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Int J Cancer. 2016 Dec 15;139(12):2771-2780. doi: 10.1002/ijc.30392.

Will cervical screening remain cost-effective in women offered the next generation nonavalent HPV vaccine? Results for four developed countries.

Author information

1
Cancer Research Division, Cancer Council NSW, Woolloomooloo, Sydney, NSW, Australia.
2
Prince of Wales Clinical School, The University of New South Wales, Australia.
3
School of Public Health, University of Sydney, Australia.
4
Institute of Cancer Sciences, University of Manchester, United Kingdom.
5
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
6
Global Coalition against Cervical Cancer, Arlington, VA.
7
Cancer Research Division, Cancer Council NSW, Woolloomooloo, Sydney, NSW, Australia. karen.canfell@nswcc.org.au.
8
Prince of Wales Clinical School, The University of New South Wales, Australia. karen.canfell@nswcc.org.au.
9
School of Public Health, University of Sydney, Australia. karen.canfell@nswcc.org.au.

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.

KEYWORDS:

HPV vaccine; cervical screening; nonavalent HPV vaccine; primary HPV screening

PMID:
27541596
DOI:
10.1002/ijc.30392
[Indexed for MEDLINE]
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