Global impact and cost-effectiveness of one-dose versus two-dose human papillomavirus vaccination schedules: a comparative modelling analysis
Abstract Background To eliminate cervical cancer as a public health problem, the World Health Organization had recommended routine vaccination of adolescent girls with two doses of the human papillomavirus (HPV) vaccine before sexual initiation. However, many countries have yet to implement HPV vacc...
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| Format: | Article |
| Language: | English |
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BMC
2023-08-01
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| Series: | BMC Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12916-023-02988-3 |
| _version_ | 1797452350893326336 |
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| author | Kiesha Prem Yoon Hong Choi Élodie Bénard Emily A. Burger Liza Hadley Jean-François Laprise Mary Caroline Regan Mélanie Drolet Stephen Sy Kaja Abbas Allison Portnoy Jane J. Kim Marc Brisson Mark Jit |
| author_facet | Kiesha Prem Yoon Hong Choi Élodie Bénard Emily A. Burger Liza Hadley Jean-François Laprise Mary Caroline Regan Mélanie Drolet Stephen Sy Kaja Abbas Allison Portnoy Jane J. Kim Marc Brisson Mark Jit |
| author_sort | Kiesha Prem |
| collection | DOAJ |
| description | Abstract Background To eliminate cervical cancer as a public health problem, the World Health Organization had recommended routine vaccination of adolescent girls with two doses of the human papillomavirus (HPV) vaccine before sexual initiation. However, many countries have yet to implement HPV vaccination because of financial or logistical barriers to delivering two doses outside the infant immunisation programme. Methods Using three independent HPV transmission models, we estimated the long-term health benefits and cost-effectiveness of one-dose versus two-dose HPV vaccination, in 188 countries, under scenarios in which one dose of the vaccine gives either a shorter duration of full protection (20 or 30 years) or lifelong protection but lower vaccine efficacy (e.g. 80%) compared to two doses. We simulated routine vaccination with the 9-valent HPV vaccine in 10-year-old girls at 80% coverage for the years 2021–2120, with a 1-year catch-up campaign up to age 14 at 80% coverage in the first year of the programme. Results Over the years 2021–2120, one-dose vaccination at 80% coverage was projected to avert 115.2 million (range of medians: 85.1–130.4) and 146.8 million (114.1–161.6) cervical cancers assuming one dose of the vaccine confers 20 and 30 years of protection, respectively. Should one dose of the vaccine provide lifelong protection at 80% vaccine efficacy, 147.8 million (140.6–169.7) cervical cancer cases could be prevented. If protection wanes after 20 years, 65 to 889 additional girls would need to be vaccinated with the second dose to prevent one cervical cancer, depending on the epidemiological profiles of the country. Across all income groups, the threshold cost for the second dose was low: from 1.59 (0.14–3.82) USD in low-income countries to 44.83 (3.75–85.64) USD in high-income countries, assuming one dose confers 30-year protection. Conclusions Results were consistent across the three independent models and suggest that one-dose vaccination has similar health benefits to a two-dose programme while simplifying vaccine delivery, reducing costs, and alleviating vaccine supply constraints. The second dose may become cost-effective if there is a shorter duration of protection from one dose, cheaper vaccine and vaccination delivery strategies, and high burden of cervical cancer. |
| first_indexed | 2024-03-09T15:07:32Z |
| format | Article |
| id | doaj.art-1064689fa6cd47938b45452d7b404d71 |
| institution | Directory Open Access Journal |
| issn | 1741-7015 |
| language | English |
| last_indexed | 2024-03-09T15:07:32Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj.art-1064689fa6cd47938b45452d7b404d712023-11-26T13:34:14ZengBMCBMC Medicine1741-70152023-08-0121111410.1186/s12916-023-02988-3Global impact and cost-effectiveness of one-dose versus two-dose human papillomavirus vaccination schedules: a comparative modelling analysisKiesha Prem0Yoon Hong Choi1Élodie Bénard2Emily A. Burger3Liza Hadley4Jean-François Laprise5Mary Caroline Regan6Mélanie Drolet7Stephen Sy8Kaja Abbas9Allison Portnoy10Jane J. Kim11Marc Brisson12Mark Jit13Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical MedicineModelling and Economics Unit, Data, Analytics and Surveillance, UK Health Security AgencyCentre de recherche du CHU de Québec - Université LavalCenter for Health Decision Science, Harvard T.H. Chan School of Public HealthDepartment of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical MedicineCentre de recherche du CHU de Québec - Université LavalCenter for Health Decision Science, Harvard T.H. Chan School of Public HealthCentre de recherche du CHU de Québec - Université LavalCenter for Health Decision Science, Harvard T.H. Chan School of Public HealthDepartment of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical MedicineCenter for Health Decision Science, Harvard T.H. Chan School of Public HealthCenter for Health Decision Science, Harvard T.H. Chan School of Public HealthCentre de recherche du CHU de Québec - Université LavalDepartment of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical MedicineAbstract Background To eliminate cervical cancer as a public health problem, the World Health Organization had recommended routine vaccination of adolescent girls with two doses of the human papillomavirus (HPV) vaccine before sexual initiation. However, many countries have yet to implement HPV vaccination because of financial or logistical barriers to delivering two doses outside the infant immunisation programme. Methods Using three independent HPV transmission models, we estimated the long-term health benefits and cost-effectiveness of one-dose versus two-dose HPV vaccination, in 188 countries, under scenarios in which one dose of the vaccine gives either a shorter duration of full protection (20 or 30 years) or lifelong protection but lower vaccine efficacy (e.g. 80%) compared to two doses. We simulated routine vaccination with the 9-valent HPV vaccine in 10-year-old girls at 80% coverage for the years 2021–2120, with a 1-year catch-up campaign up to age 14 at 80% coverage in the first year of the programme. Results Over the years 2021–2120, one-dose vaccination at 80% coverage was projected to avert 115.2 million (range of medians: 85.1–130.4) and 146.8 million (114.1–161.6) cervical cancers assuming one dose of the vaccine confers 20 and 30 years of protection, respectively. Should one dose of the vaccine provide lifelong protection at 80% vaccine efficacy, 147.8 million (140.6–169.7) cervical cancer cases could be prevented. If protection wanes after 20 years, 65 to 889 additional girls would need to be vaccinated with the second dose to prevent one cervical cancer, depending on the epidemiological profiles of the country. Across all income groups, the threshold cost for the second dose was low: from 1.59 (0.14–3.82) USD in low-income countries to 44.83 (3.75–85.64) USD in high-income countries, assuming one dose confers 30-year protection. Conclusions Results were consistent across the three independent models and suggest that one-dose vaccination has similar health benefits to a two-dose programme while simplifying vaccine delivery, reducing costs, and alleviating vaccine supply constraints. The second dose may become cost-effective if there is a shorter duration of protection from one dose, cheaper vaccine and vaccination delivery strategies, and high burden of cervical cancer.https://doi.org/10.1186/s12916-023-02988-3Cervical cancerHuman papillomavirusVaccinationSingle doseModelling |
| spellingShingle | Kiesha Prem Yoon Hong Choi Élodie Bénard Emily A. Burger Liza Hadley Jean-François Laprise Mary Caroline Regan Mélanie Drolet Stephen Sy Kaja Abbas Allison Portnoy Jane J. Kim Marc Brisson Mark Jit Global impact and cost-effectiveness of one-dose versus two-dose human papillomavirus vaccination schedules: a comparative modelling analysis BMC Medicine Cervical cancer Human papillomavirus Vaccination Single dose Modelling |
| title | Global impact and cost-effectiveness of one-dose versus two-dose human papillomavirus vaccination schedules: a comparative modelling analysis |
| title_full | Global impact and cost-effectiveness of one-dose versus two-dose human papillomavirus vaccination schedules: a comparative modelling analysis |
| title_fullStr | Global impact and cost-effectiveness of one-dose versus two-dose human papillomavirus vaccination schedules: a comparative modelling analysis |
| title_full_unstemmed | Global impact and cost-effectiveness of one-dose versus two-dose human papillomavirus vaccination schedules: a comparative modelling analysis |
| title_short | Global impact and cost-effectiveness of one-dose versus two-dose human papillomavirus vaccination schedules: a comparative modelling analysis |
| title_sort | global impact and cost effectiveness of one dose versus two dose human papillomavirus vaccination schedules a comparative modelling analysis |
| topic | Cervical cancer Human papillomavirus Vaccination Single dose Modelling |
| url | https://doi.org/10.1186/s12916-023-02988-3 |
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