentioning

confidence: 99%

Vaccination with a Human Papillomavirus L2 Multimer Provides Broad Protection against 17 Human Papillomavirus Types in the Mouse Cervicovaginal Challenge Model

Han,

Wang,

et al. 2024

Vaccines

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“…A study in England also found the decrease in price beneficial, as bivalent vaccination was not cost-effective except when reaching a price which was £41/dose cheaper than the quadrivalent vaccine ( 54 ). Researchers have suggested that low- and middle-income countries should firstly adjust HPV vaccine prices to improve the cost-effectiveness ( 55 ). Manufacturers in China should accelerate the development of domestic vaccines to reduce the cost of logistics, and partially subsidized vaccination should be further considered to release the burden of production costs.…”

Section: Discussionmentioning

confidence: 99%

“…The initial proportions of MSM at states L and H did not differ among ages. We considered 37 HPV subtypes (low-risk subtypes: HPV-6, 11,26,34,40,42,43,44,53,54,55,57,61,66,67,69,70,71,72,73,81,82,83,84; high-risk subtypes: HPV- 16,18,31,33,35,39,45,51,52,56,58,59,68) to promise better accuracy of final infection outcomes. Apart from the deaths from anal cancer, natural deaths among MSM were taken into account.…”

Section: Model Overview 221 Model Structurementioning

confidence: 99%

Effectiveness and cost-effectiveness of human papillomavirus vaccination strategies among men who have sex with men in China: a modeling study

Lin

et al. 2023

Front. Immunol.

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IntroductionThe health and economic benefits of human papillomavirus (HPV) vaccination targeted at men who have sex with men (MSM) in developing settings have been rarely assessed. This study aimed to evaluate the effectiveness and cost-effectiveness of different HPV vaccination strategies among MSM in China.MethodsA Markov model was developed to simulate HPV transmission dynamics among a total of 30.73 million MSM in China. The corresponding natural history included 6 states: susceptible, infected with low-risk subtypes, high-risk subtypes, anogenital warts and anal cancer, and deaths from anal cancer. MSM were divided into three age groups with cut-off points of 27 and 45 years. Alternative vaccination strategies were built by allocating bivalent, quadrivalent, nine-valent, or no vaccine to each of the groups. We generated the prevented infections and deaths by vaccination compared with baseline (no vaccination) and calculated incremental cost-effectiveness ratios (ICERs) to determine the optimal strategy.ResultsThe model showed that in 10 years, at baseline, the existing cases of anogenital warts would reach 5,464,225 (IQR, 4,685,708-6,174,175); that of anal cancer would reach 1,922.95 (1,716.56-2,119.93), resulting in 940.55 (732.27-1,141.87) deaths. Under 50% vaccination coverage among one age group, the prevented cases of anogenital warts were maximized with quadrivalent vaccines allocated to MSM aged 27-45 years; that of anal cancer were maximized when offering nine-valent vaccines to the same group. Under 50% vaccination coverage among all groups, the lowest ICER (34,098.09 USD/QALY, 31,146.54-37,062.88) was reached when only quadrivalent vaccines were provided. Based on this strategy, when the annual vaccination rate increased by 30%, the ICER (33,521.75 USD/QALY, 31,040.73-36,013.92) would fall below three times China’s per capita GDP. When the vaccine price decreased by 60%, the ICER was reduced to 7,344.44 USD/QALY (4,392.89-10,309.23), indicating good cost-effectiveness taking China’s per capita GDP as a threshold.ConclusionsHPV vaccination can effectively reduce the prevalence and mortality of related diseases among MSM in China, especially quadrivalent vaccines for anogenital warts and nine-valent vaccines for anal cancer. MSM aged 27-45 years were the optimal group for vaccination. Annual vaccination and appropriate adjustment of vaccine price are necessary to further improve the cost-effectiveness.

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“… 32 , 33 In a 2017 meta-analysis 34 conducted in Asian populations, HPV vaccines significantly enhanced HPV16 and HPV18-specific antibody levels. In a 2022 systematic review, 35 HPV vaccination was found to be cost-effective for implementation in high-income, middle-income, and low-income countries in Asia. In many Asian countries, the coverage of HPV vaccine remains low due to several barriers such as high cost and lack of a national HPV vaccination program.…”

Section: Cancer Burden and Risk Factors Among Ancca Membersmentioning

confidence: 99%

Mapping recommendations towards an Asian Code Against Cancer (ACAC) as part of the World Code Against Cancer Framework: an Asian National Cancer Centers Alliance (ANCCA) initiative

Ong,

Abe,

Gek Phua

et al. 2024

The Lancet Regional Health - Southeast Asia

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The cost-effectiveness of bivalent, quadrivalent, and nine-valent HPV vaccination in Asia: a systematic review

Cited by 4 publications

References 37 publications

Vaccination with a Human Papillomavirus L2 Multimer Provides Broad Protection against 17 Human Papillomavirus Types in the Mouse Cervicovaginal Challenge Model

Vaccination with a Human Papillomavirus L2 Multimer Provides Broad Protection against 17 Human Papillomavirus Types in the Mouse Cervicovaginal Challenge Model

Effectiveness and cost-effectiveness of human papillomavirus vaccination strategies among men who have sex with men in China: a modeling study

Mapping recommendations towards an Asian Code Against Cancer (ACAC) as part of the World Code Against Cancer Framework: an Asian National Cancer Centers Alliance (ANCCA) initiative

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