Cost–effectiveness of the prophylactic HPV vaccine: An application to the Netherlands taking non-cervical cancers and cross-protection into account

Despite an effective screening programme, 600–700 women are still diagnosed with cervical cancer in the Netherlands each year. In 2009 a prophylactic vaccine against HPV-type 16 and 18 was implemented in the national immunisation programme to decrease the incidence of cervical cancer. There is evidence that infections with several oncogenic HPV types other than the vaccine types 16 and 18 are also prevented by vaccination, also known as cross-protection. Besides cervical cancer, HPV can also cause cancers at other sites such as the oropharynx, vulva, vagina and the anus/anal area. In this study we estimated the maximum health and economic benefits of vaccinating 12-year old girls against infection with HPV, taking cross-protection and non-cervical cancers into account. In the base-case, we found an incremental cost ratio (ICER) of €5815 per quality adjusted life year (QALY). Robustness of this result was examined in sensitivity analysis. The ICER proved to be most sensitive to vaccine price, discounting rates, costs of cervical cancer and to variation in the disutility of cervical cancer.     

Parental acceptance of human papillomavirus (HPV) vaccination in Indonesia: a cross-sectional study

Background

Cervical cancer ranks the second most frequent cancer in Indonesian women. In Indonesia, human papillomavirus (HPV) vaccine acceptance has not been studied before.

Objective

To determine parental HPV vaccine acceptance in Indonesia, and factors that influence their decision. Factors include sociodemographic factors, knowledge of HPV, HPV vaccination and cervical cancer, health beliefs about cervical cancer, and attitudes towards vaccination in general.

Methods

746 parents, with at least 1 daughter aged 0-14, were interviewed using questionnaires based on published and adjusted interviews. Interviews were done in sub district public health centers, general governmental hospitals, and via house-visits, in 5 Indonesian provinces.

Results

Parental HPV vaccine acceptance was 96.1%. Logistic regression revealed that age, beliefs regarding cervical cancer, and attitudes towards vaccination in general were significantly associated with HPV vaccine acceptance. Of the participants, 66.0%, 16.6%, and 15.8% had heard about cervical cancer, HPV, and HPV vaccination respectively. The mean total knowledge score was 1.91(Standard Deviation 2.31) on a 0-8 scale. Health beliefs about cervical cancer and attitudes towards vaccination in general were positive. Participants named the high cost of the vaccine, fear for side-effects, and chosen vaccination locations as possible barriers towards HPV vaccine implementation.

Discussion

Parental HPV vaccine acceptance is high, but knowledge about HPV and cervical cancer is low. During HPV vaccination programs, focus should not only be on providing information, but also on existing beliefs and attitudes towards cervical cancer and vaccination in general. If HPV vaccination programs were to be implemented in Indonesia, the indicated barriers should be taken into account.     

Knowledge and intention to participate in cervical cancer screening after the human papillomavirus vaccine

Background

If women who receive the human papillomavirus (HPV) vaccine are unduly reassured about the cancer prevention benefits of vaccination, they may choose not to participate in screening, thereby increasing their risk for cervical cancer. This study assesses adult women's knowledge of the need to continue cervical cancer screening after HPV vaccination, describes Pap test intentions of vaccinated young adult women, and evaluates whether knowledge and intentions differ across groups at greatest risk for cervical cancer.

Methods

Data were from the 2008 Health Information National Trends Survey (HINTS) and the 2008 National Health Interview Survey (NHIS), which initiated data collection approximately 18 months after the first FDA approval of an HPV vaccine. We calculated associations between independent variables and the outcomes using chi-square tests.

Results

Of 1586 female HINTS respondents ages 18 through 74, 95.6% knew that HPV-vaccinated women should continue to receive Pap tests. This knowledge did not vary significantly by race/ethnicity, education, income, or healthcare access. Among 1101 female NHIS respondents ages 18-26 who had ever received a Pap test, the proportion (12.7%; n = 139) who reported receipt of the HPV vaccine were more likely than those not vaccinated to plan to receive a Pap test within three years (98.1% vs. 92.5%, p < 0.001).

Conclusions

US adult women possess high knowledge and intention to participate in Pap testing after HPV vaccination. The vast majority of young adult women who received the HPV vaccine within its first two years on the market intend to participate in cervical cancer screening in the near future. Future studies are needed to examine whether those vaccinated in adolescence will become aware of, and adhere to, screening guidelines as they become eligible.     

Willingness of pregnant women to vaccinate themselves and their newborns with the HPV vaccine

Objective

To evaluate the willingness of pregnant women to accept the HPV vaccine for their newborns as well as themselves.

Methods

An 18-item questionnaire was distributed to antepartum women. Demographic data about the respondent's current pregnancy and her knowledge of HPV and the HPV vaccine was collected. Information about the respondent's HPV and HPV vaccine status as well as her acceptance of the vaccine for herself during pregnancy and her newborn son and/or daughter after delivery was also collected.

Results

Three hundred surveys were completed and available for review. Only 6 respondents (2%) had received the HPV vaccine. Despite the small group of patients who had previously been vaccinated, 112 respondents (37.3%) stated that they would receive the HPV vaccine during pregnancy if recommended by an obstetrician. 99 respondents (33%) stated that they would vaccinate their newborn female infant and 83 (27.7%) stated would vaccinate their male infants.

Conclusion

Providing the HPV vaccine to pregnant women as well as newborns could be an important way to increase the patient population who is protected against HPV. A percentage of pregnant women are willing to accept the vaccine for themselves and their newborns.     

Comparative cost-effectiveness of the quadrivalent and bivalent human papillomavirus vaccines: A transmission-dynamic modeling study

Background

The quadrivalent and bivalent human papillomavirus (HPV) vaccines are now licensed in several countries. We compared the cost-effectiveness of the HPV vaccines to provide evidence for policy decisions.

Methods

We developed HPV-ADVISE, a multi-type individual-based transmission-dynamic model of HPV infection and disease (anogenital warts, and cervical, anogenital and oropharyngeal cancers). We calibrated the model to sexual behavior and epidemiologic data from Canada, and estimated quality-adjusted life-years (QALYs) lost and costs ($CAN 2010) from the literature. Vaccine-type efficacy was based on a systematic literature review. The analysis was performed from the healthcare provider perspective, and costs and benefits were discounted at 3%. Predictions are presented using the median [10th;90th percentiles] of simulations.

Results

Under base-case assumptions (vaccinating 10-year-old girls, 80% coverage, $95/dose), using the quadrivalent and bivalent vaccines is estimated to cost $15,528 [12,056;19,140] and $20,182 [15,531;25,240] per QALY-gained, respectively. At equal price, the quadrivalent vaccine is more cost-effective than bivalent under all scenarios investigated, except when assuming longer duration of protection for the bivalent and minimal anogenital warts burden. Under base-case assumptions, the maximum additional cost per dose for the quadrivalent vaccine to remain more cost-effective than the bivalent is $32 [17;46] (using a $40,000/QALY-gained threshold). Results were most sensitive to discounting, time-horizon, differences in durations of protection and anogenital warts burden.

Conclusions

Vaccinating pre-adolescent girls against HPV is predicted to be highly cost-effective. If equally priced, the quadrivalent is the most economically desirable vaccine. However, ultimately, the most cost-effective HPV vaccine will be determined by their relative price.     

Pharmacoeconomic assessment of implementing a universal PCV-13 vaccination programme in the Valencian public health system (Spain)

Background

Heptavalent pneumococcal conjugate vaccine (PCV-7) was licensed to provide immunity against pneumococcal disease caused by seven serotypes of S. pneumoniae. Thirteen-valent pneumococcal conjugate vaccine (PCV-13) includes 6 additional serotypes for preventing invasive pneumococcal disease.

Objective

The objective of this study was to estimate the potential health benefits, costs, and cost-effectiveness of vaccination with PCV-13 in the Community of Valencia and to generate valuable information for policy makers at regional and country levels.

Methods

A decision tree was designed to determine the health and economic outcomes in hypothetical cohorts of vaccinated and unvaccinated children followed over their lifetime. Information about disease incidence and serotype distribution were gathered from local databases and from published and unpublished local records. PCV-13 effectiveness was extrapolated from PCV-7 efficacy data. A 5% of herd effect and a serotype replacement of 25% were considered for the base case scenario. Only direct costs were taken into account and results were expressed in terms of life-years gained (LYG) and quality adjusted life years (QALY).

Results

Implementing a universal PCV-13 vaccination program in the Community of Valencia would decrease the number of hospital admitted pneumonia to less than 4571 cases while avoiding 310 cases of IPD and 82,596 cases of AOM throughout the cohort lifetime. A total of 190 S. pneumoniae related deaths would be averted over the same period. Total medical costs of non-vaccinating the cohort of newborns would reach up to 403,850.859 € compared to 438,762.712 € that would represent vaccinating the cohort. The incremental cost of vaccinating the children was estimated in 12,794 €/LYG and 10,407 €/QALY, respectively.

Conclusions

A universal PCV-13 vaccination program in the Community of Valencia would be a cost-effective intervention from the payer perspective after preventing for pneumococcal infections and for decreasing its associated mortality and morbidity.     

HPV vaccination among a community sample of young adult women

Objectives

Despite the high efficacy of the human papillomavirus (HPV) vaccine, uptake has been slow and little data on psychosocial barriers to vaccination exist.

Methods

A community sample of 428 women enrolled in a longitudinal study of social development in the Seattle WA metropolitan area were interviewed about HPV vaccine status, attitudes, and barriers to HPV vaccination in spring 2008 or 2009 at ∼age 22.

Results

Nineteen percent of women had initiated vaccination, 10% had completed the series, and ∼40% of unvaccinated women intended to get vaccinated. Peer approval was associated with vaccine initiation (adjusted prevalence ratio (APR) 2.1; 95% confidence interval 1.4-3.2) and intention to vaccinate (APR 1.4; 1.1-1.9). Belief the vaccine is <75% effective was associated with less initiation (APR 0.6; 0.4-0.9) or intention to vaccinate (APR 0.5; 0.4-0.7). Vaccine initiation was also less likely among cigarette smokers and illegal drug users, whereas intention to vaccinate was more common among women currently attending school or with >5 lifetime sex partners, but less common among women perceiving low susceptibility to HPV (APR 0.6; 0.5-0.9).

Conclusions

HPV vaccination uptake was low in this community sample of young adult women. Increasing awareness of susceptibility to HPV and the high efficacy of the vaccine, along with peer interventions to increase acceptability, may be most effective.     

Cost-effectiveness of vaccination against herpes zoster in adults aged over 60 years in Belgium

Aim

To assess the cost-effectiveness of vaccinating all or subgroups of adults aged 60 to 85 years against herpes zoster.

Methods

A deterministic compartmental static model was developed (in freeware R), in which cohorts can acquire herpes zoster according to their age in years. Surveys and database analyses were conducted to obtain as much as possible Belgian age-specific estimates for input parameters. Direct costs and Quality-Adjusted Life-Year (QALY) losses were estimated as a function of standardised Severity Of Illness (SOI) scores (i.e. as a function of the duration and severity of herpes zoster disease).

Results

Uncertainty about the average SOI score for a person with herpes zoster, the duration of protection from the vaccine, and the population that can benefit from the vaccine, exerts a major impact on the results: under assumptions least in favour of vaccination, vaccination is not cost-effective (i.e. incremental cost per QALY gained >€48,000 for all ages considered) at the expected vaccine price of €90 per dose. At the same price, but under assumptions most in favour of vaccination, vaccination is found to be cost-effective (i.e. incremental cost per QALY gained <€5500 for all ages considered). Vaccination of age cohort 60 seems more cost-effective than vaccination of any older age cohort in Belgium.

Discussion

If the vaccine price per dose drops to €45, HZ vaccination of adults aged 60-64 years is likely to be cost-effective in Belgium, even under assumptions least in favour of vaccination. Unlike previous studies, our analysis acknowledged major methodological and model uncertainties simultaneously and presented outcomes for 26 different target ages at which vaccination can be considered (ages 60-85).     

Modeling the impact of quadrivalent HPV vaccination on the incidence of Pap test abnormalities in the United States

Background

We present data on Pap test results and HPV prevalence from the HPV Sentinel Surveillance project, a multiyear surveillance project enrolling women from a diverse set of 26 clinics throughout the US from 2003 to 2005. We use mathematical modeling to illustrate the potential timing and magnitude of decreases in Pap test abnormalities in sexually transmitted disease (STD), family planning, and primary care clinics in the US as a result of HPV vaccination.

Methods

The probability of an abnormal Pap result was based on three factors: (1) infection with HPV 16/18, or both; (2) infection with high-risk HPV types other than HPV 16/18; and (3) infection with HPV 6/11, or both. We estimated the relative reduction in the probability of an abnormal Pap result over the first 25 years of a female-only, quadrivalent HPV vaccination program, compared to a scenario of no HPV vaccination in which the probability of abnormal Pap results was assumed constant.

Results

The probability of an abnormal Pap result ranged from 7.0% for the lowest risk group (those without any high-risk HPV types and without HPV 6/11) to 45.2% for the highest risk group (those with HPV 16/18 and at least one other high-risk HPV type). Estimated reductions in abnormal Pap results among women in the 21- to 29-year age group were 0.8%, 10.2%, and 11.3% in years 5, 15, and 25 of the vaccine program respectively, in the lower vaccine coverage scenario, and 7.4%, 21.4%, and 22.2%, respectively, in the higher coverage scenario.

Conclusions

Our results suggest that HPV vaccination will have a discernable impact on the probability of Pap abnormalities, but the timing and magnitude of the reduction will depend substantially on vaccine coverage and the degree of cross-protection against high risk HPV types other than HPV 16/18.     

Human papillomavirus vaccine coverage in the United States, National Health and Nutrition Examination Survey, 2007-2008

Objectives

This study aims to estimate human papillomavirus (HPV) vaccine coverage by demographic and sexual behavior characteristics 1-2 years after vaccine licensure in a nationally representative sample of females aged 9-59 years in the United States.

Methods

In 2007-2008, a total of 2775 females aged 9-59 years responded to questions on HPV vaccine receipt in the National Health and Nutrition Examination Survey (NHANES). Demographic and sexual characteristics were evaluated for select age categories in bivariate analyses after adjusting for survey design.

Results

Overall, 15.2% of females aged 11-26 years reported HPV vaccine initiation; vaccine initiation varied significantly by age. We found no significant difference in vaccine initiation by race or poverty level in either 11-18 or 19-26-year olds. Significantly more 19-26-year olds with private insurance initiated vaccine (16.3%) than those with public insurance (4.0%) (p = 0.04). Among females aged 14-18 years, vaccine initiation was higher in those who ever had sex (28.6%) compared to those who had never had sex (17.8%) (p = 0.05).

Conclusions

These results describe HPV vaccine initiation shortly after vaccine licensure. Vaccine initiation was highest in females aged 14-18 years. Efforts should be made to increase HPV vaccine coverage for the recommended age groups.     

A Low-Fat Vegan Diet Elicits Greater Macronutrient Changes, but Is Comparable in Adherence and Acceptability, Compared with a More Conventional Diabetes Diet among Individuals with Type 2 Diabetes

Background

Although therapeutic diets are critical to diabetes management, their acceptability to patients is largely unstudied.

Objective

To quantify adherence and acceptability for two types of diets for diabetes.

Design

Controlled trial conducted between 2004 and 2006.

Subjects/setting

Individuals with type 2 diabetes (n=99) at a community-based research facility. Participants were randomly assigned to a diet following 2003 American Diabetes Association guidelines or a low-fat, vegan diet for 74 weeks.

Main outcome measures

Attrition, adherence, dietary behavior, diet acceptability, and cravings.

Statistical analyses

For nutrient intake and questionnaire scores, t tests determined between-group differences. For diet-acceptability measures, the related samples Wilcoxon sum rank test assessed within-group changes; the independent samples Mann-Whitney U test compared the diet groups. Changes in reported symptoms among the groups was compared using χ² for independent samples.

Results

All participants completed the initial 22 weeks; 90% (45/50) of American Diabetes Association guidelines diet group and 86% (42/49) of the vegan diet group participants completed 74 weeks. Fat and cholesterol intake fell more and carbohydrate and fiber intake increased more in the vegan group. At 22 weeks, group-specific diet adherence criteria were met by 44% (22/50) of members of the American Diabetes Association diet group and 67% (33/49) of vegan-group participants (P=0.019); the American Diabetes Association guidelines diet group reported a greater increase in dietary restraint; this difference was not significant at 74 weeks. Both groups reported reduced hunger and reduced disinhibition. Questionnaire responses rated both diets as satisfactory, with no significant differences between groups, except for ease of preparation, for which the 22-week ratings marginally favored the American Diabetes Association guideline group. Cravings for fatty foods diminished more in the vegan group at 22 weeks, with no significant difference at 74 weeks.

Conclusions

Despite its greater influence on macronutrient intake, a low-fat, vegan diet has an acceptability similar to that of a more conventional diabetes diet. Acceptability appears to be no barrier to its use in medical nutrition therapy.     

The Health Technology Assessment of bivalent HPV vaccine Cervarix in Italy

Introduction

Health Technology Assessment (HTA) approach was applied to Human Papilloma Virus (HPV) vaccine in the Italian context.

Methods

Epidemiology and costs of HPV infection and related diseases, vaccine efficacy, clinical and economic impact of the HPV vaccination and women's knowledge and attitudes towards vaccination were assessed.

Results

HPV infections pooled prevalence in Italy was 19% (95%CI: 10–30%) and cervical cancer incidence was 9.8/100,000 per year. The mean costs for in situ and invasive carcinoma hospitalisation were estimated respectively in €1745.87 and €2616.16. HPV vaccines have demonstrated high efficacy and good safety profile. The meta-analysis on efficacy results in preventing persistent cervical infections by HPV16 and 18 for both HPV vaccines resulted in 87% (95%CI: 80–91%) and 78% (95%CI: 62–87%). Modelling the impact of vaccination with bivalent vaccine, it would reduce cancer cases by 67% and be cost-effective, with a cost per Quality Adjusted Life Years (QALYs) gained of €22,055.

Conclusion

The thoroughness of the evaluation allowed us accounting for all the aspects of HPV infection/diseases. The HTA report on the HPV vaccine demonstrated to be a comprehensive tool for an informed decision making process.     

Human papillomavirus vaccine initiation among adolescent girls in high-risk communities

Background

We assessed human papillomavirus (HPV) vaccine uptake among adolescent girls, parents’ intentions to vaccinate daughters, and barriers and facilitators of vaccination in a population at elevated risk for cervical cancer.

Methods

Between October 2007 and June 2008, telephone surveys were conducted with randomly selected parents/guardians of 11-18 year old girls attending public middle and high schools serving economically disadvantaged populations in Los Angeles County.

Results

We surveyed 509 predominantly Hispanic (81%) and African American (16%) parents; 71% responded in Spanish. Overall, 23% reported their daughter had received ≥1 dose of HPV vaccine. Although 93% of daughters had seen a doctor in the past year, only 30% reported that a provider recommended HPV vaccine. Characteristics positively associated with odds of having initiated HPV vaccine were having heard of the vaccine (adjusted odds ratio [aOR] 2.6), belief in vaccine effectiveness (aOR 2.9), and doctor recommendation (aOR 48.5). Negative attitudes toward HPV vaccine (aOR 0.2) and needing more information about it (aOR 0.1) were negatively associated with vaccine initiation. Of those with unvaccinated daughters (n = 387), 62% said they “probably/definitely will” vaccinate within the next year and 21% were undecided or didn’t know; only 11% said they definitely won’t.

Conclusions

About one-quarter of adolescent girls in this at-risk community had initiated HPV vaccine by mid-2008. Provider recommendation was the single most important factor associated with vaccination. Because a substantial proportion of parents remain undecided about HPV vaccine, health care providers can play a key role by providing needed information and offering HPV vaccine to all eligible adolescents.     

HPV vaccine acceptability in Ghana, West Africa

Objective

Cervical cancer is a leading cause of cancer-related mortality among women in Ghana. As of this writing no data are available concerning knowledge, attitudes and acceptability of human papillomavirus (HPV) vaccination by women in Ghana.

Methods

Between November and December 2009, a self-administered survey was used to elicit information from 264 Ghanaian women, ages 18-65.

Results

Overall, 40% had heard about HPV vaccine and 94% were willing to vaccinate themselves or their daughters. Ideal age for vaccination was 12.7 years. Most women (75%) thought the vaccine should be received regardless of one's number of sex partners. The most prevalent concerns were whether the vaccine would be administered safely using clean needles (82%), and possible future side effects (77%). Concerns about cost and vaccine encouraging earlier sex were reported by nearly half. Significant barriers to vaccine acceptance were women's lack of knowledge about the gravity of cervical cancer in Ghana and utility of Pap test in detecting it, low perceived risk for cervical cancer, low social support to vaccine use, and low self-efficacy to find a doctor or clinic to get vaccinated (p < 05). About 55% of the women did not know the vaccine only works among those who are not yet infected with HPV. Schools and television were the most preferred methods of educating the public and cervical cancer prevention ranked as the ideal message (80%). Most respondents believed the decision to vaccinate their daughter should be made by both parents (34%) or in conjunction with the daughter (37%), as opposed to the government (17%).

Conclusions

Educational programs addressing specific barriers identified in the current study have the potential to significantly improve HPV vaccine uptake in Ghana.     

Incremental cost-effectiveness evaluation of vaccinating girls against cervical cancer pre- and post-sexual debut in Belgium

Background

Vaccination against human papillomavirus (HPV) to prevent cervical cancer (CC) primarily targets young girls before sexual debut and is cost-effective. We assessed whether vaccination with the HPV-16/18 AS04-adjuvanted vaccine added to screening remains cost-effective in females after sexual debut compared to screening alone in Belgium. The role of protection against non-HPV-16/18 was also investigated.

Methods

A published Markov cohort model was adapted to Belgium. The model replicated the natural history of HPV infection, the effects of screening, and vaccination. Vaccine efficacy (VE) included non-HPV-16/18 protection based on the PATRICIA clinical trial data. Pre- and post-HPV exposure VE were differentiated. Lifetime vaccine protection was assumed. Input data were obtained from literature review, national databases and a Delphi panel. Costing was from a healthcare payer perspective. Costs were discounted at 3% and effects at 1.5%. The incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) gained and the number of lesions prevented with vaccination from age 12 to 40 was evaluated. The specific effect of non-HPV-16/18 protection was investigated. Univariate sensitivity analysis was performed on key variables.

Results

The model estimated that vaccinating a cohort of 100,000 girls at age 12 would prevent 646 CC cases over a lifetime (102 non-HPV-16/18) with an ICER of €9171/QALY. Vaccinating at age 26 would prevent 340 CC cases (40 non-HPV-16/18) with an ICER of €17,348/QALY and vaccinating at age 40 would prevent 146 CC cases (17 non-HPV-16/18) with an ICER of €42,847/QALY. The ICER remained under the highly cost-effective threshold (1×GDP/capita) until age 33 years and under the cost-effective threshold (3×GDP/capita) beyond age 40.

Conclusion

Extending HPV vaccination to females post-sexual debut could lead to a substantial reduction in CC-related burden and would be cost-effective in Belgium.     

Systematic literature review of cross-protective effect of HPV vaccines based on data from randomized clinical trials and real-world evidence

BackgroundThe extent of cross-protection provided by currently licensed bivalent and quadrivalent HPV vaccines versus direct protection against HPV 31-, 33-, 45-, 52-, and 58-related disease is debated. A systematic literature review was conducted to establish the duration and magnitude of cross-protection in interventional and observational studies.MethodsPubMed and Embase databases were searched to identify randomized controlled trials (RCT) and observational studies published between 2008 and 2019 reporting on efficacy and effectiveness of HPV vaccines in women against non-vaccine types 31, 33, 45, 52, 58, and 6 and 11 (non-bivalent types). Key outcomes of interest were vaccine efficacy against 6- and 12-month persistent infection or genital lesions, and type-specific genital HPV prevalence or incidence. RCT data were analyzed for the according-to-protocol (bivalent vaccine) or negative-for-14-HPV-types (quadrivalent vaccine) efficacy cohorts.ResultsData from 23 RCTs and 33 observational studies evaluating cross-protection were extracted. RCTs assessed cross-protection in post-hoc analyses of small size subgroups. Among fully vaccinated, baseline HPV-naïve women, the bivalent vaccine showed statistically significant cross-protective efficacy, although with wide confidence intervals, against 6-month and 12-month persistent cervical infections and CIN2+ only consistently for HPV 31 and 45, with the highest effect observed for HPV 31 (range 64.6% [95% CI: 27.6 to 83.9] to 79.1% [97.7% CI: 27.6 to 95.9] for 6-month persistent infection; maximal follow-up 4.7 years). No cross-protection was shown in extended follow-up. The quadrivalent vaccine efficacy reached statistical significance for HPV 31 (46.2% [15.3–66.4]; follow-up: 3.6 years). Similarly, observational studies found consistently significant effectiveness only against HPV 31 and 45 with both vaccines.ConclusionsRCTs and observational studies show that cross-protection is inconsistent across non-vaccine HPV types and is largely driven by HPV 31 and 45. Furthermore, existing data suggest that it wanes over time; its long-term durability has not been established.     

Text message reminders to promote human papillomavirus vaccination

Objective

To implement and evaluate text message reminders for the second (HPV2) and third (HPV3) vaccine doses.

Design

Site-based intervention.

Setting

Nine pediatric sites (5 academic and 4 private) located in New York City.

Participants

Parents of adolescents 9-20 years who received HPV1 or HPV2 during the intervention period, January-June 2009.

Intervention

Parents who enrolled received up to three weekly text message reminders that their daughter was due for her next vaccine dose.

Outcome measure

On-time receipt of the next vaccine dose, within one month of its due date.

Results

During the intervention period, of 765 eligible HPV vaccine events, 434 enrollment instructions were distributed to parents (56.7% of doses). Parents of 124 adolescent girls (28.6% of those handed instructions) activated text message reminders. Comparing children of parents who enrolled versus those who did not, on-time receipt of next HPV vaccine dose occurred among 51.6% (95% CI 42.8-60.4%) versus 35.0% (95% CI 29.6-40.2%) of adolescents (p = .001). Similarly, among a historical cohort of adolescents, receiving HPV1 or HPV2 in the six months prior to the intervention period, on-time receipt of next vaccine dose was noted for 38.1% (95% CI 35.2-41.0%) (p = .003). Increases in receipt of next vaccine dose among intervention subjects were sustained at 4 months following the vaccine due date. Using a logistic regression model, after controlling for insurance and site of care, intervention subjects were significantly more likely than either control population to receive their next HPV vaccine dose on-time.

Conclusion

Among those choosing to enroll, text message reminders were an effective intervention to increase on-time receipt of HPV2 or HPV3.     

Cost-effectiveness analysis of human papillomavirus-vaccination programs to prevent cervical cancer in Austria

Objective

The study predicts long-term cervical cancer related population health and economic effects of introducing the HPV-vaccination for 12-year-old girls (and boys) in addition to current screening compared with screening only.

Method

Health effects are predicted by a dynamic transmission model. Model results are used to calculate incremental cost-effectiveness ratios (ICER) in € per life year gained (LYG) for a time-horizon between 2008 and 2060 from a public payer and a societal perspective.

Results

Vaccination of girls results a discounted ICER of € 64,000/LYG and € 50,000/LYG from a payer's and societal perspectives respectively. The additional vaccination of boys increases the ICER to € 311,000 and € 299,000/LYG respectively. Results were most sensitive to vaccination price, discount rate and time-horizon.

Conclusion

HPV-vaccination for girls should be cost-effective when adopting a longer time-horizon and a societal perspective. Applying a shorter time frame and a payer's perspective or vaccinating boys may not be cost-effective without reducing the vaccine price.