The health and economic impact of cervical cancer screening and human papillomavirus vaccination in kidney transplant recipients.
BACKGROUND
The risk of cervical cancer in women who are kidney transplant recipients is increased, but little is known about the effectiveness of screening and human papillomavirus (HPV) vaccination in this group of women. We sought to determine the cost effectiveness of annual screening for cervical cancers using conventional cytology, liquid-based cytology (LBC), and pretransplant HPV vaccination in kidney transplant recipients.


METHODS
Three deterministic Markov models were developed to compare the costs and health outcomes in a cohort of women (n=1000) with kidney transplants aged 18 to 69 who underwent annual screening using conventional cytology, LBC, and HPV vaccination in HPV naïve women.


RESULTS
After a screening period of 50 years, the incremental benefits of screening using conventional cytology compared with no screening were 0.05 life years saved (LYS) (18.2 days of lives saved), the incremental costs were $608, giving an incremental cost-effectiveness ratio of $12,160 per LYS. Compared with conventional cytology alone, the incremental cost-effectiveness ratios of annual screening using LBC and HPV vaccination before transplantation (assuming nonwaning efficacy) were $127,000 and $152,333 per LYS, respectively.


CONCLUSIONS
The recommended policy of annual screening using conventional cytology is cost effective. The replacement of conventional cytology with LBC is likely to provide minimal survival benefits but considerable costs. Assuming the reported trial-based vaccine efficacy in HPV naïve women, a program of HPV vaccination before kidney transplantation is unlikely to be cost effective. Additional data about the long-term efficacy and safety of HPV vaccination is required before it should be included as standard care of renal transplant recipients.
NHMRC Centre for Clinical Research Excellence in Renal Medicine, Children's Hospital at Westmead, NSW, Australia. germainw@chw.edu.au
Germaine
G
Wong
Kirsten
K
Howard
Angela
A
Webster
Jeremy R
JR
Chapman
Jonathan C
JC
Craig
D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000191:economics*; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D053918:Papillomavirus Vaccines / Q000191:economics* / Q000627:therapeutic use*; D011336:Probability; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000453:epidemiology / Q000276:immunology* / Q000532:radiotherapy; D055815:Young Adult
D053918:Papillomavirus Vaccines