Health and economic benefits of single-dose HPV vaccination in a Gavi-eligible country
Open accessAbstract
BACKGROUND: Although guidelines for prophylactic human papillomavirus (HPV) vaccination recommend two doses for girls ages 9-14 years, several studies have demonstrated similar protection with one dose. Our objective was to evaluate the long-term health and economic impacts of routine one-dose HPV vaccination compared to (1) no vaccination and (2) two-dose HPV vaccination in a low-income country. METHODS: We used a three-tiered hybrid modeling approach that captured HPV transmission, cervical carcinogenesis, and population demographics to project long-term health and economic outcomes associated with one-dose HPV vaccination (assuming 80% efficacy against HPV-16/18 infections under three waning scenarios) and two-dose HPV vaccination (assuming 100% efficacy over the lifetime) in Uganda. Costs included the vaccine program (dosage and delivery) costs over a 10-year period and cervical cancer costs over the lifetimes of the current population of Ugandan women. Health outcomes included number of cervical cancer cases and disability-adjusted life years (DALYs). Incremental cost-effectiveness ratios (i.e., cost per DALY averted) were calculated and compared against the Ugandan per-capita gross domestic product. RESULTS: Routine one-dose HPV vaccination of 9-year-old girls required substantial upfront investment but was cost-saving compared to no vaccination when accounting for the cost-offsets from future cancers averted. Forty years after initiating routine vaccination and depending on assumptions of vaccine waning, one-dose HPV vaccination with equivalent coverage (70%) averted 15-16% of cervical cancer cases versus 21% with two-dose vaccination but required only half the upfront economic investment. Vaccination with two doses had an attractive cost-effectiveness profile except if one-dose vaccination enabled higher coverage (90% vs. 70%) and did not wane. CONCLUSIONS: One-dose HPV vaccination resulted in cost-savings compared to no vaccination and could be cost-effective compared to two-dose vaccination if protection is longstanding and higher coverage can be achieved.
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The study used a comparative modelling approach including three models that have been extensively peer reviewed and validated with post-vaccination surveillance data.
“First, we used a comparative modelling approach including three models that have been extensively peer reviewed and validated with post-vaccination surveillance data.30, 31, 32, 33, 34, 35, 36”
From Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries (2020) · cites this paper as [32]
The Methods (Analytic overview; page unavailable) describe a three-tiered approach linking Harvard-HPV, Harvard-CC, and Harvard-Scale Up. The paper does not say that these three models were extensively peer reviewed or validated against post-vaccination surveillance data; the Methods (Simulation models; page unavailable) describe calibration to Ugandan epidemiological outcomes, which is not the same claim. (LLM, conf=0.88)
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- Authors
- Burger, E. A., Campos, N. G., Sy, S., Regan, C., & Kim, J. J.
- Affiliations
- Harvard University (US)
- Corresponding author
- Burger, Emily A.
- Venue
- Vaccine
- Publisher
- Elsevier BV
- Published
- 2018-08
- Volume
- 36
- Issue
- 32
- Pages
- 4823-4829
- ISSN
- 0264-410X (ISSN-L)
- PMC
- PMC6066173
- OpenAlex
- W2803487478
- Cited by
- 72
- References
- 22
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 20 · 2023: 6 · 2022: 9 · 2021: 10 · 2020: 8 · 2019: 6 · 2018: 3
- FWCI
- 5.27
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Vaccine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
- Funders
- Bill and Melinda Gates Foundation
- Topics
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Surgery › Genital Health and Disease
- Keywords
- HPV vaccination, single-dose vaccination, two-dose vaccination, cervical cancer prevention, vaccine waning, cost-effectiveness, disability-adjusted life years, low-income countries, Uganda, HPV 16/18, cervical carcinogenesis
- MeSH terms
- Adolescent, Uterine Cervical Neoplasms, Child, Cost-Benefit Analysis, Delivery of Health Care, Female, Humans, Immunization Schedule, Uganda, Quality-Adjusted Life Years, Papillomavirus Infections, Mass Vaccination, Human papillomavirus 18, Human papillomavirus 16, Papillomavirus Vaccines
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