economicimpactofhpvvaccine-rutgersuniversity.ppt

A Cost-Effectiveness Analysis of Alternative Human papillomavirus (HPV) Vaccination Strategies Elamin H. Elbasha Merck Research Laboratories, USA Presentation outline HPV infection and disease HPV vaccines Merck model Public health impact Economic impact Summary and conclusions HPV infection HPV is small, non-enveloped, encapsulated, double-stranded DNA virus HPV encodes two structural proteins L1 codes for major capsid protein L2 codes for minor capsid proteins Enormous HPV diversity More than 100 HPV genotypes More than 40 types infect ano-genital tract At least 13 high-risk types cause cervical cancer Ubiquitous Lifetime Risk of HPV infection up to 70% among sexually active Major risk factor for HPV acquisition: number of sexual partners HPV infection life cycle Conditions associated with HPV types 16, 18, 6,11 By end of presentation, 16 women would die from cervical cancer Immunologic Basis for HPV vaccines L1 HPV major capsid protein self-assembles into empty virus-like particles (VLPs) In animal models of papillomavirus infection using species-specific VLPs Vaccination results in protection from infection and disease Efficacy associated with development of neutralizing antibodies Transfer of serum from vaccinated to unvaccinated animals transfers protective efficacy Protection is prophylactic, not likely to be therapeutic Protection is likely to be type-specific HPV vaccines Prepared from virus-like particles (non-infectious) Produced by recombinant technology Do not contain any live biological product or DNA GARDASIL? [prophylactic quadrivalent HPV (6,11,16,18) vaccine] licensed in U.S. other countries First vaccine to prevent cervical cancer, precancerous genital lesions, and genital warts Series of three injections over a six-month period Safe and highly efficacious CERVARIX? [prophylactic bivalent HPV (16,18) vaccine] in final stages of clinical testing Research questions What are the epidemiologic consequences of HPV vaccination? What is the sensit