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Factors Influencing the Cost-Effectiveness Outcomes of HPV Vaccination and Screening Interventions in Low-to-Middle-Income Countries (LMICs): A Systematic Review

Applied Health Economics and Health Policy volume 18, pages 641–654 (2020)Cite this article

Abstract

Background

Cervical cancer ranks fourth amongst the commonest malignancies worldwide and the second most prevalent cancer afflicting women in low-to-middle income countries (LMICs), hence, of great public health importance. LMICs are the most affected regions as evidenced by their high prevalence of the disease. Mortality associated with cervical neoplasms is preventable through the implementation of recommended preventive approaches.

Aims

This review aimed to appraise evidence on the cost effectiveness of cervical cancer prevention interventions in LMICs involving cervical screening and human papilloma virus (HPV) vaccination programmes.

Methods

A search of CINAHL, MEDLINE, PubMed, and Web of Science was elicited and studies published between 1st January 2008 and 31st December 2018 were retrieved. Two authors independently undertook the screening, review, selection of studies, and data extraction with disagreements being resolved through discussion and consensus.

Results

Twelve studies were selected. The cost-effectiveness outcomes of HPV vaccination and screening interventions are dependent on age, screening method used, intervention coverage, and the number of doses or visits required for vaccination and screening, respectively. A combination of visual inspection with acetic acid (VIA) screening and HPV vaccination appears to be the most cost-effective approach in reducing the lifetime risk for HPV-linked cervical neoplasms. Similarly, vaccination as a stand-alone intervention is potentially cost effective provided the coverage is maintained between 70 and 100%.

Conclusions

HPV vaccination and screening interventions may be cost effective in LMICs and potentially reduce the lifetime risk, economic burden, and associated mortality. However, it is important to consider the factors that influence the cost effectiveness of cervical cancer prevention interventions for better outcomes to be realised.

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Data Availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request through bernardokeah@gmail.com or c.h.ridyard@bangor.ac.uk.

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Author information

Affiliations

  1. School of Healthcare Sciences, Bangor University, Bangor, Gwynedd, LL57 2EF, UK

    Bernard O. Okeah

  2. Centre for Health Economics and Medicines Evaluation, Bangor University, Normal Site, Bangor, Gwynedd, LL57 2PZ, UK

    Colin H. Ridyard

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  1. Bernard O. Okeah
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  2. Colin H. Ridyard
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Contributions

BO: conceived the idea, designed the study protocol and was the first reviewer; CR: verified the study protocol, was the second reviewer and supervised the study. The authors discussed the findings of this study and contributed to the final report.

Corresponding author

Correspondence to Colin H. Ridyard.

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Appendices

Appendix 1: Search Strategy [MEDLINE]

[[[[[[[[[developing countries] AND uterine cervical neoplasms]] AND [[hpv OR human papillomavirus OR papillomaviridae]]]] AND [[[[[[[screen*] OR test*] OR check*] OR monitor*] OR triag*]] OR [[[“visual inspection”] OR cytology] OR [[papanicolaou OR pap smear]]]]]] OR [[[[[[developing countries] AND uterine cervical neoplasms]] AND [[hpv OR human papillomavirus OR papillomaviridae]]]] AND [[[vaccin*] OR immun*] OR innoculat*]]]] AND [[[[[cost-effective* OR cost effective*]]] OR [[cost-benefit* OR cost benefit*]]] OR [[cost-utility OR cost utility]]] AND [hasabstract[text] AND [“2008/01/01”[PDAT] : “2018/12/31”[PDAT]] AND Humans[Mesh]].

Appendix 2: Search History [MEDLINE]

S33 S23 AND S27 Limiters—Date of Publication: 20080101–20181231; Abstract Available; English Language
Search modes—Boolean/Phrase
S32 S23 AND S27 Limiters—Date of Publication: 20080101–20171231; Abstract Available; English Language
Search modes—Boolean/Phrase
S31 S23 AND S27 Limiters—Abstract Available; English Language
Search modes—Boolean/Phrase
S30 S23 AND S27 Limiters—Abstract Available; English Language
Search modes—Boolean/Phrase
S29 S23 AND S27 Limiters—Abstract Available
Search modes—Boolean/Phrase
S28 S23 AND S27 Search modes—Boolean/Phrase
S27 S24 OR S25 OR S26 Search modes—Boolean/Phrase
S26 Cost–utility or cost utility Search modes—Boolean/Phrase
S25 Cost-benefit* or cost benefit* Search modes—Boolean/Phrase
S24 Cost-effective* or cost effective* Search modes—Boolean/Phrase
S23 S17 OR S22 Search modes—Boolean/Phrase
S22 S5 AND S21 Search modes—Boolean/Phrase
S21 S18 OR S19 OR S20 Search modes—Boolean/Phrase
S20 innoculat* Search modes—Boolean/Phrase
S19 immun* Search modes—Boolean/Phrase
S18 vaccin* Search modes—Boolean/Phrase
S17 S5 AND S16 Search modes—Boolean/Phrase
S16 S11 OR S15 Search modes—Boolean/Phrase
S15 S12 OR S13 OR S14 Search modes—Boolean/Phrase
S14 papanicolaou or papsmear Search modes—Boolean/Phrase
S13 cytology Search modes—Boolean/Phrase
S12 "visual inspection" Search modes—Boolean/Phrase
S11 S6 OR S7 OR S8 OR S9 OR S10 Search modes—Boolean/Phrase
S10 triag* Search modes—Boolean/Phrase
S9 monitor* Search modes—Boolean/Phrase
S8 check* Search modes—Boolean/Phrase
S7 test* Search modes—Boolean/Phrase
S6 screen* Search modes—Boolean/Phrase
S5 S3 AND S4 Search modes—Boolean/Phrase
S4 hpv or human papilomavirus or Papillomaviridae Search modes—Boolean/Phrase
S3 S1 AND S2 Search modes—Boolean/Phrase
S2 [MM "Uterine Cervical Neoplasms"] Search modes—Boolean/Phrase
S1 [MM "Developing Countries"] Search modes—Boolean/Phrase

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Okeah, B.O., Ridyard, C.H. Factors Influencing the Cost-Effectiveness Outcomes of HPV Vaccination and Screening Interventions in Low-to-Middle-Income Countries (LMICs): A Systematic Review. Appl Health Econ Health Policy 18, 641–654 (2020). https://doi.org/10.1007/s40258-020-00576-7

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