Assessing cost-effectiveness of HPV vaccines with decision analytic models: what are the distinct challenges of low- and middle-income countries A protocol for a systematic reviewReportar como inadecuado

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Systematic Reviews

, 4:68

First Online: 12 May 2015Received: 31 March 2015Accepted: 05 May 2015DOI: 10.1186-s13643-015-0057-8

Cite this article as: Ekwunife, O.I., Grote, A.G., Mosch, C. et al. Syst Rev 2015 4: 68. doi:10.1186-s13643-015-0057-8


BackgroundCervical cancer poses a huge health burden, both to developed and developing nations, making prevention and control strategies necessary. However, the challenges of designing and implementing prevention strategies differ for low- and middle-income countries LMICs as compared to countries with fully developed health care systems. Moreover, for many LMICs, much of the data needed for decision analytic modelling, such as prevalence, will most likely only be partly available or measured with much larger uncertainty. Lastly, imperfect implementation of human papillomavirus HPV vaccination may influence the effectiveness of cervical cancer prevention in unpredictable ways. This systematic review aims to assess how decision analytic modelling studies of HPV cost-effectiveness in LMICs accounted for the particular challenges faced in such countries. Specifically, the study will assess the following: 1 whether the existing literature on cost-effectiveness modelling of HPV vaccines acknowledges the distinct challenges of LMICs, 2 how these challenges were accommodated in the models, 3 whether certain parameters systemically exhibited large degrees of uncertainty due to lack of data and how influential were these parameters on model-based recommendations, and 4 whether the choice of modelling herd immunity influences model-based recommendations, especially when coverage of a HPV vaccination program is not optimal.

MethodsWe will conduct a systematic review to identify suitable studies from MEDLINE via PubMed, EMBASE, NHS Economic Evaluation Database NHS EED, EconLit, Web of Science, and CEA Registry. Searches will be conducted for studies of interest published since 2006. The searches will be supplemented by hand searching of the most relevant papers found in the search. Studies will be critically appraised using Consolidated Health Economic Evaluation Reporting Standards CHEERS statement checklist. We will undertake a descriptive, narrative, and interpretative synthesis of data to address the study objectives.

DiscussionThe proposed systematic review will assess how the cost-effectiveness studies of HPV vaccines accounted for the distinct challenges of LMICs. The gaps identified will expose areas for additional research as well as challenges that need to be accounted for in future modelling studies.

Systematic review registrationPROSPERO CRD42015017870.

KeywordsUterine cervical neoplasm Papillomavirus vaccines Mass vaccination Cost-effectiveness analysis Low- and middle-income countries AbbreviationsCHEERSConsolidated Health Economic Evaluation Reporting Standards

CINCervical intraepithelial neoplasia

DALYsDisability-adjusted life years

GDPGross domestic product

HPVHuman papillomavirus

LMICsLow- and middle-income countries

LYGsLife years gained

NHS EEDNHS Economic Evaluation Database

PRISMAPreferred Reporting Items in Systematic Reviews and Meta-analyses

VIAVisual inspection with acetic acid

WHOWorld Health Organization

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Autor: Obinna I. Ekwunife - Andreas Gerber Grote - Christoph Mosch - James F. O’Mahony - Stefan K. Lhachimi


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