Epidemiological and economic impact of human papillomavirus vaccines.
BACKGROUND
Despite screening, cervical cancer (CC) remains a serious health care problem. Because human papillomavirus (HPV) is the necessary cause of CC, the development of 2 new vaccines can have a tremendous impact on CC and other HPV-related conditions. In this systematic review, the epidemiological and economic impacts of HPV are evaluated.


METHODS
A literature search was conducted through MEDLINE, Web of Science, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature. Articles were selected based on inclusion and exclusion criteria. Economic evaluations were submitted to a quality assessment.


RESULTS
Sixteen articles were selected to review the epidemiological impact of HPV vaccines, and 11 were selected to review the economic impact. The studies were very heterogeneous because of different assumptions. Nevertheless, a substantial reduction in CC is reported consistently and a (smaller) reduction in precancerous lesions and HPV prevalence. Cost-effectiveness ratios are also very diverse and dependent on the assumptions made. An HPV vaccine can be profitable if duration of vaccine-related immunity is high, efficacy is high, price is low, screening is reduced, administration is before sexual activity, discount rate is not too high, or if there is herd immunity.


CONCLUSIONS
Human papillomavirus vaccines have the potential to reduce CC by at least approximately half of its current incidence, and this might be cost-effective if there is high efficacy with a long-lasting immunity.
Jeurissen
Sarah
S
Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. sarah.jeurissen@ugent.be
Makar
Amin
A
D000293:Adolescent; D000328:Adult; D002648:Child; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D030361:Papillomavirus Infections / Q000191:economics / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000008:administration & dosage / Q000191:economics* / Q000276:immunology; D011230:Precancerous Conditions / Q000191:economics / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control; D015995:Prevalence; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control; D055815:Young Adult
D053918:Papillomavirus Vaccines