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Vaccine. 2014 Feb 3;32(6):733-9. doi: 10.1016/j.vaccine.2013.11.049. Epub 2013 Nov 26.

Estimation of the potential overall impact of human papillomavirus vaccination on cervical cancer cases and deaths.

Author information

1
Health Economics, GlaxoSmithKline Vaccines, Avenue Fleming, 20, Wavre, 1300, Belgium. Electronic address: georges.m.van-kriekinge@gsk.com.
2
Cancer Epidemiology Research Program, Institut Català d'Oncologia (ICO)-IDIBELL, CIBERESP, L'Hospitalet de Llobregat, Catalonia, Spain.
3
Gynecologic Oncology Centre, General University Hospital of the First Medical School, Charles University, Prague, Czech Republic.
4
Health Economics, GlaxoSmithKline Vaccines, Avenue Fleming, 20, Wavre, 1300, Belgium.

Abstract

BACKGROUND:

Human papillomavirus (HPV) vaccination offers potential for primary prevention of HPV-related pre-cancers and cancers as demonstrated in clinical trials. Mathematical models have estimated the potential real-life impact of vaccination on the burden of cervical cancer (CC). However, these are restricted to evaluations in a limited number of countries.

METHODS:

Potential decline in CC cases and deaths with the AS04-adjuvanted HPV-16/18 vaccine of young girls naïve to HPV, was estimated at steady-state (vaccine coverage: 0-100%) based on clinical trial and country-specific incidence data. Data on vaccine efficacy were taken from the end of study PATRICIA trial of the AS04-adjuvanted HPV-16/18 vaccine. The numbers of cases and deaths due to HPV-16/18 were estimated and compared with those due to any HPV type to estimate the additional cases prevented. This difference estimates CC cases and deaths avoided due to protection against non-vaccine HPV types. Cost-offsets due to reductions in CC treatment were estimated for five countries (Brazil, Canada, Italy, Malaysia and South African Republic) using country-specific unit cost data. Additionally, cervical intraepithelial neoplasia grade 2 or 3 (CIN2/3)-related burden (cases and treatment costs) prevented by vaccination were estimated for two countries (Italy and Malaysia).

RESULTS:

HPV vaccination could prevent a substantial number of CC cases and deaths in countries worldwide, with associated cost-offsets due to reduced CC treatment. Cross-protection increased the estimated potential number of CC cases and deaths prevented by 34 and 18% in Africa and Oceania, respectively. Moreover, vaccination could result in a substantial reduction in the number of CIN2/3 lesions and associated costs.

CONCLUSION:

HPV vaccination could reduce the burden of CC and precancerous lesions in countries worldwide, part of disease burden reduction being related to protection against non HPV-16/18 related types.

KEYWORDS:

CC; CIN; Cervical cancer; HPV; HSIL; Human papillomavirus; ICO; Institut Català d’Oncologia; LEEP; LLETZ; TVC; VE; Vaccination; WHO; World Health Organization; cervical cancer; cervical intraepithelial neoplasia; high-grade squamous intraepithelial lesion; human papillomavirus; large loop excision of the transformation zone.; loop electrosurgical excision procedure; total vaccinated cohort; vaccine efficacy

PMID:
24291200
DOI:
10.1016/j.vaccine.2013.11.049
[Indexed for MEDLINE]
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