title: Adding a quadrivalent human papillomavirus vaccine to the UK cervical cancer screening programme: A cost-effectiveness analysis.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Dept, of Obstetrics and Gynecology, Duke University, Durham, NC 27705, USA. kulas002@mc.duke.edu
authors.forename: Shalini L
authors.initials: SL
authors.lastname: Kulasingam
authors.forename: Steve
authors.initials: S
authors.lastname: Benard
authors.forename: Ruanne V
authors.initials: RV
authors.lastname: Barnabas
authors.forename: Nathalie
authors.initials: N
authors.lastname: Largeron
authors.forename: Evan R
authors.initials: ER
authors.lastname: Myers