published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Public Health / Master / Master of Public Health

Background Human Papillomavirus (HPV) infection is the most common sexually transmitted infection worldwide. It is the leading cause of genital warts and cervical cancer, and is strongly associated with oropharyngeal and other anogenital cancers. To date, two prophylactic HPV vaccines are available, both of which have shown high efficacies in protection against vaccine-type HPV infection and HPV-associated diseases in both males and females. Despite the proven efficacies, male vaccination has not been included in any national vaccination programme worldwide. In Hong Kong, vaccine uptake remains low despite the Department of Health’s recommendation, and a routine comprehensive vaccination programme is yet to be adopted. However, very limited cost-effectiveness data are available to guide policy makers on the economic potential of implementing routine HPV vaccination, especially that of extending vaccination to males. This systematic review is among the first to evaluate the latest cost-effectiveness analyses of HPV vaccination in men and apply the synthesis to the context of Hong Kong, which will help local policy makers in their consideration of implementing a comprehensive HPV vaccination programme in Hong Kong, especially whether to extend vaccination to males. Methodology A systematic review was conducted to retrieve literatures that provide full economic evaluations of cost-effectiveness analyses of HPV vaccination programmes that included males, by searching in the MEDLINE (Ovid system) using relevant keywords. English articles that provide full economic evaluations of cost-effectiveness analyses of HPV vaccination programmes in men or in both sexes in the age group of 9-45 years were considered as potential studies for inclusion in this review. Results The literature search identified 117 studies, 107 among them failed to meet the inclusion criteria, 2 were duplicated studies, 1 did not meet the quality assessment criteria described by Drummond et al. A total of 7 studies were included in this review. All studies adopted dynamic models, except one using static model, which did not take into account the effect of herd immunity on HPV transmission. The studies measured the cost-effectiveness using different assumptions on vaccine costs, coverage, efficacies, duration of protection, costing and perspectives. Only several studies took a societal perspective in their analyses and included non-medical and indirect costs. 4 among all studies explored the cost-effectiveness of extending HPV vaccination to males, 2 only focused on female-only HPV vaccination with indirect benefits to males, and 1 only evaluated vaccination of the men who have sex with men (MSM) population. The discrepancies in different costing and outcome measures lowered the comparability of cost-effectiveness analyses. Yet, in general, the studies reported vaccine efficacies and duration of protection to significantly impact the cost-effectiveness of vaccination in both sexes. Moreover, vaccine coverage is critical to influence cost-effectiveness, for male vaccination would only be cost-effective given a female vaccine coverage of 50% or below. Conclusion and Implications Evidence from recent cost-effectiveness analyses suggested that vaccinating 12-year-olds is cost-effective. School-based immunization programmes are recommended to vaccinate the population at an early age before sexual debut for better clinical and economic benefits. Extending HPV vaccination to boys will be cost-effective when female vaccine coverage is low. Given a low vaccine uptake rate among schoolgirls in Hong Kong, policy makers should consider expanding vaccination to boys when implementing a routine immunization programme by synthesizing findings from epidemiological and economic evaluations. / published_or_final_version / Community Medicine / Master / Master of Public Health

Background: Human papillomavirus vaccination is newly developed in this decade. There are 2 types of vaccines. Bivalent vaccine targets on HPV types 16, 18 to prevent cervical cancer. Quadrivalent vaccine target on HPV type 6, 11, 16, 18 to prevent genital warts and cervical cancer. England has adopted a population –based HPV vaccination program. In attempt to find out the worthiness to implement the population-based vaccination program in Hong Kong, this project reviewed 15 cost-effectiveness analyses in Asian countries. Asian countries may have the similar characteristics, such as culture, sex behavior, genome, etc, that makes the result more applicable to Hong Kong. Methodology: Cost-effectiveness analysises of human papillomavirus vaccination were identified by the searching engine MEDLINE (Ovid) by using relevant keywords. All English and Chinese articles relevant to the topic were identified. Articles conducted for the cost-effectiveness of human papillomavirus vaccine in Asian countries were considered as the potential literature for the review. Result and Discussion: The searching engine identified 259 literatures, 16 of them are in Asian countries, 1 of them did not meet the criteria of quality assessment. 15 of them are included in this review. 6 different model approaches were used in the 15 articles. Results from the same countries in 2 separated articles were heterogeneous. That may probably due to the different assumption and perspectives used. Different perspectives would include different costing. Studies only including the direct cost would likely over-estimate the cost-effectiveness of the vaccine. The threshold value adopted would also affect the result. A stricter threshold value would under-estimate the cost-effectiveness. Some low-and-middle income countries has no available data on the vaccination because the vaccine is not available in the market, the data would only rely on the past literature or international data. 12 out of the 15 studies showed that the vaccination is cost-effective in the countries. Conclusion and Implication: the ICER is sensitive to the price of the vaccine, the efficacy, the duration of protection, the discount rate, the screening coverage rate, and the age of receiving vaccination, the vaccination coverage rate and the cervical cancer or genital warts incidence rate. Some studies showed that regular screening combined with vaccination program would be cost-effective. In the studies comparing the 2 types of vaccines, all the results showed that quadrivalent vaccine dominant to the bivalent vaccine. Moreover, the vaccination would decrease the cervical cancer incidence by 20% to 90%. In view of the prevalence of HPV type and the high incidence rate of genital warts. The quadrivalent vaccine is likely beneficial to Hong Kong / published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Zoology / Master / Master of Philosophy

published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences