Value in Health Regional Issues

Real-World Data on Cervical Cancer: The Impact of 2020 COVID-19 Outbreak on the Treatment Patterns and Healthcare Resources Utilization in Brazilian Public Health System

To assess the treatment patterns and healthcare resources utilization of patients with cervical cancer (CC) within the Brazilian public health system (SUS) in 2020 versus previous years, according to the stage of disease at the diagnosis. An observational retrospective study was conducted using the data from SUS administrative database. The period of analysis comprised 2014 to 2019 for pre-COVID-19 pandemic period and 2020 for the first year of the COVID-19 pandemic. The study included patients with at least 1 claim under the ICD-10 code C53, and patients were classified as non-advanced CC (naCC) (stages I-II) and advanced CC (aCC) (stages III-IV). From 2014 to 2020, a total of 206 861 women were eligible, and staging information was available for 90 073 patients (43.5%) that composed the final cohort of this study. In the 2014 to 2019 period, 60.5% of patients had CC in advanced stages, whereas in 2020 the proportion was 63.3%. Between 2014 and 2019, chemoradiotherapy was the most common treatment for both naCC (37.4%) and aCC (42.4%). In 2020, chemoradiotherapy remained the top treatment for naCC (34.8%), whereas chemotherapy only (CT only) was the most performed treatment for aCC (40.2%). In 2020, the proportion of patients with at least 1 hospitalization and outpatient visits was lower across all stages. The findings of this study underscore the need for targeted policy interventions to improve the postpandemic healthcare landscape in Brazil. Stakeholders should prioritize the development and implementation of public policies aimed at strengthening screening programs and promoting early diagnosis of CC.

The Clinical and Economic Impact of a Nonavalent Versus Bivalent Human Papillomavirus National Vaccination Program in Taiwan

This study aimed to estimate the epidemiologic and economic impact of a nonavalent human papillomavirus (HPV) vaccination program for 13- to 14-year-old females compared with that of the bivalent vaccine in Taiwan. A previously developed dynamic transmission model for the nonavalent HPV vaccine was adapted to the Taiwan setting. The natural history of cervical cancer and genital warts was simulated by the HPV model assuming an 80% vaccination coverage rate in girls aged 13 to 14 years of age with a 2-dose schedule for the nonavalent and bivalent HPV vaccines. A lifetime duration of vaccine protection was assumed for the HPV vaccine types. The model estimated that the nonavalent HPV vaccine would prevent an additional 15 951 cervical cancer cases, 6600 cervical cancer-related deaths, 176 702 grade 2 or grade 3 cervical intraepithelial neoplasia cases, 103 959 grade 1 cervical intraepithelial neoplasia cases, and 1 115 317 genital warts cases compared with the bivalent HPV vaccine. The nonavalent HPV vaccination program was projected to cost an additional New Taiwan dollars (NTD) 675.21 per person and to produce an additional 0.00271 quality-adjusted life-year per person over 100 years compared with the bivalent HPV vaccine. Thus, the incremental cost-effectiveness ratio of the nonavalent HPV vaccine versus the bivalent HPV vaccine was NTD 249 462/quality-adjusted life-year. A nonavalent HPV vaccination program for 13- to 14-year-old girls would have additional public health and economic impacts and would be highly cost-effective compared with the bivalent HPV vaccine, relative to per capita gross domestic product, which is estimated at NTD 746 526 for Taiwan.

Microcosting Analysis of Advanced Ovarian Cancer: Real-World Evidence From the Perspective of a Reference Public Brazilian Hospital

Evaluate the cost of advanced ovarian cancer, using the microcosting technique, based on real-world evidence from the perspective of a reference Brazilian public hospital. Retrospective cohort study of patients newly diagnosed with advanced ovarian cancer in 2017 and followed-up for up to 5 years. A bottom-up microcosting method was applied, using the activity-based cost approach, which evaluates service costs based on activity consumption throughout patients' journey. The results indicate a median overall survival of 35.3 months and a median age of 57 years (33-80 years old). The average cost per patient was USD 34 991.595 over a period of 35.3 months, with admissions because of the disease progression and end-of-life care being the most relevant. The results show that the costs of activities currently involved in the treatment of advanced ovarian cancer represent an important economic impact for the public health system. These data can support future analyses on the impact of incorporating new technologies for the treatment of ovarian cancer and on the financing and sustainability of the Brazilian public healthcare system.

Cost-Utility Analysis of Expanding Human Papillomavirus Vaccination to Adult Women in Indonesia: A Markov Model Approach

Human papillomavirus (HPV) infection is not only associated with cervical cancer but also with anogenital cancers and head and neck cancers. Cancers related to HPV contribute not only to high rates of morbidity and mortality but also impose significant healthcare costs. A population-based Markov model for HPV-related cancers in Indonesia was developed using Microsoft Excel. We hypothesized a cohort of 100,000 population of girls and 100,000 population of adult women starting from 11 years old and followed until 74 years old based on 2 strategies. HPV vaccination of girls (current situation) as a base case and HPV vaccination of girls and adult women as a new proposed intervention. One-way and probabilistic sensitivity analyses were carried out to address the uncertainty in this study. Including adult women in HPV vaccination for preventing HPV-related cancers results in an incremental cost-effectiveness ratio of IDR -747,610/quality-adjusted life years. This indicated that including adult women alongside girls in preventing HPV-related cancers through HPV vaccination is cost saving. HPV vaccination is capable of reducing the incidence of HPV-related cancers in both girls and women. The number of HPV-related cancer cases that can be prevented in the intervention group compared with the base case is 2274 new cases per 100,000 population. Our study demonstrates that adding adult women to the existing vaccination program (HPV vaccination in girls) in Indonesia is a cost-saving strategy for preventing HPV-related cancers. We recommend the implementation of a vaccination program for adult women could be included as a requirement for marriage for prospective brides.

Mathematical Models for Evaluating Effectiveness and Cost-Effectiveness of Cervical Cancer Control Policies in Populations Including Women Living With Human Immunodeficiency Virus: A Scoping Review

Mathematical modeling is increasingly used to inform cervical cancer control policies, and model-based evaluations of such policies in women living with human immunodeficiency virus (HIV) are an emerging research area. We did a scoping review of published literature to identify research gaps and inform future work in this field. We systematically searched literature up to April 2022 and included mathematical modeling studies evaluating the effectiveness or cost-effectiveness of cervical cancer prevention strategies in populations including women living with HIV. We extracted information on prevention strategies and modeling approaches. We screened 1504 records and included 22 studies, almost half of which focused on South Africa. We found substantial between-study heterogeneity in terms of strategies assessed and modeling approaches used. Fourteen studies evaluated cervical cancer screening strategies, 7 studies assessed human papillomavirus vaccination (with or without screening), and 1 study evaluated the impact of HIV control measures on cervical cancer incidence and mortality. Thirteen conducted cost-effectiveness analyses. Markov cohort state-transition models were used most commonly (n = 12). Most studies (n = 17) modeled the effect of HIV by creating HIV-related health states. Thirteen studies performed model calibration, but 11 did not report the calibration methods used. Only 1 study stated that model code was available upon request. Few model-based evaluations of cervical cancer control strategies have specifically considered women living with HIV. Improvements in model transparency, by sharing information and making model code publicly available, could facilitate the utility of these evaluations for other high disease-burden countries, where they are needed for assisting policy makers.

Economic Evaluation of Neoadjuvant Versus Adjuvant Chemotherapy in Cancer Treatment: A Systematic Review and Meta-Analysis