INTRODUCTIONCervical cancer is the tenth most common cancer and the eighth most frequent cause of death among women in Singapore. As human papillomavirus (HPV) infection is the necessary cause of cervical cancer, the risk of cervical cancer can be substantially reduced through vaccination. This study was conducted to evaluate the cost-effectiveness of two-dose HPV vaccination as part of a national vaccination programme for 12-year-old girls in Singapore, from the perspective of the healthcare payer.

METHODSA lifetime Markov cohort model was used to evaluate the cost-effectiveness of introducing the AS04-adjuvanted HPV-16/18 vaccine (AS04-HPV-16/18v) to the current cervical screening programme in Singapore. Furthermore, the cost-effectiveness of the AS04-HPV-16/18v was compared with the HPV-6/11/16/18 vaccine (4vHPV). Model inputs were derived from local data, where possible, and validated by clinical experts in Singapore.

RESULTSIntroduction of the AS04-HPV-16/18v in Singapore was shown to prevent 137 cervical cancer cases and 48 cervical cancer deaths when compared with screening alone. This resulted in an incremental cost-effectiveness ratio of SGD 12,645 per quality-adjusted life year (QALY) gained, which is cost-effective according to the World Health Organization threshold for Singapore. When discounted at 3%, AS04-HPV-16/18v was dominant over 4vHPV, with cost savings of SGD 80,559 and 28 additional QALYs gained. In the one-way sensitivity analysis, AS04-HPV-16/18v remained cost-effective compared with screening alone and dominant compared with 4vHPV.

CONCLUSIONAS04-HPV-16/18v is the most cost-effective choice for reducing the burden of cervical cancer through universal mass vaccination for 12-year-old girls in Singapore.

Drugs are used essentially to treat illnesses in humans and animals. When metabolized in food animals, they are harmless, but residues may remain in tissues, meat and milk that can present risks in the food chain. A longterm consequence of drug residues in food of animal origin is the development and emergence of antimicrobial resistance (AMR). Generally, increasing the use of antimicrobials in medical and veterinary practice exacerbates AMR. Spread of infection or resistant pathogen or resistance genes in the environment can be explained by the close link between humans, animals, and the environment. The public health and economic impact of AMR have been estimated to be around 100 trillion US dollars each year and food animals are a major reservoir of AMR microorganisms in many low and middle income countries (LMIC). However,due to the lack of data on food-borne pathogens and antimicrobial usage is a challenge in the control of AMR in LMICs where the food industry is heterogeneous, largely informal, and unregulated. Emergence and transmission of AMR in developing countries are linked to food of animal origins, but the awareness of this relationship is low. Overall, the challenge of food insufficiency also described as food insecurity and a lack of adequate food safety measures can worsen the incidence and persistence of AMR. This review summarizes the issues and challenges of emerging drug resistant pathogens from food animals in developing countries, and highlights the importance of a holistic perspective in addressing AMR in humans in the context of the One Health approach.
Animals ; One Health ; Drug Resistance, Bacterial ; Anti-Bacterial Agents ; Developing Countries