<![CDATA[Cost-effectiveness of elimination of HPV-cancers]]>

Dr. Mark Jit presented the prospects of elimination or eradication of the major oncogenic human papillomavirus (HPV) types 16 and 18 by national vaccination programs, especially in relation to cost-effectiveness. The eradication of smallpox in the 1970’s continue to result in annual savings of 70 million international dollars worth and puts the HPV16/18 eradication goal into perspective (Figure 1).

A recent systematic review of 17 different dynamic transmission models suggest that elimination of all genital HPV types other than HPV16 results from 80% coverage girls-only vaccination. For the elimination of HPV16, a gender-neutral vaccination program with a similar coverage for 40 years will probably be needed [1].

The imminent problems with strategies that attempt single country-specific elimination are the maintenance costs of high coverage vaccination and the vigilance for re-introduction (table 1). These are due to the vulnerability of the general population to outbreaks and to the increasing marginal costs that result from attempts to increase vaccination coverage in hard-to-reach sub-populations. On the other hand, global eradication of HPV types 16/18 (or other vaccine-covered oncogenic HPV types) would require at least 10 additional years of gender-neutral vaccination with 80% coverage worldwide, according to a dynamic transmission model.

Compared to the two current options: no vaccination or partial coverage HPV vaccination (the current national programs), HPV eradication targets the abolishment of the associated disease burden. This would eventually be cost-saving, even if a much bigger investment than that of the past smallpox or the present polio eradication.

Figure 1. A child infected with smallpox. Since the 1980 declaration of small pox worldwide eradication, every year approximately 70 million international dollars are being saved. Vaccination enables a long term avoidance of disease and the benefits will continue to cumulate over the years.

Table 1. Cost and impact - of different human papillomavirus vaccination options.

References
1. Brisson M, Bernard E, Drolet M, et al. Population-level impact, herd immunity, and elimination after human papillomavirus vaccination: a systematic review and meta-analysis of predictions from transmission-dynamic models. Lancet Global Health, 2016. 1e:p.8-17.

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Mark Jit, PhD
London School of Hygiene & Tropical Medicine and Public Health
London, England
M.Jit@lshtm.ac.uk

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