The DOI matches its Crossref record; 31 of the 31 references it cites were found in a registry or an index; 2 of the 30 sources its claims cite were checked for support.
Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India
Open accessAbstract
Cervical cancer is a leading cause of cancer death among women in low-income countries, with approximately 25% of cases worldwide occurring in India. We estimated the potential health and economic impact of different cervical cancer prevention strategies. After empirically calibrating a cervical cancer model to country-specific epidemiologic data, we projected cancer incidence, life expectancy, and lifetime costs (I$2005), and calculated incremental cost-effectiveness ratios (I$/YLS) for the following strategies: pre-adolescent vaccination of girls before age 12, screening of women over age 30, and combined vaccination and screening. Screening differed by test (cytology, visual inspection, HPV DNA testing), number of clinical visits (1, 2 or 3), frequency (1 x , 2 x , 3 x per lifetime), and age range (35-45). Vaccine efficacy, coverage, and costs were varied in sensitivity analyses. Assuming 70% coverage, mean reduction in lifetime cancer risk was 44% (range, 28-57%) with HPV 16,18 vaccination alone, and 21-33% with screening three times per lifetime. Combining vaccination and screening three times per lifetime provided a mean reduction of 56% (vaccination plus 3-visit conventional cytology) to 63% (vaccination plus 2-visit HPV DNA testing). At a cost per vaccinated girl of I$10 (per dose cost of $2), pre-adolescent vaccination followed by screening three times per lifetime using either VIA or HPV DNA testing, would be considered cost-effective using the country's per capita gross domestic product (I$3452) as a threshold. In India, if high coverage of pre-adolescent girls with a low-cost HPV vaccine that provides long-term protection is achievable, vaccination followed by screening three times per lifetime is expected to reduce cancer deaths by half, and be cost-effective.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
This modeling study projected that in India, pre-adolescent HPV 16/18 vaccination plus screening three times per lifetime could substantially reduce cervical cancer burden and be cost-effective if the vaccine is very low-cost. At a cost per vaccinated girl of I$10 (about $2 per dose), vaccination followed by VIA or HPV DNA screening was expected to be cost-effective using India’s per capita GDP (I$3452) as a threshold.
Key findings
- Assuming 70% coverage, pre-adolescent HPV 16/18 vaccination alone reduced mean lifetime cervical cancer risk by 44% (range, 28–57%); screening three times per lifetime reduced risk by 21–33%.
- Combining vaccination with screening three times per lifetime gave a mean reduction of 56% (vaccination plus 3-visit conventional cytology) to 63% (vaccination plus 2-visit HPV DNA testing).
- At I$10 per vaccinated girl, vaccination followed by screening three times per lifetime using VIA cost I$290 per year of life saved (YLS); at I$20 per vaccinated girl, single-visit VIA screening alone cost I$60 per YLS compared with no intervention and became more cost-effective than vaccination alone.
- At a vaccine price of about $100 per dose (I$360 per vaccinated girl), vaccination was dominated by screening alone; combined vaccination plus single-visit VIA rose to I$7230 per YLS. If only HPV DNA testing was available, screening alone was dominated below I$50 per vaccinated girl, and combined vaccination plus two-visit HPV DNA testing three times per lifetime was I$1780 per YLS across that range.
Methods
- An individual-based stochastic microsimulation model of cervical carcinogenesis was calibrated to country-specific epidemiologic data from southeastern India, including HPV prevalence and type distribution from Tamil Nadu and cancer incidence from Bangalore and Chennai registries; a single birth cohort of girls entered at age 9 and was followed for life.
- Strategies compared were pre-adolescent HPV 16/18 vaccination before age 12, screening of women over age 30 by cytology, VIA, or HPV DNA testing with varying visits, frequency, and ages, and combined vaccination plus screening; base case assumed 70% coverage, screening at ages 35, 40, and 45, 3% annual discounting, societal perspective, and costs in I$2005.
- Outcomes were cancer incidence reduction, life expectancy gains, discounted lifetime costs, and incremental cost-effectiveness ratios (I$/YLS), with one-way, two-way, and probabilistic sensitivity analyses across good-fitting parameter sets.
Limitations
- The paper states that model parameter uncertainty remains, especially about HPV natural history in older women, type-specific immunity after natural infection, and multiple HPV infections; lack of high-quality temporal trend data limited calibration to a single birth cohort.
- The authors state they used a microsimulation model rather than an HPV transmission model, so herd immunity was not directly modeled, and they describe the findings as exploratory and cost-effectiveness estimates as approximate; affordability was not equivalent to cost-effectiveness.
- Evident from the text: base-case results assume lifelong vaccine protection and 70% coverage, use cost estimates from a prior India screening analysis, and assume 15% loss to follow-up between visits; actual vaccine price and programmatic delivery costs in India were unknown.
Model-written summary. Check it against the paper before relying on it.
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Verification
Claims the paper makes
2 of 30 cited sources checked · 0 supported · 1 flagged · accuracy not yet measured
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“While our independent dynamic model (Kim et al, 2007b) has been previously used to include the herd immunity effects in an HPV vaccine policy analysis, sensitivity analyses that reduced incidence based on these findings, found the main policy results would be unlikely to change.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Discussion
What the sources say
- Partly supportedcites Kim et al, 2007b sourceExperimental — accuracy not yet measured
The Methods (Dynamic model; page unavailable) say that projected reductions in HPV incidence, including herd-immunity effects, were used as inputs to the policy model. The Results report sensitivity analyses and the Discussion favours prioritising vaccination of girls, but our copy does not identify a sensitivity analysis that reduced incidence based on those herd-immunity findings or state that such an analysis left the main policy results unchanged. (LLM, conf=0.82)
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Partly supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Pre-adolescent vaccination alone reduced cancer incidence by 44% (range, 28–57%) and was more effective than screening alone (Figure 2, upper panel).”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Results > Reduction in lifetime risk of cancer
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“At a vaccine price per dose of approximately $100 (I$360 per vaccinated girl), vaccination was dominated by (i.e., either less costly and less cost-effective than or more costly and less effective than) screening alone.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Results > Cost-effectiveness of vaccination and screening
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For example, without screening, a threshold of 50% cancer reduction (dashed red line) was expected to be attainable with vaccination alone only at vaccination coverage rates exceeding 80% and vaccine efficacy of 100%.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Results > Sensitivity analysis
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Assuming 70% coverage, mean reduction in lifetime cancer risk was 44% (range, 28–57%) with HPV 16,18 vaccination alone”
- Also stated in: § Reduction in lifetime risk of cancer · plain
“Pre-adolescent vaccination alone reduced cancer incidence by 44% (range, 28–57%)”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- The authors state this as an assumption: The mechanism of cervical carcinogenesis does not fundamentally differ between countries.
- The authors state this as an assumption: Vaccinated girls have life-long protection against HPV 16 and 18.
- The authors state this as an assumption: Vaccinated girls are subject to the same rate of infection with other high-risk HPV types as those who are not vaccinated.
- Also stated in: § Reduction in lifetime risk of cancer · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Once the cost per vaccinated girl reached I$50, screening alone was no longer dominated.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Results > Cost-effectiveness of vaccination and screening
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Vaccination and screening three times per lifetime with VIA was I$290 per YLS.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Results > Cost-effectiveness of vaccination and screening
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In this case, screening three times per lifetime with two-visit HPV DNA testing was I$720 per YLS, compared to no intervention.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Results > Cost-effectiveness of vaccination and screening
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“All strategies requiring multiple visits became more attractive when loss to follow-up was reduced.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Results > Sensitivity analysis
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Combining vaccination and screening three times per lifetime provided a mean reduction of 56% (vaccination plus 3-visit conventional cytology) to 63% (vaccination plus 2-visit HPV DNA testing).”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- The authors state this as an assumption: The mechanism of cervical carcinogenesis does not fundamentally differ between countries.
- The authors state this as an assumption: Vaccinated girls have life-long protection against HPV 16 and 18.
- The authors state this as an assumption: Vaccinated girls are subject to the same rate of infection with other high-risk HPV types as those who are not vaccinated.
- It may state two separate claims as one. 25
- The quote only partly states this claim. 1
- Probably not a substantial claim. 21
At least one cited source doesn’t support this claim or points to a different paper, and none confirmed it — see the verdicts below.
In the paper
“This was a purposeful decision as the former can simulate detailed screening strategies as well as vaccination, and includes other HPV types not targeted by the vaccine, enabling us to take advantage of all available data by calibrating to many epidemiological targets (Garnett et al, 2006).”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Discussion
What the sources say
- Disputedcites Kim et al, 2007b sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 1 partially supported, 1 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Checked by a reasoning model — may be wrong.
- Not checked — no full text of the sourcecites Garnett et al, 2006 source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Disputed
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Across this same range of vaccine costs, pre-adolescent vaccination combined with two-visit HPV DNA testing three times per lifetime was I$1780 per YLS; at higher costs (I$360 per vaccinated girl) this strategy increased to I$7650 per YLS, compared to the next best strategy.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Results > Cost-effectiveness of vaccination and screening
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Assuming a cost of I$20 per vaccinated girl, if VIA screening was 30% less sensitive and costs were increased to I$2, vaccination alone dominated VIA screening, although VIA combined with vaccination approximated I$975 per YLS (see Supplementary Appendix).”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Results > Sensitivity analysis
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“When the cost per vaccinated girl reached and exceeded I$20, screening three times per lifetime (at ages 35, 40, and 45) with a single-visit VIA strategy was less costly and more cost-effective than vaccination alone, and cost I$60 per YLS compared to no intervention.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Results > Cost-effectiveness of vaccination and screening
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“and 21–33% with screening three times per lifetime.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe quote only partly states this claim.
- The authors state this as an assumption: The mechanism of cervical carcinogenesis does not fundamentally differ between countries.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A combined strategy of vaccination and screening always provided greater cancer reduction than vaccination alone; however, the incremental benefits achieved by adding screening three times per lifetime were greater at lower vaccination coverage rates.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Results > Sensitivity analysis
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Assuming that all strategies were equally available (Table 2a) and provided the cost per vaccinated girl was I$10 ($2 per dose) or less, vaccination alone was more effective and cost-effective than screening alone.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Results > Cost-effectiveness of vaccination and screening
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For example, if training costs associated with VIA raised the total screening cost such that it would approach that of HPV DNA testing, vaccination plus screening three times per lifetime with two-visit HPV DNA testing was favored, at I$1780 per YLS – if a rapid HPV DNA test was available, allowing for a single-visit screen-and-treat strategy, this result would become even more favourable.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Results > Sensitivity analysis
Strength:hedged· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“At vaccination coverage rates of 40–50%, screening coverage would need to exceed 80%, but at vaccination coverage of 70%, screening coverage of 40–50% would suffice.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Results > Sensitivity analysis
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“For example, we found that per 1000 girls vaccinated, 15 deaths would be averted (Goldie et al. 2008 in press), which compares favourably to 3 deaths prevented per 1000 children vaccinated for rotavirus (IAVI/PATH, 2007).”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Discussion
What the sources say
- Not checked — no full text of the sourcecites Goldie et al. 2008 in press source
- Not matchedcites IAVI/PATH, 2007
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“We have previously documented a small expected increase in non-16,18 cancers (Goldie et al, 2003, 2007), although we again found that the impact on the main cost-effectiveness results was small.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Discussion
What the sources say
- Not matchedcites Goldie et al, 2003, 2007
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although the rank-ordering of screening strategies from most effective to least effective, was two-visit HPV DNA testing, single-visit VIA, and three-visit cytology, differences between these screening approaches were somewhat attenuated at higher vaccination coverage rates.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For example, across the good-fitting parameter sets, the mean cancer reduction with vaccination alone ranged from 28 to 57%, whereas with combined vaccination and screening three times per lifetime using two-visit HPV DNA testing ranged from 53 to 76%.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: Vaccination prevents infections with HPV types 16 and 18.
- Rests on an assumption: Screening allows for treatment of precancerous lesions (caused by any high-risk HPV type) before progression to invasive cancer.
None of the sources cited for this claim have been checked yet.
In the paper
“We followed published recommendations for economic evaluations (DCPP; Gold et al, 1996; Drummond et al, 2005; WHO CHOICE) by adopting a societal perspective and discounting future costs and life years by 3% annually.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Materials and methods > Analytic overview
What the sources say
- Not matchedcites Gold et al, 1996
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked — no full text of the sourcecites Drummond et al, 2005 source
- Not matchedcites WHO CHOICE
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“To explicitly incorporate the effect of parameter uncertainty, cost-effectiveness analyses were conducted with a random sample of good-fitting parameter sets, and results were reported as the mean and range of outcomes, whereas incremental cost-effectiveness ratios were reported as the ratio of the mean costs divided by the mean effects of one strategy vs another across the good-fitting parameter”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Materials and methods > Epidemiological data
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
In the paper
“Although cervical cancer is the most frequent cancer diagnosis in Indian women, age-adjusted incidence rates vary between regions, ranging from 10.9 in Trivandrum to 47.2 per 100 000 person-years at risk in Chennai (Parkin et al, 2005).”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Abstract
What the sources say
- Not matchedcites Parkin et al, 2005
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In India, if high coverage of pre-adolescent girls with a low-cost HPV vaccine that provides long-term protection is achievable, vaccination followed by screening three times per lifetime is expected to reduce cancer deaths by half, and be cost-effective.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: The mechanism of cervical carcinogenesis does not fundamentally differ between countries.
- The authors state this as an assumption: Vaccinated girls have life-long protection against HPV 16 and 18.
- The authors state this as an assumption: Vaccinated girls are subject to the same rate of infection with other high-risk HPV types as those who are not vaccinated.
In the paper
“Although there is no consensus on a specific cost-effectiveness threshold, below which an intervention would be considered cost-effective, one suggested heuristic has been to use the country's per capita GDP (WHO, 2001).”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Results > Cost-effectiveness of vaccination and screening
What the sources say
- Not matchedcites WHO, 2001
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
- Not matched
In the paper
“Although cervical cancer is the most frequent cancer diagnosis in Indian women, age-adjusted incidence rates vary between regions, ranging from 10.9 in Trivandrum to 47.2 per 100 000 person-years at risk in Chennai (Parkin et al, 2005).”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Abstract
What the sources say
- Not matchedcites Parkin et al, 2005
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
In the paper
“More than 25% of cervical cancer cases worldwide occur in India (Ferlay et al, 2004).”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Abstract
What the sources say
- Not matchedcites Ferlay et al, 2004
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Parameter uncertainty was evaluated using one- and two-way sensitivity analysis, and probabilistic analysis.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Materials and methods > Analytic overview
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“As the model includes vaccine-targeted and non-targeted HPV types, we were able to explore the potential effect of an increase in non-vaccine-targeted HPV types.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Discussion
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“On the basis of age-specific incidence and projected demographic changes, the expected new cases of cervical cancer in India will increase from 132 082 in year 2002, to more than 330 000 in 2050 (Ferlay et al, 2004).”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Discussion
What the sources say
- Not matchedcites Ferlay et al, 2004
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“they are synergistic, and provide substantially greater benefits than either alone.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: Vaccination prevents infections with HPV types 16 and 18.
- Rests on an assumption: Screening allows for treatment of precancerous lesions (caused by any high-risk HPV type) before progression to invasive cancer.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The strategies that we have identified as cost-effective in this analysis may still be prohibitively expensive in India”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Discussion
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“if there is less robust vaccine-induced immunity in girls with other diseases, such as severe anaemia, chronic illness or HIV”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Discussion
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“For most of these factors, a lack of data prohibit us from estimating the magnitude of individual potential effects; that being said, these are uncertain issues for which empiric data are needed.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Discussion
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Prevention and treatment of cervical cancer, the leading cause of cancer in Indian women, is a priority according to the country's National Cancer Control Programme (Government of India, 2005).”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Discussion
What the sources say
- Not matchedcites Government of India, 2005
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“if there are herd immunity benefits to unvaccinated individuals”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Discussion
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“this ratio is a fraction of India's per capita GDP, and would be considered very cost-effective according to suggested benchmarks for developing countries (WHO, 2001).”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Discussion
What the sources say
- Not matchedcites WHO, 2001
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“If a cytology-based strategy could be conducted in two visits without the use of colposcopy for diagnostic confirmation, it could be more attractive than predicted by our analysis due to reduced loss to follow-up.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Discussion
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Our analysis has several limitations, and thus, we emphasise that our results are intended to provide quantitative approximations of the potential benefits of HPV vaccination, and to provide qualitative insight into the relative value of primary and secondary prevention.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Discussion
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Given the range of uncertainties and the limitations of this analysis, our findings should be considered exploratory and our estimates of cost-effectiveness approximate, and should be interpreted in the context of the analytic purpose of this work, that is, to leverage the best available data to provide insight into decisions that policy makers in India are discussing right now.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Discussion
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the impact of the vaccine could be higher if there is long-term cross-protection against non-16,18 type infection”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Discussion
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Similarly, a lack of high quality data on temporal trends of HPV-related disease limited our ability to calibrate the model to different time points, and contributed to the choice to simulate a single birth cohort.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“or if vaccine-induced immunity wanes while individuals are still at risk for new HPV infections.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Discussion
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“and if non-cervical HPV 16,18-related cancers and diseases are prevented.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Discussion
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In addition to model parameter uncertainty, there are uncertainties with respect to the natural history of HPV, especially in older women, the nature of type-specific immunity following natural infection, and the relationships between different HPV types in the case of multiple infections.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Discussion
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The effectiveness of the vaccine could be lower than we projected if older girls, who may have been infected previously with type 16 or 18, are vaccinated”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Discussion
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although screening three time per lifetime prevents additional deaths from non-16 and 18-type associated cancers, as well as 16,18-associated cancers in the proportion of the population not vaccinated, it also provides some insurance of cancer risk protection in the context of the uncertainty around long-term vaccine performance in a non-clinical trial situation.”
§ Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: Screening allows for treatment of precancerous lesions (caused by any high-risk HPV type) before progression to invasive cancer.
The authors state this as an assumption.
The mechanism of cervical carcinogenesis does not fundamentally differ between countries.
“We assumed that the mechanism of cervical carcinogenesis does not fundamentally differ between countries; as such, initial natural history model estimates, and their plausible ranges, were based on the best available data regardless of specific setting.”
The authors state this as an assumption.
Vaccinated girls have life-long protection against HPV 16 and 18.
“We also assumed vaccinated girls have life-long protection against HPV 16 and 18, but are subject to the same rate of infection with other high-risk HPV types as those who are not vaccinated.”
The authors state this as an assumption.
Vaccinated girls are subject to the same rate of infection with other high-risk HPV types as those who are not vaccinated.
“We also assumed vaccinated girls have life-long protection against HPV 16 and 18, but are subject to the same rate of infection with other high-risk HPV types as those who are not vaccinated.”
The paper relies on this without support.
Vaccination prevents infections with HPV types 16 and 18.
“with vaccination preventing infections with HPV types 16 and 18”
The paper relies on this without support.
Screening allows for treatment of precancerous lesions (caused by any high-risk HPV type) before progression to invasive cancer.
“screening allowing for treatment of precancerous lesions (caused by any high-risk HPV type) before progression to invasive cancer”
The paper relies on this without support.
The vast majority of women will lack curative treatment, and approximately two-thirds will die from cervical cancer.
“The vast majority of women will lack curative treatment, and thus, approximately two-thirds will die from this preventable disease.”
The paper relies on this without support.
Women who will benefit from vaccination are not in the same birth cohorts as the women who benefit from screening in the short-run.
“women who will benefit from vaccination are not in the same birth cohorts as the women who benefit from screening in the short-run”
The paper relies on this without support.
The vaccine-preventable cervical cancer burden in India is a product of underlying cervical cancer incidence, the proportion of cancer attributable to HPV 16 and 18, long-term vaccine efficacy, and ability to achieve high coverage in adolescent girls before sexual activity.
“The vaccine-preventable cervical cancer burden in India is a product of several factors, including the underlying cervical cancer incidence, the proportion of cancer attributable to HPV 16 and 18, the long-term vaccine efficacy, and the ability to achieve high coverage in adolescent girls before sexual activity.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Using an individual based stochastic model for India, Diaz et al (2008) reported mean cancer reduction as 29%, 21% and 33%, when women were screened thrice per lifetime with VIA, cytology and HPV DNA, respectively. [47]”
From Cost effectiveness of strategies for cervical cancer prevention in India (2020) · cites this paper as [47]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Our projections also support previous modelling studies2, 31, 32 that found high coverage of vaccination against HPV16 and HPV18 in girls aged 10 years could reduce the burden of cervical cancer in India considerably, and enable the country to reach the WHO elimination target even with single-dose vaccination.”
From Evidence-based impact projections of single-dose human papillomavirus vaccination in India: a modelling study (2022) · cites this paper as [32]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Screening three times in a lifetime reduces cervical cancer risk by 21-33% (Diaz et al., 2008).”
From Indian Parents Prefer Vaccinating their Daughters against HPV at Older Ages (2014) · cites this paper as Diaz et al., 2008
The cited source says what the claim attributes to it.
In the citing paper
“However, our cost estimates were higher than what was reported by Diaz et al and Goldie et al even after adjustment of latter estimates for inflation since the year of estimation. [47, 48].”
From Cost effectiveness of strategies for cervical cancer prevention in India (2020) · cites this paper as [47]
Citations
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Flagged first, then by citations
Research works printed but not linked: 2
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Cited by
Sorted by citations
Items 101–132 of 132
Njau, J. D., & Cairns, L. (2016) · Vaccine Reports · doi:10.1016/j.vacrep.2016.11.002 · Cited by 3
Reply to Cost‐effectiveness calculations of human papillomavirus vaccination in Punjab may be flawed
Prinja, S., Bahuguna, P., Faujdar, D. S., Jyani, G., Srinivasan, R., Ghoshal, S., Suri, V., Singh, M. P., & Kumar, R. (2017) · Cancer · doi:10.1002/cncr.31074 · Cited by 3
“The first point is based on purported differences between our findings and those of Diaz et al.2 Diaz et al stated that when the cost per vaccinated girl reached Int $ 20 (US $6.60), the strategy of vaccination alone became dominated by the strategy of screening alone.”
MethodInfluentialRasmussen, P. W., Hoffman, R. M., Phiri, S., Makwaya, A., Kominski, G. F., Bastani, R., Moses, A., & Moucheraud, C. (2024) · BMC Health Services Research · doi:10.1186/s12913-024-11226-2 · Cited by 3
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“In a study by Diaz M et al.(17) preadolescent vaccination alone reduced cancer incidence by 44% (range, 28–57%) and was more effective than screening alone (Fig.”
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Cervical Cancer and Ethical issues in HPV Vaccination
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“The lifetime risk of cervical cancer can reduce by 44% among 70% of the pre-adolescent girls (girls below age 12) who are vaccinated against HPV 9 .”
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Azangou‐Khyavy, M., Ghasemi, E., Rezaei, N., Khanali, J., Kolahi, A.-A., Malekpour, M.-R., Heidari‐Foroozan, M., Nasserinejad, M., Mohammadi, E., Abbasi‐Kangevari, M., et al. (2024) · Figshare · doi:10.6084/m9.figshare.25067309
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Costs of HPV vaccination programs in low- and middle-income countries: A systematic review
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“and screening in India found that these strategies could be effective in reducing cancer burden by as much as 63 % and could prove to be a cost-effective health strategy for the country as a whole [11].”
HPV and Cervical Cancer Epidemiology - Current Status of HPV Vaccination in India
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Metadata
- Authors
- Diaz, M., Kim, J. J., Albero, G., de Sanjosé, S., Clifford, G., Bosch, F. X., & Goldie, S. J.
- Affiliations
- Harvard University (US)
- Institut Català d'Oncologia (ES)
- Centre international de recherche sur le cancer (FR)
- Corresponding author
- Goldie, S J
- Venue
- British Journal of Cancer
- Published
- 2008-07
- Volume
- 99
- Issue
- 2
- Pages
- 230-238
- ISSN
- 0007-0920 (ISSN-L)
- 1532-1827
- PMC
- PMC2480962
- OpenAlex
- W1987323551
- Semantic Scholar
- 8c34bd3b6bae21af6572788bf120992d70c59ffe
- Cited by
- 132
- References
- 30
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 10 · 2023: 5 · 2022: 2 · 2021: 5 · 2020: 4 · 2019: 6 · 2018: 3 · 2017: 14 · 2016: 9 · 2015: 12 · 2014: 3 · 2013: 14 · 2012: 8
- FWCI
- 7.44
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-sa
- www.springer.com/tdm (unspecified)
- Locations
- British Journal of Cancer (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (submittedVersion, cc-by)
- PubMed Central (submittedVersion, cc-by)
- Funders
- Bill and Melinda Gates Foundation (30505)
- Topics
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- cervical cancer, cervical cancer screening, cost-effectiveness, HPV testing, visual inspection with acetic acid, cytology, cancer incidence, life expectancy, lifetime costs, cancer prevention, India
- MeSH terms
- Uterine Cervical Neoplasms, Cost-Benefit Analysis, DNA, Viral, Female, Humans, India, Mass Screening, Risk Factors, Stochastic Processes, Vaccination, Models, Statistical, Models, Economic, Papillomavirus Infections, Human papillomavirus 18, Human papillomavirus 16, Papillomavirus Vaccines
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
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