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Title: Effectiveness Modelling and Economic Evaluation of Primary HPV Screening for Cervical Cancer Prevention in New Zealand
Authors: Lew JB; Simms KT; Smith MA; Lewis H; Neal H; Canfell K
Categories: Early Detection, Diagnosis, and Prognosis - Technology and/or Marker Testing in a Clinical Setting
Cancer Type - Cervical Cancer
Year: 2016
Journal Title: PLOS One
Volume: 11
Issue: 5
Abstract: Background New Zealand (NZ) is considering transitioning from 3-yearly cervical cytology screening in women 20–69 years (current practice) to primary HPV screening. We evaluated HPV-based screening in both HPV-unvaccinated women and cohorts offered HPV vaccination in New Zealand (vaccination coverage ~50%). Methods A complex model of HPV transmission, vaccination, cervical screening, and invasive cervical cancer was extensively validated against national population-based datasets. Sixteen potential strategies for HPV screening were considered. Results Most primary HPV strategies were more effective than current practice, for both unvaccinated women and cohorts offered vaccination. The optimal strategy for both groups was 5-yearly HPV screening in women aged 25–69 years with partial genotyping for HPV 16/18 and referral to colposcopy, and cytological triage of other oncogenic types. This is predicted to reduce cervical cancer incidence and mortality by a further 12–16% and to save 4–13% annually in program costs (excluding overheads). The findings are sensitive to assumptions about future adherence to initiating screening at 25 years. Conclusion Primary HPV screening with partial genotyping would be more effective and less costly than the current cytology-based screening program, in both unvaccinated women and cohorts offered vaccination. These findings have been considered in a review of cervical screening in NZ.
Division: Cancer Research Division
Funding Body: This study was funded by Ministry of Health, New Zealand. The funder participated in the study by providing cost information and guided the design of the cervical cancer screening and follow-up strategies; one of the authors (HN) is employed by the funder, and another (HL) was previously employed by the funder. KC receive salary support from the National Health and Medical Research Council of Australia (CDF #1082989).
DOI: 10.1371/journal.pone.0151619
Appears in Collections:Research Articles

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