title: Optimization of primary and secondary cervical cancer prevention strategies in an era of cervical cancer vaccination: a multi-regional health economic analysis.
abstract: With the recent advent of cervical cancer vaccines, many questions relating to the best overall prevention methods for cervical disease are beginning to arise. A Markov model was used across five geographic regions (Canada, The Netherlands, Taiwan, UK, US) to examine the clinical benefits and cost-effectiveness of: (1) vaccination combined with screening, considering changes to screening-related parameters and (2) vaccination combined with screening, considering changes to screening policy. Given the assumptions used in this analysis, adding vaccination to current screening is likely to be cost-effective in the regions studied. When considering vaccination with several plausible changes to screening programmes, locations with the most frequent Papanicolaou smear testing may achieve the most efficiency gains by adopting a less frequent screening interval or incorporating HPV testing into their screening practices. Although it may be beneficial to change screening to maximize efficiency, the most cost-effective strategies for vaccination and screening combinations may not lead to the greatest reductions in cervical cancer; therefore such policy decisions may vary depending on region-specific goals. Finally, new screening paradigms such as primary HPV testing should be considered in future analyses.
authors.affiliation: Health Economics and Outcomes Research, i3 Innovus, 1016-A Sutton Drive, Burlington, Ontario, Canada. raina.rogoza@i3innovus.com
authors.forename: Raina M
authors.initials: RM
authors.lastname: Rogoza
authors.forename: Nicole
authors.initials: N
authors.lastname: Ferko
authors.forename: James
authors.initials: J
authors.lastname: Bentley
authors.forename: Chris J L M
authors.initials: CJ
authors.lastname: Meijer
authors.forename: Johannes
authors.initials: J
authors.lastname: Berkhof
authors.forename: Kung-Liahng
authors.initials: KL
authors.lastname: Wang
authors.forename: Levi
authors.initials: L
authors.lastname: Downs
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Smith
authors.forename: Eduardo L
authors.initials: EL
authors.lastname: Franco
mesh_terms: D005260:Female; D006801:Humans; D017059:Models, Econometric; D030361:Papillomavirus Infections / Q000191:economics* / Q000517:prevention & control*; D002583:Uterine Cervical Neoplasms / Q000191:economics* / Q000517:prevention & control*; D014611:Vaccination / Q000191:economics*