Modeling Preventative Strategies against Human Papillomavirus-Related Disease in Developed Countries

被引:94
作者
Canfell, Karen [1 ,2 ]
Chesson, Harrell [3 ]
Kulasingam, Shalini L. [4 ]
Berkhof, Johannes [5 ]
Diaz, Mireia [6 ]
Kim, Jane J. [7 ]
机构
[1] NSW Canc Council, Canc Epidemiol Res Unit, Sydney, NSW, Australia
[2] Univ Sydney, Sch Publ Hlth, Sydney, NSW 2006, Australia
[3] Ctr Dis Control & Prevent, Atlanta, GA USA
[4] Univ Minnesota, Sch Publ Hlth, Div Epidemiol & Community Hlth, Minneapolis, MN USA
[5] Vrije Univ Amsterdam Med Ctr, Dept Epidemiol & Biostatist, Amsterdam, Netherlands
[6] Inst Catala Oncol, CERP, Unit Infect & Canc UNIC, Lhospitalet De Llobregat, Barcelona, Spain
[7] Harvard Univ, Sch Publ Hlth, Dept Hlth Policy & Management, Ctr Hlth Decis Sci, Boston, MA 02115 USA
基金
英国医学研究理事会;
关键词
HPV; Intraepithelial neoplasia; Uterine cervical neoplasms; Vulvar; Vaginal; Anal; Oral cavity and oropharyngeal cancer; Anogenital warts; Recurrent Respiratory Papillomatosis; Vaccines; Mathematical models; Cervical cancer screening; Cost-effectiveness analysis; Developed countries; COST-EFFECTIVENESS ANALYSIS; QUADRIVALENT HPV VACCINE; CERVICAL-CANCER PREVENTION; ECONOMIC-EVALUATION; PARTICLE VACCINE; PREDICTED IMPACT; WOMEN; HEALTH; INFECTION; EFFICACY;
D O I
10.1016/j.vaccine.2012.06.091
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Over the last 5 years, prophylactic vaccination against human papillomavirus (HPV) in pre-adolescent females has been introduced in most developed countries, supported by modeled evaluations that have almost universally found vaccination of pre-adolescent females to be cost-effective. Studies to date suggest that vaccination of pre-adolescent males may also be cost-effective at a cost per vaccinated individual of similar to US$400-500 if vaccination coverage in females cannot be increased above similar to 50%; but if it is possible, increasing coverage in females appears to be a better return on investment. Comparative evaluation of the quadrivalent (HPV16,18,6,11) and bivalent (HPV16,18) vaccines centers around the potential trade-off between protection against anogenital warts and vaccine-specific levels of cross-protection against infections not targeted by the vaccines. Future evaluations will also need to consider the cost-effectiveness of a next generation nonavalent vaccine designed to protect against similar to 90% of cervical cancers. The timing of the effect of vaccination on cervical screening programs will be country-specific and will depend on vaccination catch-up age range and coverage and the age at which screening starts. Initial evaluations suggest that if screening remains unchanged, it will be less cost-effective in vaccinated compared to unvaccinated women but, in the context of current vaccines, will remain an important prevention method. Comprehensive evaluation of new approaches to screening will need to consider the population-level effects of vaccination over time. New screening strategies of particular interest include delaying the start age of screening, increasing the screening interval and switching to primary HPV screening. Future evaluations of screening will also need to focus on the effects of disparities in screening and vaccination uptake, the potential effects of vaccination on screening participation, and the effects of imperfect compliance with screening recommendations. This article forms part of a special supplement entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012. (C) 2012 Elsevier Ltd. All rights reserved.
引用
收藏
页码:F157 / F167
页数:11
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