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Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India.

Diaz M, Kim JJ, Albero G, de Sanjosé S, Clifford G, Bosch FX, Goldie SJ - Br. J. Cancer (2008)

Bottom Line: We estimated the potential health and economic impact of different cervical cancer prevention strategies.Screening differed by test (cytology, visual inspection, HPV DNA testing), number of clinical visits (1, 2 or 3), frequency (1 x , 2 x , 3 x per lifetime), and age range (35-45).Vaccine efficacy, coverage, and costs were varied in sensitivity analyses.

View Article: PubMed Central - PubMed

Affiliation: Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Av. Gran Via, s/n km. 2.7, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.

ABSTRACT
Cervical cancer is a leading cause of cancer death among women in low-income countries, with approximately 25% of cases worldwide occurring in India. We estimated the potential health and economic impact of different cervical cancer prevention strategies. After empirically calibrating a cervical cancer model to country-specific epidemiologic data, we projected cancer incidence, life expectancy, and lifetime costs (I$2005), and calculated incremental cost-effectiveness ratios (I$/YLS) for the following strategies: pre-adolescent vaccination of girls before age 12, screening of women over age 30, and combined vaccination and screening. Screening differed by test (cytology, visual inspection, HPV DNA testing), number of clinical visits (1, 2 or 3), frequency (1 x , 2 x , 3 x per lifetime), and age range (35-45). Vaccine efficacy, coverage, and costs were varied in sensitivity analyses. Assuming 70% coverage, mean reduction in lifetime cancer risk was 44% (range, 28-57%) with HPV 16,18 vaccination alone, and 21-33% with screening three times per lifetime. Combining vaccination and screening three times per lifetime provided a mean reduction of 56% (vaccination plus 3-visit conventional cytology) to 63% (vaccination plus 2-visit HPV DNA testing). At a cost per vaccinated girl of I$10 (per dose cost of $2), pre-adolescent vaccination followed by screening three times per lifetime using either VIA or HPV DNA testing, would be considered cost-effective using the country's per capita gross domestic product (I$3452) as a threshold. In India, if high coverage of pre-adolescent girls with a low-cost HPV vaccine that provides long-term protection is achievable, vaccination followed by screening three times per lifetime is expected to reduce cancer deaths by half, and be cost-effective.

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Model calibration. Selected model output from a random sample of good-fitting parameter sets are compared with the 95% confidence intervals of the empirical data (solid black lines) including HPV type distribution in cervical disease (upper panel) and age-specific cancer incidence rates (lower panel). Additional calibration results can be found in the Supplementary Appendix.
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fig1: Model calibration. Selected model output from a random sample of good-fitting parameter sets are compared with the 95% confidence intervals of the empirical data (solid black lines) including HPV type distribution in cervical disease (upper panel) and age-specific cancer incidence rates (lower panel). Additional calibration results can be found in the Supplementary Appendix.

Mentions: Details of the model parameterisation process can be found in the Supplementary Appendix and previous publications (Goldhaber-Fiebert et al, 2007; Goldie et al, 2007; Kim et al, 2007a). Briefly, after initial values and plausible ranges for each model input parameter were established, repeated simulations were undertaken, each drawing different combinations of parameter values and projecting model outcomes with each set of parameter combinations. The outcomes produced by each parameter set were scored according to their fit with multiple calibration target data based on likelihood scoring functions. A composite goodness-of-fit score for each parameter set was computed by summing the log likelihood of each model outcome. Figure 1 shows examples of model output from a sample of a good-fitting parameter sets compared with the empirical data. Additional results may be found in the Supplementary Appendix.


Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India.

Diaz M, Kim JJ, Albero G, de Sanjosé S, Clifford G, Bosch FX, Goldie SJ - Br. J. Cancer (2008)

Model calibration. Selected model output from a random sample of good-fitting parameter sets are compared with the 95% confidence intervals of the empirical data (solid black lines) including HPV type distribution in cervical disease (upper panel) and age-specific cancer incidence rates (lower panel). Additional calibration results can be found in the Supplementary Appendix.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2480962&req=5

fig1: Model calibration. Selected model output from a random sample of good-fitting parameter sets are compared with the 95% confidence intervals of the empirical data (solid black lines) including HPV type distribution in cervical disease (upper panel) and age-specific cancer incidence rates (lower panel). Additional calibration results can be found in the Supplementary Appendix.
Mentions: Details of the model parameterisation process can be found in the Supplementary Appendix and previous publications (Goldhaber-Fiebert et al, 2007; Goldie et al, 2007; Kim et al, 2007a). Briefly, after initial values and plausible ranges for each model input parameter were established, repeated simulations were undertaken, each drawing different combinations of parameter values and projecting model outcomes with each set of parameter combinations. The outcomes produced by each parameter set were scored according to their fit with multiple calibration target data based on likelihood scoring functions. A composite goodness-of-fit score for each parameter set was computed by summing the log likelihood of each model outcome. Figure 1 shows examples of model output from a sample of a good-fitting parameter sets compared with the empirical data. Additional results may be found in the Supplementary Appendix.

Bottom Line: We estimated the potential health and economic impact of different cervical cancer prevention strategies.Screening differed by test (cytology, visual inspection, HPV DNA testing), number of clinical visits (1, 2 or 3), frequency (1 x , 2 x , 3 x per lifetime), and age range (35-45).Vaccine efficacy, coverage, and costs were varied in sensitivity analyses.

View Article: PubMed Central - PubMed

Affiliation: Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Av. Gran Via, s/n km. 2.7, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.

ABSTRACT
Cervical cancer is a leading cause of cancer death among women in low-income countries, with approximately 25% of cases worldwide occurring in India. We estimated the potential health and economic impact of different cervical cancer prevention strategies. After empirically calibrating a cervical cancer model to country-specific epidemiologic data, we projected cancer incidence, life expectancy, and lifetime costs (I$2005), and calculated incremental cost-effectiveness ratios (I$/YLS) for the following strategies: pre-adolescent vaccination of girls before age 12, screening of women over age 30, and combined vaccination and screening. Screening differed by test (cytology, visual inspection, HPV DNA testing), number of clinical visits (1, 2 or 3), frequency (1 x , 2 x , 3 x per lifetime), and age range (35-45). Vaccine efficacy, coverage, and costs were varied in sensitivity analyses. Assuming 70% coverage, mean reduction in lifetime cancer risk was 44% (range, 28-57%) with HPV 16,18 vaccination alone, and 21-33% with screening three times per lifetime. Combining vaccination and screening three times per lifetime provided a mean reduction of 56% (vaccination plus 3-visit conventional cytology) to 63% (vaccination plus 2-visit HPV DNA testing). At a cost per vaccinated girl of I$10 (per dose cost of $2), pre-adolescent vaccination followed by screening three times per lifetime using either VIA or HPV DNA testing, would be considered cost-effective using the country's per capita gross domestic product (I$3452) as a threshold. In India, if high coverage of pre-adolescent girls with a low-cost HPV vaccine that provides long-term protection is achievable, vaccination followed by screening three times per lifetime is expected to reduce cancer deaths by half, and be cost-effective.

Show MeSH
Related in: MedlinePlus