{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T08:25:37Z","timestamp":1777019137125,"version":"3.51.4"},"reference-count":73,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T00:00:00Z","timestamp":1732147200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004334","name":"Merck","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004334","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Recent evidence suggests that 1 dose of the human papillomavirus (HPV) vaccine may have similar effectiveness in reducing HPV infection risk compared to 2 or 3 doses.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To evaluate the public health impact and cost-effectiveness of implementing a 1-dose or a 2-dose program of the 9-valent HPV vaccine in a low- and middle-income country (LMIC).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We adapted a dynamic transmission model to the Indonesia setting, and conducted a probabilistic sensitivity analysis using distributions reflecting the uncertainty in levels and durability of protection of a 1-dose that were estimated under a Bayesian framework incorporating 3-year vaccine efficacy data from the KEN SHE trial (base-case) and 10 year effectiveness data from the India IARC study (alternative analysis). Scenarios included different coverage levels targeted at girls-only, or girls and boys. Costs and benefits were computed over 100 years from a national single-payer perspective.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>Depending on the coverage and target population, the median number of cancer cases avoided in 2-dose programs ranged between 600,000\u20132,100,000, compared to 200,000\u2013600,000 in 1-dose programs. The 1-dose programs are unlikely to be cost-effective compared to 2-dose programs even at low willingness-to-pay (WTP) thresholds. The girls-only 2-dose program tends to be cost-effective at lower WTP thresholds, particularly in scenarios with high coverage, dose price and discount rate, while the girls and boys 2-dose program is cost-effective at higher WTP thresholds. In the alternative analysis, 1-dose programs have higher probability of being cost-effective compared to the base-case, particularly for low WTP thresholds (less than 0.5 GDP) and for high coverage, dose price and discount rate.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Adoption of 1-dose programs with 9-valent vaccine in an LMIC resulted in more vaccine-preventable HPV-related cancer cases than 2-dose programs. The 2-dose programs were more likely to be cost-effective than 1-dose programs for a wide range of WTP thresholds and scenarios.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0310591","type":"journal-article","created":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T18:35:53Z","timestamp":1732214153000},"page":"e0310591","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Modeling the health and economic implications of adopting a 1-dose 9-valent human papillomavirus vaccination program in adolescents in low\/middle-income countries: An analysis of Indonesia"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3226-7231","authenticated-orcid":true,"given":"Vincent","family":"Daniels","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kunal","family":"Saxena","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oscar","family":"Patterson-Lomba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8320-0857","authenticated-orcid":true,"given":"Andres","family":"Gomez-Lievano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jarir","family":"At Thobari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2925-1922","authenticated-orcid":true,"given":"Nancy","family":"Durand","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evan","family":"Myers","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,11,21]]},"reference":[{"issue":"4","key":"pone.0310591.ref001","doi-asserted-by":"crossref","first-page":"pky045","DOI":"10.1093\/jncics\/pky045","article-title":"Burden of human papillomavirus (HPV)-related cancers attributable to HPVs 6\/11\/16\/18\/31\/33\/45\/52 and 58","volume":"2","author":"S de Sanjose","year":"2019","journal-title":"JNCI Cancer Spectr"},{"issue":"6","key":"pone.0310591.ref002","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1086\/597071","article-title":"Natural history of genital warts: analysis of the placebo arm of 2 randomized phase III trials of a quadrivalent human papillomavirus (types 6, 11, 16, and 18) vaccine","volume":"199","author":"SM Garland","year":"2009","journal-title":"J Infect Dis"},{"key":"pone.0310591.ref003","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.rmed.2017.03.030","article-title":"Recurrent respiratory papillomatosis: a state-of-the-art review","volume":"126","author":"HR Fortes","year":"2017","journal-title":"Respir Med"},{"issue":"11","key":"pone.0310591.ref004","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1086\/516784","article-title":"A 2-year prospective study of human papillomavirus persistence among women with a cytological diagnosis of atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion","volume":"195","author":"M Plummer","year":"2007","journal-title":"J Infect Dis"},{"issue":"10","key":"pone.0310591.ref005","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1002\/cncy.21738","article-title":"HPV vaccination in Southern Africa: A jab of hope in the fight against cervical cancer","volume":"124","author":"P Michelow","year":"2016","journal-title":"Cancer Cytopathol"},{"issue":"17","key":"pone.0310591.ref006","doi-asserted-by":"crossref","first-page":"1576","DOI":"10.1056\/NEJMoa1010971","article-title":"HPV vaccine against anal HPV infection and anal intraepithelial neoplasia","volume":"365","author":"JM Palefsky","year":"2011","journal-title":"N Engl J Med"},{"issue":"2","key":"pone.0310591.ref007","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.ygyno.2009.04.035","article-title":"Age-appropriate use of human papillomavirus vaccines in the U.S","volume":"114","author":"PE Castle","year":"2009","journal-title":"Gynecol Oncol"},{"key":"pone.0310591.ref008","unstructured":"Global strategy to accelerate the elimination of cervical cancer as a public health problem. 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Effectiveness and immunogenicity of one dose of HPV vaccine compared with no vaccination, two doses, or three doses (Cochrane Response). Accessed on: April 6, 2021. 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a data-linkage study","volume":"95","author":"R Donken","year":"2019","journal-title":"Sex Transm Infect"},{"issue":"1","key":"pone.0310591.ref031","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1186\/s13063-021-05608-8","article-title":"Single-dose HPV vaccination efficacy among adolescent girls and young women in Kenya (the KEN SHE Study): study protocol for a randomized controlled trial","volume":"22","author":"RV Barnabas","year":"2021","journal-title":"Trials"},{"key":"pone.0310591.ref032","doi-asserted-by":"crossref","first-page":"3224","DOI":"10.1038\/s41591-023-02658-0","article-title":"Durability of single-dose HPV vaccination in young Kenyan women: randomized controlled trial 3-year results","volume":"29","author":"RV Barnabas","year":"2023","journal-title":"Nat Med"},{"issue":"10","key":"pone.0310591.ref033","doi-asserted-by":"crossref","first-page":"e1485","DOI":"10.1016\/S2214-109X(22)00306-0","article-title":"Comparing one dose of HPV vaccine in girls aged 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