Cost-effectiveness of quadrivalent human papillomavirus (HPV) vaccination in Mexico: A transmission dynamic model-based evaluation☆
Section snippets
Background
Cervical cancer is the second most common cancer among women worldwide [1]. In Mexico, a national cervical cancer screening program was initiated in 1974 [2]. However, the disease remains the country's leading cause of female cancer-related mortality [3] and resulted in 4241 deaths in 2004 [4]. Human papillomavirus (HPV) infections are the primary cause of cervical, [5] anal, penile, vaginal and vulvar cancers, [6] anogenital warts [7] and recurrent respiratory papillomatoses [8], [9] and also
Methods
A full description of the development, structure and selection of inputs for the dynamic transmission model is reported elsewhere [12], [13]. Here, we briefly describe the model structure and selection of inputs relevant to the population in Mexico (Table 1).
Health outcomes
For each of the six vaccination strategies, Figure 1, Figure 2, Figure 3, Figure 4 depict the model projected HPV 6, 11, 16 and 18-related incidence of clinically diagnosed CIN 2/3 and cervical cancer for females, and genital warts for males and females (among individuals ages 12 and over), during the 100 years following the introduction of HPV vaccination.
For all disease endpoints examined, we found the most clinically effective strategy to be vaccination of 12-year-old females and males
Discussion
Consistent with our prior results reported for the U.S. population, [12] data from this analysis suggest that a quadrivalent HPV 6/11/16/18 vaccine can yield substantial benefits in reducing the incidence of cervical cancer, CIN and genital warts in Mexico. In fact, the per capita incremental projected health benefits associated with each vaccination strategy, in terms of quality-adjusted life years gained, were estimated to be approximately twice as large for Mexico as for the United States
Acknowledgments
The authors thank Dr. Eduardo Lazcano-Ponce of the Instituto Nacional de Salud Pública in Mexico for helpful comments on a draft version of this manuscript.
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2018, VaccineCitation Excerpt :Therefore, the ICERs for additional age cohort immunization in these studies were likely to be overestimated as fewer individuals were potentially vaccinated and their results should be interpreted cautiously. Two studies [24,26] also found that gender-neutral HPV vaccination up to age 24 years was cost-effective. A study in United Kingdom [43] concluded that HPV vaccination up to age 24 years was only cost-effective in the presence of protection to non-naïve women, demonstrating that the exclusion of vaccine protection among non-naïve women may underestimate the cost-effectiveness of vaccinating additional older age women.
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This study was supported by Merck & Co., Inc., where authors Insinga, Dasbach and Elbasha are currently employed.