title: Effectiveness Modelling and Economic Evaluation of Primary HPV Screening for Cervical Cancer Prevention in New Zealand.
abstract: New Zealand (NZ) is considering transitioning from 3-yearly cervical cytology screening in women 20-69 years (current practice) to primary HPV screening. We evaluated HPV-based screening in both HPV-unvaccinated women and cohorts offered HPV vaccination in New Zealand (vaccination coverage ~50%).
  
  
  
  A complex model of HPV transmission, vaccination, cervical screening, and invasive cervical cancer was extensively validated against national population-based datasets. Sixteen potential strategies for HPV screening were considered.
  
  
  
  Most primary HPV strategies were more effective than current practice, for both unvaccinated women and cohorts offered vaccination. The optimal strategy for both groups was 5-yearly HPV screening in women aged 25-69 years with partial genotyping for HPV 16/18 and referral to colposcopy, and cytological triage of other oncogenic types. This is predicted to reduce cervical cancer incidence and mortality by a further 12-16% and to save 4-13% annually in program costs (excluding overheads). The findings are sensitive to assumptions about future adherence to initiating screening at 25 years.
  
  
  
  Primary HPV screening with partial genotyping would be more effective and less costly than the current cytology-based screening program, in both unvaccinated women and cohorts offered vaccination. These findings have been considered in a review of cervical screening in NZ.
authors.affiliation: Cancer Research Division, Cancer Council New South Wales, New South Wales, Australia.
authors.forename: Jie-Bin
authors.initials: JB
authors.lastname: Lew
authors.affiliation: Cancer Research Division, Cancer Council New South Wales, New South Wales, Australia.
authors.forename: Kate
authors.initials: K
authors.lastname: Simms
authors.affiliation: Cancer Research Division, Cancer Council New South Wales, New South Wales, Australia.
authors.forename: Megan
authors.initials: M
authors.lastname: Smith
authors.affiliation: Public Health Physician, Wellington, New Zealand.
authors.forename: Hazel
authors.initials: H
authors.lastname: Lewis
authors.affiliation: National Screening Unit, Ministry of Health, Wellington, New Zealand.
authors.forename: Harold
authors.initials: H
authors.lastname: Neal
authors.affiliation: Cancer Research Division, Cancer Council New South Wales, New South Wales, Australia.|School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Canfell
mesh_terms: D000328:Adult; D052685:Alphapapillomavirus / Q000302:isolation & purification*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000458:organization & administration*; D017146:Models, Organizational; D009520:New Zealand; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000821:virology; D055815:Young Adult