3 research outputs found

    Screening for cervical cancer in India: How much will it cost? A trial based analysis of the cost per case detected.

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    The cost and cost effectiveness of screening previously unscreened women by VIA, cytology or HPV testing was investigated within a large cluster randomised trial involving 131,178 women in rural India. All resources involved in implementation, training, management, recruitment, screening and diagnosis were identified and costed. We estimated the total costs and detection rates for each cluster and used these data to calculate an average cluster cost and detection rate for each screening approach. These estimates were combined to estimate a cost per case of cervical intraepithelial neoplasia grade 2/3 or invasive cancer (CIN 2/3+) detected. The average total costs per 1,000 women eligible for screening were US dollar 3,917, US dollar 6,609 and US dollar 11,779 with VIA, cytology and HPV respectively. The cost of detecting a case of CIN2/3+ using VIA was dollar 522 (95% CI dollar 429- dollar 652). Our results suggest that more CIN2/3+ cases would be detected in the same population if cytology were used instead of VIA and each additional case would cost US dollar 1065 (95% CI dollar 713- dollar2175). Delivering cervical cancer screening is potentially expensive in a low-income country although costs might be lower outside a trial setting. We found screening with VIA to be the least expensive option, but it also detected fewer cases of CIN2/3+ than other methods; its long-term cost-effectiveness will depend on the long-term benefits of early detection. Cytology was more effective at detecting cases than VIA but was also more expensive. Our findings indicate that HPV may not be a cost effective screening strategy in India at current consumable prices

    Are two doses of human papillomavirus vaccine sufficient for girls aged 15–18 years? Results from a cohort study in India

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    Extending two-dose recommendations of HPV vaccine to girls between 15 and 18 years will reduce program cost and improve compliance. Immunogenicity and vaccine targeted HPV infection outcomes were compared between 1795 girls aged 15–18 years receiving two (1–180 days) and 1515 girls of same age receiving three (1–60–180 days) doses. Immunogenicity outcomes in 15–18 year old two-dose recipients were also compared with the 10–14 year old three-dose (N = 2833) and two-dose (N = 3184) recipients. The 15–18 year old two-dose recipients had non-inferior L1-binding antibody titres at seven months against vaccine-targeted HPV types compared to three-dose recipients at 15–18 years and three-dose recipients at 10–14 years of age. Neutralizing antibody titres at 18 months in 15–18 year old two-dose recipients were non-inferior to same age three-dose recipients for all except HPV 18. The titres were inferior to those in the 10–14 year old three-dose recipients for all targeted types. Frequency of incident infections from vaccine-targeted HPV types in the 15–18 year old two-dose recipients was similar to the three dose recipients. None of the girls receiving two or three doses had persistent infection from vaccine-targeted types. These findings support that two doses of HPV vaccine can be extended to girls aged 15–18 years. Keywords: Human papillomavirus, Quadrivalent vaccine, Two doses, age 15–18 years, Immunogenicity, Incident infections, Persistent infection
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