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dc.contributor.authorCampos, Nicole G.en_US
dc.contributor.authorSharma, Monishaen_US
dc.contributor.authorClark, Andrewen_US
dc.contributor.authorKim, Jane J.en_US
dc.contributor.authorResch, Stephen C.en_US
dc.date.accessioned2016-11-18T20:47:45Z
dc.date.issued2016en_US
dc.identifier.citationCampos, Nicole G., Monisha Sharma, Andrew Clark, Jane J. Kim, and Stephen C. Resch. 2016. “Resources Required for Cervical Cancer Prevention in Low- and Middle-Income Countries.” PLoS ONE 11 (10): e0164000. doi:10.1371/journal.pone.0164000. http://dx.doi.org/10.1371/journal.pone.0164000.en
dc.identifier.issn1932-6203en
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:29408359
dc.description.abstractBackground: Cervical cancer is the fourth leading cause of cancer death in women, with 85% of cases and deaths occurring in developing countries. While organized screening programs have reduced cervical cancer incidence in high-income countries through detection and treatment of precancerous lesions, the implementation of organized screening has not been effective in low-resource settings due to lack of infrastructure and limited budgets. Our objective was to estimate the cost of comprehensive primary and secondary cervical cancer prevention in low- and middle-income countries. Methods and Findings: We performed a modeling analysis to estimate 1) for girls aged 10 years, the cost of 2-dose human papillomavirus (HPV) vaccination; and 2) for women aged 30 to 49 years, the cost of cervical cancer screening (with visual inspection with acetic acid (VIA), HPV testing, or cytology) and preventive treatment in 102 low- and middle-income countries from 2015 to 2024. We used an Excel-based costing and service utilization model to estimate financial costs (2013 US$) based on prevalence of HPV, prevalence of precancerous lesions, and screening test performance. Where epidemiologic data were unavailable, we extrapolated from settings with data using an individual-based microsimulation model of cervical carcinogenesis (calibrated to 20 settings) and multivariate regression. Total HPV vaccination costs ranged from US$8.6 billion to US$24.2 billion for all scenarios considered (immediate, 5-year, or 10-year roll-out; price per dose US$4.55-US$70 by country income level). The total cost of screening and preventive treatment ranged from US$5.1 billion (10-year roll-out, screening once at age 35 years) to US$42.3 billion (immediate roll-out, high intensity screening). Limitations of this analysis include the assumption of standardized protocols by country income level that did not account for the potential presence of multiple screening modalities or management strategies within a country, and extrapolation of cost and epidemiologic data to settings where data were limited. Conclusions: The estimated cost of comprehensive cervical cancer prevention with 2-dose HPV vaccination of 10-year-old girls and screening of women aged 30 to 49 years ranges from US$13.7 billion to US$66.5 billion, depending on speed of roll-out, vaccine price per dose, and screening test and frequency. Findings demonstrate the substantial impact of vaccine price in middle-income countries that are not eligible for assistance from Gavi, the Vaccine Alliance. Replacing routine cytology with HPV-based screening may reduce total costs. Data on the health impact and relative cost-effectiveness of strategies are needed to determine the best value for public health dollars.en
dc.language.isoen_USen
dc.publisherPublic Library of Scienceen
dc.relation.isversionofdoi:10.1371/journal.pone.0164000en
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC5053484/pdf/en
dash.licenseLAAen_US
dc.subjectBiology and life sciencesen
dc.subjectOrganismsen
dc.subjectVirusesen
dc.subjectDNA virusesen
dc.subjectPapillomavirusesen
dc.subjectHuman Papillomavirusen
dc.subjectBiology and Life Sciencesen
dc.subjectMicrobiologyen
dc.subjectMedical Microbiologyen
dc.subjectMicrobial Pathogensen
dc.subjectViral Pathogensen
dc.subjectMedicine and Health Sciencesen
dc.subjectPathology and Laboratory Medicineen
dc.subjectPathogensen
dc.subjectImmunologyen
dc.subjectVaccination and Immunizationen
dc.subjectPublic and Occupational Healthen
dc.subjectPreventive Medicineen
dc.subjectDiagnostic Medicineen
dc.subjectCancer Detection and Diagnosisen
dc.subjectCancer Screeningen
dc.subjectOncologyen
dc.subjectVaccinesen
dc.subjectCancers and Neoplasmsen
dc.subjectGynecological Tumorsen
dc.subjectCervical Canceren
dc.subjectCancer Preventionen
dc.subjectHealth Careen
dc.subjectHealth Care Policyen
dc.subjectScreening Guidelinesen
dc.subjectCancer Treatmenten
dc.titleResources Required for Cervical Cancer Prevention in Low- and Middle-Income Countriesen
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden
dc.relation.journalPLoS ONEen
dash.depositing.authorCampos, Nicole G.en_US
dc.date.available2016-11-18T20:47:45Z
dc.identifier.doi10.1371/journal.pone.0164000*
dash.contributor.affiliatedCampos, Nicole
dash.contributor.affiliatedResch, Stephen
dash.contributor.affiliatedKim, Jane


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