To date this question cannot be answered, but available evidence suggests that niche competition is unlikely Stanley et al. On the other hand by including only one HPV health state we do not face the problem of increasing susceptibility to non protected HPV types with the vaccine as encountered with other models Goldie et al. Finally, our analysis focuses on cost-effectiveness analysis. This, however, does not account for issue of budget impact and therefore affordability that can be assessed by the model but is at the end a decision to be taken by the local health authorities.
This paper describes a succinct cohort model that can be used to investigate key economic issues in HPV vaccination for the prevention of cervical cancer. The model results agreed well with observed data in France, as shown here, and indicate that HPV vaccination would be a cost-effective policy option. As the model uses data that are readily available in most countries and regions, it should be generally applicable to the evaluation of the cost effectiveness of HPV vaccination in a variety of settings. Bull Cancer 94 2 — J Med Virol 73 2 — Gynecologie Obstetrique Fertilite 34 11 — J Clin Pathol 55 4 — Gynecol Obstet Fertil 32 3 — Br J Cancer 84 12 — Br J Cancer 88 1 — Cytopathology 15 3 — Ann Oncol 14 Suppl 5 :v—v Eur J Cancer 40 8 — Vaccine 26 Suppl 5 :F16—F Institut de Veille Sanitaire.
Am J Epidemiol 7 — IARC Press. Available via IARC. Accessed August International agency for research on cancer. Accessed June Med Care 36 6 — Ann Intern Med 2 — J Natl Cancer Inst 96 8 — Lancet — Accessed March Institute of Medicine Appendix human papillomavirus. National Academy Press, Washington, p Google Scholar.
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Accessed September Vaccine 26 Suppl 10 :K76—K Br J Cancer 96 1 — Kulasingam SL, Myers ER Potential health and economic impact of adding a human papillomavirus vaccine to screening programs. JAMA 6 — Pharmacoeconomics 27 2 — Obstet Gynecol 92 4 Pt 2 — JAMA 23 — Human papillomavirus in the etiology of human cancer. Vaccine 24 Suppl 3 :S1—S February 20— Diagn Mol Pathol 8 3 — Vaccine 26 Suppl 5 :F46—F Emerg Infect Dis 9 1 — Eur J Cancer 36 17 — Vaccine 24 Suppl 3 :S—S Vaccine 26 Suppl 5 :F29—F Expert Opin Biol Ther 10 3 — Vaccine 24 Suppl 1 :S1—S J Pathol 1 — Value Health 6 1 :9— Accessed February J Cancer Res Clin Oncol 1 :3— Download references.
Bruno Detournay has performed consultancy work for GlaxoSmithKline.
This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author s and source are credited. Correspondence to Nadia Demarteau. Reprints and Permissions. Demarteau, N. A generally applicable cost-effectiveness model for the evaluation of vaccines against cervical cancer. Int J Public Health 56, — Download citation. Received : 09 July Revised : 30 September Accepted : 20 October Published : 26 November Issue Date : April Search SpringerLink Search.
Download PDF. Abstract Objective This study aimed at evaluating the cost-effectiveness of human papillomavirus virus HPV vaccination in France, using a generally applicable succinct cohort model. Methods A lifetime Markov cohort model, adapted to the French setting, simulate the natural history of oncogenic HPV infection towards cervical cancer CC.
Results The model results agreed well with real-life data. Conclusion This succinct cohort model indicated that HPV vaccination would be a cost-effective policy option in France. Variation in results across models was likely due to uncertainties about HPV natural history e. It is not clear whether any recommendation for HPV vaccination in this age range would lead to greater uptake among individuals who are likely versus unlikely to benefit. Programs and funding for adult vaccination are not available in all jurisdictions.
Adult immunization is performed primarily in the private sector. Identifying individual patients likely to benefit from adult HPV vaccination could be challenging for vaccine providers, especially those who do not regularly assess sexual risk behaviors.
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Some Work Group members felt that recommending vaccination in this age range might reduce health disparities, by increasing access to vaccination among adults with health insurance coverage. Others felt that recommending vaccination in this age range might enhance health disparities, as underinsured adults would be less likely to have access to vaccination since states have limited funds for adult vaccination programs.
The balance between desirable and undesirable consequences is closely balanced or uncertain. ACIP recommends HPV vaccination based on shared clinical decision making for individuals ages 27 through 45 years who are not adequately vaccinated. The above recommendations for individuals older than the catch-up age group also apply to MSM;  transgender people; and people with immunocompromising conditions. A majority felt that ACIP should recommend the intervention for adults based on shared clinical decision making, while a large minority felt that ACIP should not recommend the intervention in this age range.
Thus two policy options were presented to ACIP for consideration. No prevaccination physical examination e. Cervical cancer screening guidelines and recommendations should be followed.
ACIP reviews results from ongoing studies, vaccine trials, and health economic analyses as data become available, and updates vaccine policy as appropriate. ACIP members voted in favor of shared clinical decision making for adults aged 27 through 45 years, recognizing that some individuals who are at risk for new HPV infection might benefit from vaccination in this age range.
ACIP members in favor of shared clinical decision making cited data on vaccine safety and efficacy, and data suggesting that some adults in this age range might benefit from vaccination against HPV. ACIP members not in favor noted that little public health benefit is expected from vaccinating adults in this age range, compared to benefits of the existing vaccination program for adolescents.
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ACIP noted that most U. See further information external icon. Framework last updated 19 June Skip directly to site content Skip directly to page options Skip directly to A-Z link. Section Navigation. Facebook Twitter LinkedIn Syndicate. Minus Related Pages. Background: Human papillomavirus HPV is a common sexually transmitted infection of the epithelium. Uncertain Approximately 33, cancers are caused by HPV annually in the United States, including 12, oropharyngeal cancers among men and women, 10, cervical cancers among women, and 6, anal cancers among men and women; vaginal, vulvar, and penile cancers are less common.
Even so, the existing U. HPV vaccination program has resulted in significant declines in prevalence of vaccine-type HPV infections, anogenital warts, and cervical precancers. Among 14—19 and 20—24 year-old females, prevalence of 4vHPV vaccine-type infection declined from Declines have been observed among both vaccinated and unvaccinated persons, suggesting protective herd effects. Show More.
Definitions of persons considered adequately vaccinated are unchanged from prior publication Meites et al, MMWR Men who have sex with men; includes men who identify as gay or bisexual, or who intend to have sex with men.
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