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.
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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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    • "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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