global impact and cost effectiveness of one dose versus two dose human papillomavirus CORD-Papers-2022-06-02 (Version 1)

Title: 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 WHO currently recommends routine vaccination of adolescent girls with two doses of the human papillomavirus (HPV) vaccine before sexual debut. However many countries have yet to implement this 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 192 countries assuming that 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 one-year catch-up of 80% 11-14-year-old girls on the first year of the programme. Findings: Over the next century one-dose vaccination at 80% coverage could avert 64 million (80%UI 62.2-64.8) and 66.6 million (80%UI 63.4-69.1) cervical cancer cases should one dose of the vaccine confer 20 and 30 years of protection respectively. Should one dose of the vaccine provide lifelong protection at 80% vaccine efficacy 68.4 million (80%UI 63.8-69.4) cervical cancer cases could be prevented. Across all country income groups two-dose schedules conferring lifelong protection would avert only slightly more cases (2.1-8.7 million) than the one-dose scenarios explored. Around 330 to 5230 additional girls need to be vaccinated with the second dose to prevent one cervical cancer case depending on the epidemiological profiles of the country. Interpretation: 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. Funding: Bill & Melinda Gates Foundation
Published: 2021-02-08
DOI: 10.1101/2021.02.08.21251186
DOI_URL: http://doi.org/10.1101/2021.02.08.21251186
Author Name: Prem K
Author link: https://covid19-data.nist.gov/pid/rest/local/author/prem_k
Author Name: Choi Y H
Author link: https://covid19-data.nist.gov/pid/rest/local/author/choi_y_h
Author Name: Bampeacutenard ampEacutelodie
Author link: https://covid19-data.nist.gov/pid/rest/local/author/bampeacutenard_ampeacutelodie
Author Name: Burger E A
Author link: https://covid19-data.nist.gov/pid/rest/local/author/burger_e_a
Author Name: Hadley L
Author link: https://covid19-data.nist.gov/pid/rest/local/author/hadley_l
Author Name: Laprise J F
Author link: https://covid19-data.nist.gov/pid/rest/local/author/laprise_j_f
Author Name: Regan C
Author link: https://covid19-data.nist.gov/pid/rest/local/author/regan_c
Author Name: Drolet M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/drolet_m
Author Name: Sy S
Author link: https://covid19-data.nist.gov/pid/rest/local/author/sy_s
Author Name: Abbas K
Author link: https://covid19-data.nist.gov/pid/rest/local/author/abbas_k
Author Name: Kim J J
Author link: https://covid19-data.nist.gov/pid/rest/local/author/kim_j_j
Author Name: Brisson M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/brisson_m
Author Name: Jit M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/jit_m
Author Name: Benard, Elodie
Author link: https://covid19-data.nist.gov/pid/rest/local/author/benard_elodie
sha: 0d900738fc8c85343ad6b995a98a7dd62d2bedd2
license: medrxiv
source_x: MedRxiv
url: http://medrxiv.org/cgi/content/short/2021.02.08.21251186v1?rss=1
has_full_text: TRUE
Keywords Extracted from Text Content: cervical cancer 2·1-8·7 countryspecific Jit (2020) protection-as cancer HPV 16/18 medRxiv preprint appendix 4-valent low-from Cancer LMICs Vaccine herd VE onedose pre-cancer medRxiv preprint Figure 5 Gavi countries-UK Figure 1 PHE Nicaragua medRxiv preprint Figure 3 9-valent HPV vaccines vaccines-two 2-valent medRxiv preprint US vaccinees participants Email medRxiv preprint cervical cancer women CEA GDP Harvard-from 11 model-country non-cervical cancers SARS-CoV-2 neoplasias HPV-ADVISE 9-valent vaccine mark.jit@lshtm.ac.uk medRxiv preprint ADVISE cervical cancers https://doi.org/10.1101/2021.02.08.21251186 doi HPV OR human papillomavirus OR cervical cancer Harvard-set HPV vaccine HPV vaccines LICs/LMICs COVID-19 HPV-related cancers HPV-related 9-valent HPV vaccine anogenital warts cancers human papillomavirus HPV- medRxiv HPV types 6 HPV cervical HPV Vaccine https://github.com/kieshaprem/hpv-1-dose
Extracted Text Content in Record: First 5000 Characters:Email: mark.jit@lshtm.ac.uk To eliminate cervical cancer as a public health problem, WHO currently recommends routine vaccination of adolescent girls with two doses of the human papillomavirus (HPV) vaccine before sexual debut. However, many countries have yet to implement this because of financial or logistical barriers to delivering two doses outside the infant immunisation programme. 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 192 countries, assuming that 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 one-year catch-up of 80% 11-14-year-old girls on the first year of the programme. Over the next century, one-dose vaccination at 80% coverage could avert 64 million (80%UI 62·2-64·8) and 66·6 million (80%UI 63·4-69·1) cervical cancer cases should one dose of the vaccine confer 20 and 30 years of protection, respectively. Should one dose of the vaccine provide lifelong protection at 80% vaccine efficacy, 68·4 million (80%UI 63·8-69·4) cervical cancer cases could be prevented. Across all country income groups, two-dose schedules conferring lifelong protection would avert only slightly more cases (2·1-8·7 million) than the one-dose scenarios explored. Around 330 to 5230 additional girls need to be vaccinated with the second dose to prevent one cervical cancer case, depending on the epidemiological profiles of the country. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted February 8, 2021. ; https://doi.org/10.1101/2021.02.08.21251186 doi: medRxiv preprint 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. Evidence before this study Primary prevention of cervical cancer is now available with human papillomavirus (HPV) vaccination. Initially administered as a three-dose regimen, the HPV vaccine schedule recommended by WHO has now switched to two doses for individuals below the age of 15 years. Although WHO recommends all countries to routinely immunise adolescent girls with two doses, many low-and middle-income countries, with high disease burden, have yet to implement national HPV vaccination programmes because of the challenges of delivering two vaccine doses to adolescent females. Recently, HPV vaccine implementation in many countries has been further delayed due to constraints in vaccine supply and difficulties in access during COVID-19 epidemics. These financial, logistical, and supply constraints have motivated research into one-dose vaccination schedules. Evidence emerging from trials and observational studies suggests that one dose may also provide a high level of protection against incident and persistent HPV infections. If proven effective, the one-dose HPV vaccination schedule would simplify vaccine delivery and lower costs of national vaccination programmes, potentially enabling more countries to implement one and as a result, facilitating global cervical cancer prevention. We searched PubMed for trials, cohort and modelling studies published in 2018 and 2020, with the terms "(health impact OR impact OR modelling OR cost-effectiveness OR CEA OR durability OR effectiveness) AND (HPV OR human papillomavirus OR cervical cancer)" and identified 151 results. Ten published articles-four trials, three cohort studies, two modelling analyses, one systematic review of trials-evaluated the population impact of one dose of the vaccine on cervical cancer disease outcome among females and all studies showed one dose of the vaccine might be as is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted February 8, 2021. ; https://doi.org/10.1101/2021.02.08.21251186 doi: medRxiv preprint effective as two doses in preventing HPV infection. However as the trials and cohorts were single-country studies in select populations, the global impact remains unknown. Both published modelling analyses only used one model to estimate the impact of one-dose vaccination, and only examined a few countries. To our knowledge, no published article has modelled the global impact of routine one-dose vaccination on cervical cancer prevention by synthesising the results from more than one model. This study presents the first evidence on the potential global impact of a routine one-dose regimen, from a comparative modelling
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