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

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

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Canada
  • Cervical Intraepithelial Neoplasia / economics
  • Cervical Intraepithelial Neoplasia / mortality
  • Cervical Intraepithelial Neoplasia / prevention & control
  • Cervical Intraepithelial Neoplasia / virology
  • Cost of Illness
  • Cost-Benefit Analysis
  • Female
  • Germany
  • Humans
  • Mass Vaccination / economics*
  • Mexico
  • Papillomavirus Infections / economics
  • Papillomavirus Infections / prevention & control*
  • Papillomavirus Vaccines / therapeutic use*
  • South Africa
  • Thailand
  • Uterine Cervical Neoplasms / economics
  • Uterine Cervical Neoplasms / mortality
  • Uterine Cervical Neoplasms / prevention & control*
  • Uterine Cervical Neoplasms / virology

Substances

  • Papillomavirus Vaccines
  • human papillomavirus vaccine, L1 type 16, 18