title: Will cervical screening remain cost-effective in women offered the next generation nonavalent HPV vaccine? Results for four developed countries.
abstract: A next generation nonavalent human papillomavirus (HPV) vaccine ("HPV9 vaccine") is being introduced in several countries. The aims of this study were to evaluate whether cervical screening will remain cost-effective in cohorts offered nonavalent vaccines and if so, to characterize the optimal number of screening tests. We used a dynamic model of HPV vaccination and cervical screening to evaluate the cost-effectiveness of strategies involving varying numbers of primary HPV tests per lifetime for cohorts offered the nonavalent vaccine as 12 year-olds. For each of four countries-the USA, New Zealand (NZ), Australia and England-we considered local factors including vaccine uptake rates (USA/NZ uptake ∼50%; Australia/England uptake >70%), attributable fractions of HPV9-included types, demographic factors, costs and indicative willingness-to-pay (WTP) thresholds. Extensive probabilistic sensitivity analysis was performed. We found that, in the USA, four screens per lifetime was the most likely scenario, with 34% probability of being optimal at WTP US$50,000/LYS, increasing to 84% probability at US$100,000/LYS. In New Zealand, five screens per lifetime was the most likely scenario, with 100% probability of being optimal at NZ$42,000/LYS, given the assumptions used. In Australia, two screens per lifetime was the most likely scenario, with 62% probability of being optimal at AU$50,000/LYS. In England, four screens per lifetime was the most likely scenario, with 32% probability of being optimal at GB£20,000/LYS, increasing to 96% probability at GB£30,000/LYS. We conclude that some cervical screening will remain cost-effective, even in countries with high vaccination coverage. However, the optimal number of screens may vary between countries.
authors.affiliation: Cancer Research Division, Cancer Council NSW, Woolloomooloo, Sydney, NSW, Australia.|Prince of Wales Clinical School, The University of New South Wales, Australia.
authors.forename: Kate T
authors.initials: KT
authors.lastname: Simms
authors.affiliation: Cancer Research Division, Cancer Council NSW, Woolloomooloo, Sydney, NSW, Australia.|Prince of Wales Clinical School, The University of New South Wales, Australia.|School of Public Health, University of Sydney, Australia.
authors.forename: Megan A
authors.initials: MA
authors.lastname: Smith
authors.affiliation: Cancer Research Division, Cancer Council NSW, Woolloomooloo, Sydney, NSW, Australia.|Prince of Wales Clinical School, The University of New South Wales, Australia.
authors.forename: Jie-Bin
authors.initials: JB
authors.lastname: Lew
authors.affiliation: Institute of Cancer Sciences, University of Manchester, United Kingdom.
authors.forename: Henry C
authors.initials: HC
authors.lastname: Kitchener
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.|Global Coalition against Cervical Cancer, Arlington, VA.
authors.forename: Philip E
authors.initials: PE
authors.lastname: Castle
authors.affiliation: Cancer Research Division, Cancer Council NSW, Woolloomooloo, Sydney, NSW, Australia. karen.canfell@nswcc.org.au.|Prince of Wales Clinical School, The University of New South Wales, Australia. karen.canfell@nswcc.org.au.|School of Public Health, University of Sydney, Australia. karen.canfell@nswcc.org.au.
authors.forename: Karen
authors.initials: K
authors.lastname: Canfell
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D019049:Developed Countries; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000276:immunology*; D019057:Quality-Adjusted Life Years; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000517:prevention & control*; D014611:Vaccination
chemical_list: D053918:Papillomavirus Vaccines
keywords: HPV vaccine; cervical screening; nonavalent HPV vaccine; primary HPV screening