Health and economic impact of HPV 16/18 vaccination and cervical cancer screening in Eastern Africa

Nicole G. Campos, Jane J. Kim, Philip E. Castle, Jesse D. Ortendahl, Meredith O'Shea, Mireia Diaz, Sue J. Goldie

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Eastern Africa has the world's highest cervical cancer incidence and mortality rates. We used epidemiologic data from Kenya, Mozambique, Tanzania, Uganda, and Zimbabwe to develop models of HPV-related infection and disease. For each country, we assessed HPV vaccination of girls before age 12 followed by screening with HPV DNA testing once, twice, or three times per lifetime (at ages 35, 40, 45). For women over age 30, we assessed only screening (with HPV DNA testing up to three times per lifetime or VIA at age 35). Assuming no waning immunity, mean reduction in lifetime cancer risk associated with vaccination ranged from 36 to 45%, and vaccination followed by screening once per lifetime at age 35 with HPV DNA testing ranged from 43 to 51%. For both younger and older women, the most effective screening strategy was HPV DNA testing three times per lifetime. Provided the cost per vaccinated girl was less than I$10 (I$2 per dose), vaccination had an incremental cost-effectiveness ratio [I$ (international dollars)/year of life saved (YLS)] less than the country-specific per capita GDP, a commonly cited heuristic for "very cost-effective" interventions. If the cost per vaccinated girl was between I$10 (I$2 per dose) and I$25 (I$5 per dose), vaccination followed by HPV DNA testing would save the most lives and would be considered good value for public health dollars. These results should be used to catalyze design and evaluation of HPV vaccine delivery and screening programs, and contribute to a dialogue on financing HPV vaccination in poor countries.

Original languageEnglish (US)
Pages (from-to)2672-2684
Number of pages13
JournalInternational Journal of Cancer
Volume130
Issue number11
DOIs
StatePublished - Jun 1 2012
Externally publishedYes

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Human papillomavirus 18
Eastern Africa
Human papillomavirus 16
Early Detection of Cancer
Uterine Cervical Neoplasms
Vaccination
Economics
Health
DNA
Costs and Cost Analysis
Mozambique
Papillomavirus Vaccines
Zimbabwe
Uganda
Tanzania
Kenya
Cost-Benefit Analysis
Immunity
Public Health
Mortality

Keywords

  • cervical cancer
  • Eastern Africa
  • economic evaluation
  • human papillomavirus
  • screening
  • vaccination

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Campos, N. G., Kim, J. J., Castle, P. E., Ortendahl, J. D., O'Shea, M., Diaz, M., & Goldie, S. J. (2012). Health and economic impact of HPV 16/18 vaccination and cervical cancer screening in Eastern Africa. International Journal of Cancer, 130(11), 2672-2684. https://doi.org/10.1002/ijc.26269

Health and economic impact of HPV 16/18 vaccination and cervical cancer screening in Eastern Africa. / Campos, Nicole G.; Kim, Jane J.; Castle, Philip E.; Ortendahl, Jesse D.; O'Shea, Meredith; Diaz, Mireia; Goldie, Sue J.

In: International Journal of Cancer, Vol. 130, No. 11, 01.06.2012, p. 2672-2684.

Research output: Contribution to journalArticle

Campos, NG, Kim, JJ, Castle, PE, Ortendahl, JD, O'Shea, M, Diaz, M & Goldie, SJ 2012, 'Health and economic impact of HPV 16/18 vaccination and cervical cancer screening in Eastern Africa', International Journal of Cancer, vol. 130, no. 11, pp. 2672-2684. https://doi.org/10.1002/ijc.26269
Campos, Nicole G. ; Kim, Jane J. ; Castle, Philip E. ; Ortendahl, Jesse D. ; O'Shea, Meredith ; Diaz, Mireia ; Goldie, Sue J. / Health and economic impact of HPV 16/18 vaccination and cervical cancer screening in Eastern Africa. In: International Journal of Cancer. 2012 ; Vol. 130, No. 11. pp. 2672-2684.
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