Background
Methods
Model structure
Model input data
Gender | Cancer sites (ICD 10 code) | Expected number of new cases, irrespective of HPV status | HPV prevalence by site (%) | Expected number of new cases attributable to HPV | Prevalence of HPV 16/18 in HPV-positive cancers (%) | Expected number of new cancer cases attributable to HPV 16/18 | Prevalence of HPV 6/11 in HPV-positive warts (%) | Expected number of new cancer cases attributable to HPV 6/11 |
---|---|---|---|---|---|---|---|---|
Male | Head and neckb
| 67,354 | 14,098 | 12,707 | ||||
Anus (C21) | 2,162 | 84.2 | 1,821 | 87.1/6.2 | 1,699 | |||
Penis (C60) | 3,178 | 46.7 | 1,484 | 60.2/13.4 | 1,091 | |||
Genital warts | 380,961 | 85.5 | 325,722 | |||||
Female | Cervical cancer | 30,517 | - | - | 59.2/17.0 | 23,254 | ||
Vaginal | 1,869 | 69.9 | 1,306 | 76.8/10.9 | 1,146 | |||
Vulvar | 7,384 | 40.4 | 2,983 | 79.7/10.9 | 2,702 | |||
Anus (C21) | 3,727 | 84.3 | 3,141 | 87.1/6.2 | 2,929 | |||
Head and neck | 13,448 | 2,715 | 2,531 | |||||
Genital warts | 337,963 | 85.5 | 288,959 |
Gender | Male | Female | ||||||
---|---|---|---|---|---|---|---|---|
HPV genotype | 6 | 11 | 16 | 18 | 6 | 11 | 16 | 18 |
Against transient infection
†,‡
| ||||||||
- Cervical, vaginal & vulvar diseases | ― | ― | 41.1 | 62.1 | ― | ― | 76.0 | 96.3 |
- Genital warts & HPV 6, 11 | 49.0 | 57.0 | ― | ― | 76.1 | 76.1 | ― | ― |
Against persistent infection
| ||||||||
- Anal disease | ― | ― | 78.7 | 96.0 | ― | ― | 98.8 | 98.4 |
- Cervical, vaginal & vulvar diseases | ― | ― | ― | ― | ― | ― | 98.8 | 98.4 |
- Penile disease | ― | ― | 78.7 | 96.0 | ― | ― | ― | ― |
Against individual diseases
| ||||||||
- Genital warts | 84.3 | 90.9 | ― | ― | 98.9 | 100.0 | ― | ― |
Assumptions
Parameter | Values |
---|---|
Vaccine uptake, both sexes
| |
Cumulative percentage of vaccine uptake (first dose) among 12-year olds | 70% |
Vaccine adherence (probability of second and third dose), both sexes
| |
Percentage of individuals receiving the second dose given first dose | 79.7% |
Percentage of individuals receiving the third dose given second dose | 63.5% |
Duration of protection (years)
| lifelong |
External validation
Sensitivity analyses
Results
Base case analysis
Gender | Disease | Annual number of HPV 6/11/16/18 cases | Annual number of cases avoided with girls only vaccination | Incremental number of cases avoided due to GNV (vs. girls only) | Relative reduction in remaining burden: GNV vs. girls only (%) | |||
---|---|---|---|---|---|---|---|---|
At 50 years | At 100 years | At 50 years | At 100 years | At 50 years | At 100 years | |||
Female | Genital warts | 288,959 | 227,388 | 228,724 | 34,936 | 35,164 | −56.7 | −58.4 |
Cervical cancer | 23,254 | 13,848 | 19,728 | 958 | 1,362 | −10.2 | −38.6 | |
Vulvar cancer | 2,702 | 873 | 2,286 | 67 | 157 | −3.7 | −37.8 | |
Vaginal cancer | 1,146 | 406 | 981 | 31 | 66 | −4.2 | −39.9 | |
Anal cancer | 2,929 | 821 | 2,330 | 80 | 258 | −3.8 | −43.0 | |
Head/neck cancer | 2,531 | 701 | 2,020 | 67 | 220 | −3.7 | −43.0 | |
Total cancers
|
32,562
|
16,649
|
27,345
|
1,203
|
2,062
| −7.6
| −39.5
| |
Male | Genital warts | 325,722 | 202,671 | 202,587 | 85,740 | 87,900 | −69.7 | −71.4 |
Penile cancers | 1,091 | 93 | 197 | 156 | 542 | −15.6 | −60.6 | |
Anal cancers | 1,699 | 313 | 1,067 | 180 | 402 | −13.0 | −63.6 | |
Head/neck cancers | 12,707 | 2,555 | 8,203 | 1,449 | 2,967 | −14.3 | −65.9 | |
Total cancers
|
15,497
|
2,961
|
9,467
|
1,784
|
3,911
| −14.2
| −64.9
| |
Female + Male |
Genital warts
| 614,681 | 430,059 | 431,311 | 120,676 | 123,064 | −65.4 | −67.1 |
Total cancers
| 48,059 | 19,610 | 36,812 | 2,987 | 5,973 | −10.5 | −53.1 |
Sensitivity analyses
Absolute reduction (increase) of remaining cases (n) versus base case GNV vaccination strategy | Relative reduction (increase) of remaining cases (%) versus base case GNV vaccination strategy | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Duration of protection | Lifetime | 32 years | |||||||||
Coverage rate | 50% | 90% | 70% | 50% | 90% | ||||||
Vaccination strategy | B | C | D | E | F | B | C | D | E | F | |
Female | Genital warts |
40,271
| −24,568 |
68,313
|
108,009
|
38,674
|
160.6
| −98.0 |
272.5
|
430.8
|
154.3
|
Cervical cancer |
3,212
| −1,692 |
5,685
|
8,853
|
3,092
|
148.4
| −78.2 |
262.7
|
409.1
|
142.9
| |
Vulvar cancer |
337
| −158 |
568
|
925
|
285
|
130.3
| −61.2 |
219.5
|
357.4
|
110.1
| |
Vaginal cancer |
139
| −63 |
236
|
388
|
116
|
140.3
| −63.7 |
238.2
|
392.2
|
117.6
| |
Anal cancer |
357
| −192 |
598
|
978
|
300
|
104.6
| −56.3 |
175.1
|
286.4
|
88.0
| |
Head/neck cancer |
305
| −163 |
504
|
832
|
250
|
104.6
| −55.9 |
173.0
|
285.3
|
85.6
| |
Total cancers
|
4,351
| −2,269 |
7,591
|
11,976
|
4,044
|
137.9
| −71.9 |
240.6
|
379.6
|
128.2
| |
Male | Genital warts |
49,534
| −34,444 |
77,279
|
122,846
|
43,104
|
140.6
| −97.8 |
219.3
|
348.6
|
122.3
|
Penile cancers |
155
| −124 |
237
|
358
|
130
|
44.1
| −35.2 |
67.3
|
101.6
|
37.0
| |
Anal cancers |
225
| −129 |
351
|
576
|
173
|
98.0
| −56.0 |
152.7
|
250.6
|
75.1
| |
Head/neck cancer |
1,669
| −931 |
2,636
|
4,331
|
1,306
|
108.6
| −60.6 |
171.5
|
281.8
|
85.0
| |
Total cancers
|
2,050
| −1,184 |
3,224
|
5,264
|
1,609
|
96.7
| −55.9 |
152.2
|
248.5
|
75.9
| |
Female + Male |
Genital warts
|
89,805
| −59,013 |
145,592
|
230,855
|
81,778
|
148.9
| −97.9 |
241.4
|
382.8
|
135.6
|
Total cancers
|
6,400
| −3,453 |
10,815
|
17,240
|
5,653
|
121.4
| −65.5 |
205.1
|
326.9
|
107.2
|