title: Estimated health and economic impact of quadrivalent HPV (types 6/11/16/18) vaccination in Brazil using a transmission dynamic model.
abstract: BACKGROUND
  Cervical cancer is the second most common cancer among women in Brazil. We examined the health and economic impacts of quadrivalent HPV vaccination in Brazil.
  
  
  METHODS
  We adapted a previously developed transmission dynamic model to estimate the effectiveness of HPV vaccination on cervical cancer, cervical intraepithelial neoplasia grades 2 and 3 (CIN2/3), CIN1, and genital warts. We evaluated following vaccination strategies: routine vaccination of 12-year-old girls and routine vaccination in combination with a catch-up vaccination of 12 to 26-year-old women.
  
  
  RESULTS
  The model projected that the vaccination would reduce the incidence rates of HPV 6/11/16/18-related cervical cancer, CIN2/3, CIN1, and female genital warts by 94% to 98% at year 100. Routine vaccination in combination with a catch-up vaccination could prevent approximately 163,000 cases of cervical cancer, 48,000 deaths from cervical cancer, 2.3 million cases of CIN2/3, and 11.4 million genital warts in the next 50 years. The incremental cost-effectiveness ratios for female vaccination strategies ranged from R$350 to R$720 (US$219 to US$450) per quality-adjusted life year (QALY) gained.
  
  
  CONCLUSIONS
  Our study demonstrates that quadrivalent HPV female vaccination can be a cost-effective public health intervention that can substantially reduce the burden of cervical diseases and genital warts in Brazil.
authors.affiliation: Temple University, 3307 N, Broad Street, Philadelphia, PA 19140, USA. kkawai8@gmail.com
authors.forename: Kosuke
authors.initials: K
authors.lastname: Kawai
authors.forename: Gabriela Tannus Branco
authors.initials: GT
authors.lastname: de Araujo
authors.forename: Marcelo
authors.initials: M
authors.lastname: Fonseca
authors.forename: Matthew
authors.initials: M
authors.lastname: Pillsbury
authors.forename: Puneet K
authors.initials: PK
authors.lastname: Singhal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D002648:Child; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008875:Middle Aged; D015233:Models, Statistical; D030361:Papillomavirus Infections / Q000150:complications / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000191:economics*; D002583:Uterine Cervical Neoplasms / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D014611:Vaccination / Q000191:economics / Q000379:methods; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines