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Title: Modeling Preventative Strategies against HPV-Related Disease in Developed Countries
Authors: Canfell K; Chesson H; Kulasingam SL; Berkhof J; Mireia Diaz; Kim J
Categories: Cancer Control, Survivorship, and Outcomes Research - Health Services, Economic and Health Policy Analyses
Cancer Type - Cervical Cancer
Year: 2012
Journal Title: Vaccine
Volume: 30
Issue: 5
Page number start: 157
Page number end: 167
Abstract: Abstract Over the last five years, prophylactic vaccination against Human Papillomavirus (HPV) in pre-adolescent females has been introduced in most developed countries, supported by modeled evaluations which have almost universally found vaccination of pre-adolescent females to be cost-effective. Studies to date suggest that vaccination of pre-adolescent males may also be cost-effective at a cost per vaccinated individual ~US$400–500 if vaccination coverage in females cannot be increased above ~50%; but if it is possible, increasing coverage in females appears to be a better return on investment. Comparative evaluation of the quadrivalent (HPV16,18,6,11) and bivalent (HPV16,18) vaccines centers around the potential tradeoff between protection against anogenital warts and vaccine-specific levels of cross-protection against infections not targeted by the vaccines. Future evaluations will also need to consider the cost-effectiveness of a next generation nonavalent vaccine designed to protect against ~90% of cervical cancers. The timing of the effect of vaccination on cervical screening programs will be country-specific and will depend on vaccination catch-up age range and coverage and the age at which screening starts. Initial evaluations suggest that if screening remains unchanged it will be less cost-effective in vaccinated compared to unvaccinated women but, in the context of current vaccines, will remain an important prevention method. Comprehensive evaluation of new approaches to screening will need to consider the population-level effects of vaccination over time. New screening strategies of particular interest include delaying the start age of screening, increasing the screening interval and switching to primary HPV screening. Future evaluations of screening will also need to focus on the effects of disparities in screening and vaccination uptake, the potential effects of vaccination on screening participation, and the effects of imperfect compliance with screening recommendations.
Division: Cancer Research Division
Funding Body: Karen Canfell is supported by grants from the National Health and Medical Research Council, Australia (CDF APP1007994 and Project Grant #1007518), by non-commercial government and academic consulting agreements in Australia, New Zealand and the UK, and by Cancer Council NSW, Australia. Jane J. Kim is supported in part by grants from the U.S. National Cancer Institute (U54 CA164336) and the Bill and Melinda Gates Foundation (30505) for modeling of HPV and cervical cancer in developing countries.
DOI: doi: 10.1016/j.vaccine.2012.06.091
Appears in Collections:Research Articles

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