title: Estimation of the potential overall impact of human papillomavirus vaccination on cervical cancer cases and deaths.
abstract: BACKGROUND
  Human papillomavirus (HPV) vaccination offers potential for primary prevention of HPV-related pre-cancers and cancers as demonstrated in clinical trials. Mathematical models have estimated the potential real-life impact of vaccination on the burden of cervical cancer (CC). However, these are restricted to evaluations in a limited number of countries.
  
  
  METHODS
  Potential decline in CC cases and deaths with the AS04-adjuvanted HPV-16/18 vaccine of young girls naïve to HPV, was estimated at steady-state (vaccine coverage: 0-100%) based on clinical trial and country-specific incidence data. Data on vaccine efficacy were taken from the end of study PATRICIA trial of the AS04-adjuvanted HPV-16/18 vaccine. The numbers of cases and deaths due to HPV-16/18 were estimated and compared with those due to any HPV type to estimate the additional cases prevented. This difference estimates CC cases and deaths avoided due to protection against non-vaccine HPV types. Cost-offsets due to reductions in CC treatment were estimated for five countries (Brazil, Canada, Italy, Malaysia and South African Republic) using country-specific unit cost data. Additionally, cervical intraepithelial neoplasia grade 2 or 3 (CIN2/3)-related burden (cases and treatment costs) prevented by vaccination were estimated for two countries (Italy and Malaysia).
  
  
  RESULTS
  HPV vaccination could prevent a substantial number of CC cases and deaths in countries worldwide, with associated cost-offsets due to reduced CC treatment. Cross-protection increased the estimated potential number of CC cases and deaths prevented by 34 and 18% in Africa and Oceania, respectively. Moreover, vaccination could result in a substantial reduction in the number of CIN2/3 lesions and associated costs.
  
  
  CONCLUSIONS
  HPV vaccination could reduce the burden of CC and precancerous lesions in countries worldwide, part of disease burden reduction being related to protection against non HPV-16/18 related types.
authors.affiliation: Health Economics, GlaxoSmithKline Vaccines, Avenue Fleming, 20, Wavre, 1300, Belgium. Electronic address: georges.m.van-kriekinge@gsk.com.
authors.forename: Georges
authors.initials: G
authors.lastname: Van Kriekinge
authors.affiliation: Cancer Epidemiology Research Program, Institut Català d'Oncologia (ICO)-IDIBELL, CIBERESP, L'Hospitalet de Llobregat, Catalonia, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Castellsagué
authors.affiliation: Gynecologic Oncology Centre, General University Hospital of the First Medical School, Charles University, Prague, Czech Republic.
authors.forename: David
authors.initials: D
authors.lastname: Cibula
authors.affiliation: Health Economics, GlaxoSmithKline Vaccines, Avenue Fleming, 20, Wavre, 1300, Belgium.
authors.forename: Nadia
authors.initials: N
authors.lastname: Demarteau
mesh_terms: D002170:Canada; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D005858:Germany; D006801:Humans; D032541:Mass Vaccination / Q000191:economics*; D008800:Mexico; D030361:Papillomavirus Infections / Q000191:economics / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000627:therapeutic use*; D013019:South Africa; D013785:Thailand; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000401:mortality / Q000517:prevention & control* / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000191:economics / Q000401:mortality / Q000517:prevention & control / Q000821:virology
chemical_list: D053918:Papillomavirus Vaccines; C510352:human papillomavirus vaccine, L1 type 16, 18
keywords: CC; CIN; Cervical cancer; HPV; HSIL; Human papillomavirus; ICO; Institut Català d’Oncologia; LEEP; LLETZ; TVC; VE; Vaccination; WHO; World Health Organization; cervical cancer; cervical intraepithelial neoplasia; high-grade squamous intraepithelial lesion; human papillomavirus; large loop excision of the transformation zone.; loop electrosurgical excision procedure; total vaccinated cohort; vaccine efficacy