Will cervical screening remain cost-effective in women offered the next generation nonavalent HPV vaccine? Results for four developed countries.
AffiliationCancer Research Division, Cancer Council NSW, 153 Dowling Street, Woolloomooloo, Sydney, NSW, 2011, Australia
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AbstractA 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 sensitivity analysis was performed. We found that, in the USA, four screens per lifetime was the most likely scenario, with a 34% probability of being optimal at WTP US$50,000/LYS, increasing to 84% probability 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. 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 WTP of GB£20,000/QALY, increasing to 92% probability at GB£30,000/QALY. 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. This article is protected by copyright. All rights reserved.
CitationWill cervical screening remain cost-effective in women offered the next generation nonavalent HPV vaccine? Results for four developed countries. 2016: Int. J. Cancer
JournalInternational Journal of Cancer
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