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Title: Will cervical screening remain cost-effective in women offered the next generation nonavalent HPV vaccine? Results for four developed countries
Authors: Simms KT; Smith MA; Lew JB; Kitchener HC; Castle PE; Canfell K
Categories: Cancer Control, Survivorship, and Outcomes Research - Health Services, Economic and Health Policy Analyses
Cancer Type - Cervical Cancer
Early Detection, Diagnosis, and Prognosis - Technology and/or Marker Testing in a Clinical Setting
Year: 2016
Journal Title: International Journal of Cancer
Volume: 139
Issue: 12
Page number start: 2771
Page number end: 2780
Abstract: A next generation nonavalent human papillomavirus (HPV) vaccine ("HPV9 vaccine") is being introduced in several countries. The aims of this study were to evaluate whether cervical screening will remain cost-effective in cohorts offered nonavalent vaccines and if so, to characterize the optimal number of screening tests. We used a dynamic model of HPV vaccination and cervical screening to evaluate the cost-effectiveness of strategies involving varying numbers of primary HPV tests per lifetime for cohorts offered the nonavalent vaccine as 12 year-olds. For each of four countries-the USA, New Zealand (NZ), Australia and England-we considered local factors including vaccine uptake rates (USA/NZ uptake ∼50%; Australia/England uptake >70%), attributable fractions of HPV9-included types, demographic factors, costs and indicative willingness-to-pay (WTP) thresholds. Extensive probabilistic sensitivity analysis was performed. We found that, in the USA, four screens per lifetime was the most likely scenario, with 34% probability of being optimal at WTP US$50,000/LYS, increasing to 84% probability at US$100,000/LYS. In New Zealand, five screens per lifetime was the most likely scenario, with 100% probability of being optimal at NZ$42,000/LYS, given the assumptions used. In Australia, two screens per lifetime was the most likely scenario, with 62% probability of being optimal at AU$50,000/LYS. In England, four screens per lifetime was the most likely scenario, with 32% probability of being optimal at GB£20,000/LYS, increasing to 96% probability at GB£30,000/LYS. We conclude that some cervical screening will remain cost-effective, even in countries with high vaccination coverage. However, the optimal number of screens may vary between countries.
Division: Cancer Research Division
Funding Body: National Health and Medical Research Council (NHMRC) Australia. KC is supported by a NHMRC Career Development Fellowship Grant (number AP1082989).
Grant ID: APP1065892
APP1082989 (salary support for KC).
DOI: 10.1002/ijc.30392
Appears in Collections:Research Articles

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