Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

Background About 300 women get cervical cancer and about 100 die from cervical cancer every year in Norway. Cervical cancer is primarily caused by continuous infection with human papilloma virus (HPV), and over 120 strains of HPV have been identified. About 14 of these are are oncogenic. HPV-16 and HPV-18 can be found in about 70% of of the women with cervical cancer. Most HPV infections will cease by themselves, but where the infections persist, there is an increased risk for cellular changes. There exist vaccines against HPV 16/18, but there is yet no evidence that the vaccine is effective against cervical cancer. This has incited fierce debates on whether to introduce the HPV vaccine in national or statewide vaccination programs. This report aims at highlighting and discussing the moral aspects that are relevant for the decision making process with regards to HPV vaccine. Method The report uses a method developed for addressing ethical issues in health technology assessments (HTAs) that discusses central moral questions related to health interventions. The aim is not to give unequivocal answers to the questions, but rather to elucidate arguments and aspects that are important for decision makers and stake holders. Results The potential utility of HPV-16/18 vaccination is considerable, but morally challenging, as the real impact of HPV vaccination on cervical cancer is not known, and the vaccine is costly. Vaccination is an intervention towards healthy people, calling for special attention, especially as there is considerable uncertainty about its effects and side effects. It is challenging to assess future utility of potential prophylactic interventions against the utility of health interventions today. HPV vaccine of children is also challenging with respect to informed consent. Informing the public and potential persons to receive the vaccine appears to be a considerable challenge. Conclusion HPV vaccination can potentially save 40 women from getting cervical cancer every year and 13 from dying, but there is no evidence for this, and vaccination is costly. That raises a series of morally challenging issues that are important to address when deciding whether to implement the vaccine or not (and how to implement it).

Papillomavirus vaccines.

Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

Papillomavirus vaccines --- immunology --- Papillomavirus vaccines --- immunology

Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

HPV vaccination is highly efficacious against the development of high risk HPV 16/18 type related infections, the most common cause of cervical cancer. In Norway, the current screening strategy (since 1995) is to screen every 3 years, woman aged 25 to 69. How effective and cost-effective HPV vaccination alongside screening would be over the long-term remain key issues for decision makers considering programme introduction. Methods The objective of this report was to estimate the potential cost-effectiveness of an HPV 16/18 type vaccination alongside screening compared to screening alone. A dynamic model of HPV transmission was used to predict cases of cervical dysplasia, cervical cancers and deaths and the results compared against age-specific Norwegian data representing a situation without vaccination. We then explored the potential impact of a vaccine given to 12-year-old girls under a base case assumption of 90% efficacy and 90% coverage for a hypothetical time period of 2008-2060. Model outputs (e.g. reductions in cancers and cancer deaths) together with screening programme data were used to perform cost-effectiveness calculations from the health care sector perspective and society. Analyses used available Norwegian data on resource consumption patterns and published unit costs. Cost-effectiveness was measured as the incremental cost per life year gained (LYG) and quality-adjusted life year (QALY) gained. Results Introduction of vaccination, and maintaining the screening programme unchanged yielded a base case incremental cost-effectiveness ratio (ICER) that varied from NOK 477,000/LY (NOK 399,00/ QALY) to NOK 141,000/ LY (NOK 118,000/QALY) from the healthcare sector and societal perspectives respectively. Estimates were sensitive to alternative assumptions relating to efficacy, coverage, vaccine cost, discount rate, and time horizon of the analysis. Conclusion Under several plausible assumptions, our economic evaluation suggest that introduction of HPV 16/18 type vaccination to current screening in Norway may be a cost-effective strategy for further reductions in cervical cancer incidence and mortality. However, the estimates were susceptible to both the perspective adopted, and assumptions used in the modelling analyses.

Cost effectiveness. --- Papillomavirus vaccines.

Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

Human papillomavirus (HPV) causes a number of cancers and other diseases, several of which disproportionally affect Latinos. Unfortunately, Latinos also have poor uptake of HPV vaccines, which prevent HPV-associated diseases. There is a paucity of research on interventions to increase HPV vaccination among Latinos, which our work sought to address. OBJECTIVES: The objectives of the project were to (1) use community input to create a web-based educational intervention for Latino young adults (aged 18-26) and parents of Latino adolescents (aged 9-17) that provided individually and culturally tailored information about HPV for Latinos; (2) compare the impact of the intervention vs an untailored web-based educational intervention based on the HPV Vaccine Information Sheet from the Centers for Disease Control and Prevention, vs usual care (individualized physician discussion of the vaccine and/or receipt of a paper version of the on HPV Vaccine Information Sheet) on vaccine use among young adults and adolescents. METHODS: In phase I, community input representing end-users of our intervention created the intervention for Latinos. In phase II, we evaluated this new intervention, called CHICOS (Combatting HPV Infection and Cancers), in a 3-armed, randomized controlled trial conducted in the waiting rooms of 5 family medicine practices serving mainly Latinos. We assessed the relative efficacy of CHICOS vs an untailored intervention, both of which were delivered via iPad, vs usual care for their impact on HPV vaccine uptake among adolescent and young adult Latinos. Eligible participants were English- or Spanish-speaking young adult patients (aged 18-26 years) or parents of Latino adolescents (aged 9-17 years) who reported not yet completing the 3-dose HPV vaccine series (ie, 0, 1, or 2 doses). Data on the primary outcomes--6 different measures of HPV vaccine uptake--came from the clinics' medical records and the statewide immunization registry. The primary analyses were 2-way comparisons between arms (ie, tailored vs untailored, tailored vs control, untailored vs control), stratified by adolescent vs young adult vaccination. We used multiple imputation to account for missing data and analyzed data using an intent-to-treat (ITT) approach. Secondary outcomes included changes in vaccination intention from before to after viewing the iPad materials (tailored and untailored arms only), time between study enrollment and HPV vaccine doses received (all arms), and patterns of utilization of the tailored and untailored websites. RESULTS: Significant Latino community input through a series of 6 focus group and quarterly meetings with a community advisory board in phase I was used to create CHICOS. Phase II enrolled 1294 parents and young adults. In the ITT analyses, nearly all vaccination outcomes assessed in 2-way comparisons demonstrated no statistically significant differences between groups. The 1 exception was completion of the series among adolescents who entered the study with at least 1 dose. In this analysis, the tailored group performed significantly better than the untailored group (odds ratio [OR], 2.0; 95% CI, 1.1-3.8) but there were no statistically significant differences in completing the 3-dose series among this subgroup when the tailored intervention was compared against usual care (OR, 1.6; 95% CI, 0.8-3.2). Few young adults received HPV doses. Individuals in the untailored arm took a statistically nonsignificant longer time to receive vaccine doses than those in the untailored or usual care arms. The untailored and tailored interventions significantly improved vaccination intention from baseline to postintervention; the amount of change was the same in the 2 groups. CONCLUSIONS: Neither the tailored intervention nor the untailored intervention improved HPV vaccination outcomes in adolescents and young adults. In young adults, the rate of HPV vaccination was uniformly low across the 3 study arms, resulting in high rates of missing data.

Adolescent. --- Papillomavirus vaccines.

Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

This book presents a comprehensive global strategy to eliminate cervical cancer as a public health issue, spearheaded by the World Health Organization (WHO). It emphasizes the importance of cost-effective, evidence-based interventions, including vaccination against human papillomavirus (HPV), regular cervical cancer screenings, and timely treatment of pre-cancerous lesions. The narrative incorporates personal stories from cervical cancer survivors, highlighting the emotional and physical challenges faced by patients and their families. The book aims to educate healthcare providers, policymakers, and the general public about the significance of early detection and treatment, as well as the socio-economic disparities in cervical cancer incidence and mortality rates. The author advocates for global solidarity, political commitment, and investment in healthcare systems to achieve the WHO's elimination targets by 2030. It is intended for a broad audience, including health professionals, policymakers, and advocates for women's health.

Papillomavirus vaccines. --- Public health.