The Use of Reimbursement Data for Timely Monitoring of Vaccination Coverage: The Example of Human Papillomavirus Vaccine Following Public Concerns About Vaccine Safety

Background

Since 2011 public concerns about Human Papillomavirus (HPV) vaccination safety and efficacy arose in France. We explored the relevance of using vaccines reimbursement data to assess the impact of those public concerns on vaccination coverage.

Methods

We used the Permanent Sample of Beneficiaries which was, at the time of the study, a representative sample of 1/97 ^th health insurance beneficiaries of the main Social Security scheme, the General Health Insurance Scheme, covering approximately 77 % of the French resident population. We estimated HPV vaccination coverage among girls born between 1995 and 1999 at their 15 ^th , 16 ^th and 17 ^th birthday.

Results

The coverage for complete vaccination among 16 years old girls decreased from 26.5 % in the first semester of 2011 to 18.6 % in the first semester of 2014.

Conclusions

HPV vaccination coverage was already low in 2011 and continued to decrease thereafter. Vaccines reimbursement data allowed us to reactively monitor the impact of the controversy on vaccination coverage and design counteracting measures.

Below:  Vaccination coverage with one dose of HPV vaccine at 15 th birthday and three doses at 16 th birthday, by quarter periods, January 2010–June 2014

Below:  Cumulative vaccination coverage for 3 doses of HPV vaccine according to age and half year of birth. France

Full article at:   http://goo.gl/pTup37

By:   Laure Fonteneau¹², Marine Ragot¹, Isabelle Parent du Châtelet¹, Jean-Paul Guthmann¹and Daniel Lévy-Bruhl^1*

¹Institut de Veille Sanitaire (InVS), Saint-Maurice, France

²European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden

 

More at:  https://twitter.com/hiv_insight

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GAVI: 15 Years, 500 Million Vaccines

Via:  http://www.gavi.org/data-vis/  HT https://twitter.com/Gavi

Monitoring Effect of Human Papillomavirus Vaccines in US Population, Emerging Infections Program, 2008–2012

Below:  Prevalence of human papillomavirus (HPV) types among women with a diagnosis of cervical intraepithelial neoplasia grade 2 or 3 or adenocarcinoma in situ, Emerging Infections Program HPV-IMPACT project, 2008–2012. HPV-16 and -18 are the most common oncogenic HPV types; HPV-6 and -11 are nononcogenic HPV types that cause genital warts and respiratory papillomatosis.

In 2007, five Emerging Infections Program (EIP) sites were funded to determine the feasibility of establishing a population-based surveillance system for monitoring the effect of human papillomavirus (HPV) vaccine on pre-invasive cervical lesions. The project involved active population-based surveillance of cervical intraepithelial neoplasia grades 2 and 3 and adenocarcinoma in situ as well as associated HPV types in women >18 years of age residing in defined catchment areas; collecting relevant clinical information and detailed HPV vaccination histories for women 18–39 years of age; and estimating the annual rate of cervical cancer screening among the catchment area population. The first few years of the project provided key information, including data on HPV type distribution, before expected effect of vaccine introduction. The project’s success exemplifies the flexibility of EIP’s network to expand core activities to include emerging surveillance needs beyond acute infectious diseases. Project results contribute key information regarding the impact of HPV vaccination in the United States.

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If there was a vaccine against cancer, wouldn't you get it for your keiki?

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A Cost-Utility Analysis of Cervical Cancer Screening and Human Papillomavirus Vaccination in the Philippines

Below: Costs and health outcomes of optimal strategies for the prevention of cervical cancer

Below:  Efficiency frontier curve of optimal cervical cancer prevention strategies at varying coverage scenarios

Below:  Model validation

Across all coverage scenarios, VIA has been shown to be a dominant and cost-saving screening strategy with incremental cost-effectiveness ratio (ICER) ranging from dominant to Php 61,059 (1443 USD) per QALY gained. VIA can reduce cervical cancer cases and deaths by 25 %. Pap smear screening was found to be not cost-effective due to its high cost in the Philippines. Adding HPV vaccination at a cost of 54 USD per vaccinated girl on top of VIA screening was found to be potentially cost-effective using a threshold of 1 GDP per capita (i.e., Php 120,000 or 2835 USD/ QALY) with the most favorable assumption of providing lifelong immunity against high-risk oncogenic HPV types 16/18. The highest incremental QALY gain was achieved with 80 % coverage of the combined strategy of VIA at 35 to 45 years old done every five years following vaccination at 11 years of age with an ICER of Php 33,126 (783 USD). This strategy may result in a two-thirds reduction in cervical cancer burden. HPV vaccination is not cost-effective when vaccine protection lasts for less than 20 years.

High VIA coverage targeting women aged 35–45 years old at five-year intervals is the most efficient and cost-saving strategy in reducing cervical cancer burden in the Philippines. Adding a vaccination program at high coverage among 11-year-old girls is potentially cost-effective in the Philippines assuming a life-long duration of vaccine efficacy.

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