Adding a quadrivalent human papillomavirus vaccine to the UK cervical screening programme: A cost-effectiveness analysis

Dept, of Obstetrics and Gynecology, Duke University, Durham, NC 27705, USA.
Cost Effectiveness and Resource Allocation (Impact Factor: 0.87). 02/2008; 6(1):4. DOI: 10.1186/1478-7547-6-4
Source: PubMed


We assessed the cost-effectiveness of adding a quadrivalent (6/11/16/18) human papillomavirus (HPV) vaccine to the current screening programme in the UK compared to screening alone.
A Markov model of the natural history of HPV infection incorporating screening and vaccination was developed. A vaccine that prevents 98% of HPV 6, 11, 16 and 18-associated disease, with a lifetime duration and 85% coverage, in conjunction with current screening was considered.
Vaccination with screening, compared to screening alone, was associated with an incremental cost-effectiveness ratio of pound21,059 per quality adjusted life year (QALY) and pound34,687 per life year saved (LYS). More than 400 cases of cervical cancer, 6700 cases of cervical intraepithelial neoplasia and 4750 cases of genital warts could be avoided per 100,000 vaccinated girls. Results were sensitive to assumptions about the need for a booster, the duration of vaccine efficacy and discount rate.
These analyses suggest that adding a quadrivalent HPV vaccine to current screening in the UK could be a cost-effective method for further reducing the burden of cervical cancer.

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    • "that undergoing a cytology test is associated with no utility loss; the utility value for CIN1 is 0.987, 0.87 for CIN2–3, 0.76 for FIGO I, 0.67 for FIGO II–IV, and 0.938 for those surviving cervical cancer (Kulasingam et al., 2008; Kohli et al., 2012). "
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    ABSTRACT: Human papillomavirus (HPV) vaccination within a nonorganized setting creates a poor cost-effectiveness scenario. However, framed within an organized screening including primary HPV DNA testing with lengthening intervals may provide the best health value for invested money. To compare the effectiveness and cost-effectiveness of different cervical cancer (CC) prevention strategies, including current status and new proposed screening practices, to inform health decision-makers in Spain, a Markov model was developed to simulate the natural history of HPV and CC. Outcomes included cases averted, life expectancy, reduction in the lifetime risk of CC, life years saved, quality-adjusted life years (QALYs), net health benefits, lifetime costs, and incremental cost-effectiveness ratios. The willingness-to-pay threshold is defined at 20 000&OV0556;/QALY. Both costs and health outcomes were discounted at an annual rate of 3%. A strategy of 5-year organized HPV testing has similar effectiveness, but higher efficiency than 3-year cytology. Screening alone and vaccination combined with cytology are dominated by vaccination followed by 5-year HPV testing with cytology triage (12 214&OV0556;/QALY). The optimal age for both ending screening and switching age from cytology to HPV testing in older women is 5 years later for unvaccinated than for vaccinated women. Net health benefits decrease faster with diminishing vaccination coverage than screening coverage. Primary HPV DNA testing is more effective and cost-effective than current cytological screening. Vaccination uptake improvements and a gradual change toward an organized screening practice are critical components for achieving higher effectiveness and efficiency in the prevention of CC in Spain.
    European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP) 09/2015; DOI:10.1097/CEJ.0000000000000202 · 3.03 Impact Factor
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    • "After title and abstracts reading, 21 passed to the full-text review. Thirteen out of 21 papers were finally included in the analysis (Insinga 2007; Insinga 2008; Chesson 2008; Elbasha 2007; Brisson 2007; Bergeron 2008; Ginsberg 2007; Boot 2007; Dasbach 2008; Szucs 2008; Kulasingam 2008; Jit 2008; Mennini 2005). All the articles which dealt with economic analysis of bivalent vaccine (against genotypes 16 and 18) were excluded as well as papers in non English language. "
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    ABSTRACT: AimInterest in the quality of economic analyses is increasing in the field of decision-making. Drummond’s checklist is a useful tool. This study aimed to use a weighted version of Drummond’s checklist together with a consensus of experts to derive a new scoring system to improve the evaluation of economic analyses of tetravalent human papillomavirus (HPV) vaccine as a case study. MethodsDrummond’s checklist is composed of 35 items divided into 3 sections: study design, data collection and analysis and interpretation of results. To weight the items, a group of experts was asked to attribute a score according to their importance. A bibliographic search of economic evaluations of tetravalent HPV vaccine was performed. Two researchers assessed the quality of selected studies according to the original and weighted checklist. ResultsThe weighted scores assigned by the consensus to study design, data collection and analysis and interpretation of results were 26, 45 and 48, respectively. Thirteen papers were included in the review of economic evaluations of tetravalent HPV vaccine. According to the weighted Drummond’s checklist, their median quality score was 74 with a maximum of 119. The highest score was reached in the study design section. ConclusionAccording to the weighted Drummond’s checklist, studies were judged to be of medium quality. The main pitfalls were found in issues assigned the highest scores by the consensus, underlying the utility of weighting available checklists to improve the estimate of the quality of economic analyses. The weighted checklist could be thus proposed as a scoring tool to assess the quality. KeywordsCosts and cost analysis–Papillomavirus vaccines–Quality–Health Technology Assessment
    Journal of Public Health 04/2011; 19(2):103-111. DOI:10.1007/s10389-010-0377-z · 2.06 Impact Factor
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    • "In order to support informed decision making about whether to recommend (and finance) HPV vaccination publicly, epidemiological models that aim at long-term predictions of cervical cancer morbidity and mortality for various prevention program alternatives are a useful tool. They have been developed for several countries, often in combination with an economic evaluation (Kulasingam and Myers 2003; Sanders and Taira 2003; Goldie et al. 2004, 2007; Taira et al. 2004; Barnabas and Garnett 2005; Garnett et al. 2006; Brisson et al. 2007; Elbasha et al. 2007; French et al. 2007; Insinga et al. 2007; Kohli et al. 2007; National Board of Health and Danish Centre for Health Technology Assessement 2007; Neilson and Freiesleben de Blasio 2007; Thiry et al. 2007; Bergeron et al. 2008; Dasbach et al. 2008; Jit et al. 2008; Kim and Goldie 2008; Kulasingam et al. 2008). However, for producing reliable results, countryspecific models are required that take into account countryspecific features such as screening policy, epidemiology of the disease under evaluation and HPV prevalence. "
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    ABSTRACT: Aim: Cervical cancer incidence and mortality have decreased for the last 20 years in Austria; however, they remain relatively high in comparison to other European countries. Screening quality has been suboptimal. In this paper we aim to predict the population-wide long-term effects on cervical cancer morbidity and mortality after introducing an HPV vaccination for 12-year-old girls (and boys) in addition to current screening in comparison with screening only. Methods: Health effects are predicted by a dynamic transmission model that was previously applied in the UK and the Norwegian contexts and validated for Austria. Outcomes analyzed are restricted to cervical cancer mortality and morbidity, which are predicted until 2060 assuming a coverage rate between 65% and 85%, a duration of protection between 10 years and lifelong, and a vaccine efficacy between 80% and 100% in the base case and best case, respectively. Additionally, implications for cancer epidemiology until 2088 are estimated. Results: Compared to screening only, screening plus vaccination of 12-year-old girls (and boys) would result in a median reduction of 10% (15%) fewer new cancer cases and 13% (20%) fewer cervical cancer deaths under best case assumptions over 52 years in the overall female population. In 2060, female population-based incidence and mortality would decrease by 27% and 43%, respectively, when vaccinating girls only and by 37% and 45% when additionally vaccinating boys. After 2060, a continuous further decrease in incidence and mortality can be expected with a maximum of minus 43% and 53%, respectively, in 2088 when vaccinating girls only. Conclusion: Although a constant decrease in cervical cancer incidence and mortality is to be expected after introducing a population-wide HPV vaccination program in Austria, the reduction predicted by this model is lower than expected from clinical trials. This is due to several factors, such as low coverage rate and the long time horizon required for generating the maximum benefit of the vaccination in the overall population. In the context of limited resources, for further reducing cervical cancer in Austria, HPV vaccination programs need to be weighed against other public health alternatives such as improving screening quality.
    Journal of Public Health 02/2010; 18(1). DOI:10.1007/s10389-009-0276-3 · 2.06 Impact Factor
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