How to screen for cervical cancer after HPV16/18 vaccination in The Netherlands.
In The Netherlands, vaccination against HPV16/18 has been recommended for all 12-year-old girls. Because screening of vaccinated women remains important, we evaluated the model-based cost-effectiveness of cervical cancer screening strategies. We considered cytology and the HPV DNA test as primary screening instrument, varied the number of screening rounds from 7 to 4, and set the screening starting age at 30 and 35 years. Our model predicted reductions in cervical cancer mortality between 60 and 81% (from 199 deaths to 37-79) when adding screening to vaccination (assumptions for vaccination: 95% efficacy, 100% compliance, lifelong protection). Screening 5 times with HPV DNA (euro11,133/QALY) or 7 times with cytology (euro17,627/QALY) were scenarios with comparable costs and effects and incremental cost-effectiveness ratios below the threshold in The Netherlands (euro20,000 per QALY).
Coupé
Veerle M H
VM
Department of Clinical Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands. v.coupe@vumc.nl
de Melker
H E
HE
Snijders
Peter J F
PJ
Meijer
Chris J L M
CJ
Berkhof
Johannes
J
D003198:Computer Simulation; D003362:Cost-Benefit Analysis / Q000191:economics; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D015233:Models, Statistical; D009426:Netherlands; D030361:Papillomavirus Infections / Q000191:economics / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000191:economics; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control / Q000821:virology; D014611:Vaccination / Q000191:economics
D053918:Papillomavirus Vaccines