title: Economic Evaluation of Screening Strategies Combined with HPV Vaccination of Preadolescent Girls for the Prevention of Cervical Cancer in Vientiane, Lao PDR.
abstract: BACKGROUND
  Several approaches to reduce the incidence of invasive cervical cancers exist. The approach adopted should take into account contextual factors that influence the cost-effectiveness of the available options.
  
  
  OBJECTIVE
  To determine the cost-effectiveness of screening strategies combined with a vaccination program for 10-year old girls for cervical cancer prevention in Vientiane, Lao PDR.
  
  
  METHODS
  A population-based dynamic compartment model was constructed. The interventions consisted of a 10-year old girl vaccination program only, or this program combined with screening strategies, i.e., visual inspection with acetic acid (VIA), cytology-based screening, rapid human papillomavirus (HPV) DNA testing, or combined VIA and cytology testing. Simulations were run over 100 years. In base-case scenario analyses, we assumed a 70% vaccination coverage with lifelong protection and a 50% screening coverage. The outcome of interest was the incremental cost per Disability-Adjusted Life Year (DALY) averted.
  
  
  RESULTS
  In base-case scenarios, compared to the next best strategy, the model predicted that VIA screening of women aged 30-65 years old every three years, combined with vaccination, was the most attractive option, costing 2 544 international dollars (I$) per DALY averted. Meanwhile, rapid HPV DNA testing was predicted to be more attractive than cytology-based screening or its combination with VIA. Among cytology-based screening options, combined VIA with conventional cytology testing was predicted to be the most attractive option. Multi-way sensitivity analyses did not change the results. Compared to rapid HPV DNA testing, VIA had a probability of cost-effectiveness of 73%. Compared to the vaccination only option, the probability that a program consisting of screening women every five years would be cost-effective was around 60% and 80% if the willingness-to-pay threshold is fixed at one and three GDP per capita, respectively.
  
  
  CONCLUSIONS
  A VIA screening program in addition to a girl vaccination program was predicted to be the most attractive option in the health care context of Lao PDR. When compared with other screening methods, VIA was the primary recommended method for combination with vaccination in Lao PDR.
authors.affiliation: Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR.|Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, Canada.
authors.forename: Phetsavanh
authors.identifier: http://orcid.org/0000-0003-0655-8323
authors.initials: P
authors.lastname: Chanthavilay
authors.affiliation: Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, Canada.|Institut de la Francophonie pour la Médecine tropicale, Vientiane, Lao PDR.
authors.forename: Daniel
authors.initials: D
authors.lastname: Reinharz
authors.affiliation: Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR.|Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.|Centre for Tropical Medicine and Global Health, Churchill Hospital, University of Oxford, Oxford, United Kingdom.
authors.forename: Mayfong
authors.initials: M
authors.lastname: Mayxay
authors.affiliation: Gynecologic Oncology Unit, Setthathirath Hospital, Vientiane, Lao PDR.
authors.forename: Keokedthong
authors.initials: K
authors.lastname: Phongsavan
authors.affiliation: Centre for Tropical Medicine and Global Health, Churchill Hospital, University of Oxford, Oxford, United Kingdom.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Marsden
authors.affiliation: Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, Canada.
authors.forename: Lynne
authors.initials: L
authors.lastname: Moore
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.|Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: White
mesh_terms: D002648:Child; D005260:Female; D006801:Humans; D007812:Laos; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000821:virology
chemical_list: D053918:Papillomavirus Vaccines