Article

Cost-effectiveness of human papillomavirus vaccination and screening in Spain

Unit of Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, Av. Gran Via 199-203, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
European journal of cancer (Oxford, England: 1990) (Impact Factor: 4.82). 11/2010; 46(16):2973-85. DOI: 10.1016/j.ejca.2010.06.016
Source: PubMed

ABSTRACT In Spain, prophylactic vaccination against human papillomavirus (HPV) types 16 and 18 is being offered free-of-charge to one birth cohort of girls aged 11-14. Screening is opportunistic (annual/biannual) contributing to social and geographical disparities.
A multi-HPV-type microsimulation model was calibrated to epidemiologic data from Spain utilising likelihood-based methods to assess the health and economic impact of adding HPV vaccination to cervical cancer screening. Strategies included (1) screening alone of women over age 25, varying frequency (every 1-5 years) and test (cytology, HPV DNA testing); (2) HPV vaccination of 11-year-old girls combined with screening. Outcomes included lifetime cancer risk, life expectancy, lifetime costs, number of clinical procedures and incremental cost-effectiveness ratios.
After the introduction of HPV vaccination, screening will need to continue, and strategies that incorporated HPV testing are more effective and cost-effective than those with cytology alone. For vaccinated girls, 5-year organised cytology with HPV testing as triage from ages 30 to 65 costs 24,350€ per year of life saved (YLS), assuming life-long vaccine immunity against HPV-16/18 by 3 doses with 90% coverage. Unvaccinated girls would benefit from organised cytology screening with HPV testing as triage; 5-year screening from ages 30 to 65 costs 16,060€/YLS and 4-year screening from ages 30 to 85 costs 38,250€/YLS. Interventions would be cost-effective depending on the cost-effectiveness threshold and the vaccine price.
In Spain, inequitable coverage and overuse of cytology make screening programmes inefficient. If high vaccination coverage among pre-adolescent girls is achieved, organised cytology screening with HPV triage starting at ages 30 to at least 65 every 4-5 years represents the best balance between costs and benefits.

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    • "Health outcomes were reported as a mean and range of results, while incremental cost-effectiveness ratios were reported as the ratio of the difference in mean costs divided by the difference in mean effects across the good-fitting parameter sets for one strategy compared with the next best alternative. The calibration process has been previously described [30] [31] [32] [33] [34] [35] [36] and details of the calibration data, methods, and results for all three countries are provided in the Appendix. Strategies that were evaluated in this analysis include: (1) HPV16/18 vaccination of pre-adolescent girls (by age 12); (2) screening alone; and (3) combined pre-adolescent HPV16/18 vaccination and screening. "
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    Vaccine 12/2013; 31S6:G65-G77. DOI:10.1016/j.vaccine.2012.06.096 · 3.49 Impact Factor
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    • "Our findings show that a 3 year screening interval is safe although based on a small sample of women. hrHPV triage is likely to result in a cost-effective strategy if screening intervals are kept and diverts women from colposcopy in hrHPV negative women [10,22]. However, although the sensitivity of hrHC2 was very high, specificity was relatively low increasing unnecessarily the number of women referred to colposcopy because of a positive test. "
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