Article type
Year
Abstract
Background: HPV vaccines are an important intervention for preventing cervical cancer. In public health, associated costs should be included for making decisions. Thus, economic evaluations (EE) play a relevant role, especially in the context of low- and middle-income countries (LMICs).
Objectives:To describe and appraise critically the available published EE evidence on HPV vaccines in LMICs.
Methods: A systematic literature review using a validated search strategy was carried out to identify a complete EE (cost-effectiveness, cost-utility and cost-benefit analysis) for HPV vaccines in LMICs published up to March 2015 in PubMed/MEDLINE, EMBASE and the Cochrane Library. Language restrictions were not used. Congress abstracts were excluded. Quality assessment was performed using the Consensus on Health Economic Criteria instrument. Also, age at which vaccinated, analysis perspective, clinical and economical outcomes, type of vaccine, model performed, Incremental cost-effectiveness ratio (ICER), and founding were analyzed, as well as other variables.
Results: A total of 1827 citations were obtained, of which 415 were duplicates. After tittle and abstract screening, 64 unique studies were reviewed (Fig 1) and 43 EEs were included for full qualitative synthesis -18 additional studies from a previous systematic review - (Table 1). Only seven studies were done specifically in low-income countries. Vaccination age ranged between from 10 to 15 years old. Most investigations incorporated only cervical cancer (32), but others additionally included harms (11) in their analysis. Most studies (34) were funded by public resources and indirect costs were assessed in 23 studies. The static models are the most frequent technique used and 10 studies had a multi-country evaluation. In most studies, findings suggested that vaccination is likely to be cost-effective; however these results are dependent on context and can be affected by GDP per head and existing cervical cancer screening program.
Conclusions: Beyond the significant heterogeneity and limited quality of current evidence, there is a tendency to support the cost-effectiveness of HPV vaccines in these countries.
Objectives:To describe and appraise critically the available published EE evidence on HPV vaccines in LMICs.
Methods: A systematic literature review using a validated search strategy was carried out to identify a complete EE (cost-effectiveness, cost-utility and cost-benefit analysis) for HPV vaccines in LMICs published up to March 2015 in PubMed/MEDLINE, EMBASE and the Cochrane Library. Language restrictions were not used. Congress abstracts were excluded. Quality assessment was performed using the Consensus on Health Economic Criteria instrument. Also, age at which vaccinated, analysis perspective, clinical and economical outcomes, type of vaccine, model performed, Incremental cost-effectiveness ratio (ICER), and founding were analyzed, as well as other variables.
Results: A total of 1827 citations were obtained, of which 415 were duplicates. After tittle and abstract screening, 64 unique studies were reviewed (Fig 1) and 43 EEs were included for full qualitative synthesis -18 additional studies from a previous systematic review - (Table 1). Only seven studies were done specifically in low-income countries. Vaccination age ranged between from 10 to 15 years old. Most investigations incorporated only cervical cancer (32), but others additionally included harms (11) in their analysis. Most studies (34) were funded by public resources and indirect costs were assessed in 23 studies. The static models are the most frequent technique used and 10 studies had a multi-country evaluation. In most studies, findings suggested that vaccination is likely to be cost-effective; however these results are dependent on context and can be affected by GDP per head and existing cervical cancer screening program.
Conclusions: Beyond the significant heterogeneity and limited quality of current evidence, there is a tendency to support the cost-effectiveness of HPV vaccines in these countries.