Will cervical screening remain cost‐effective in women offered the next generation nonavalent HPV vaccine? Results for four developed countries. Issue 12 (12th October 2016)

• Record Type: Journal Article
• Authors: Simms, Kate T.; Smith, Megan A.; Lew, Jie‐Bin; Kitchener, Henry C.; Castle, Philip E.; Canfell, Karen
• Is Part Of: International journal of cancer. Volume 139:Issue 12(2016:Dec. 15)
• Page Start: 2771
• Page End: 2780
• Publication Date: 2016-10-12
• Subjects: nonavalent HPV vaccine -- primary HPV screening -- HPV vaccine -- cervical screening; Cancer -- Periodicals; Cancer -- Prevention -- Periodicals; 616.994
• DOI: 10.1002/ijc.30392
• Languages: English
• ISSNs: 0020-7136

Abstract

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. Abstract : What's new? A second generation nonavalent human papillomavirus (HPV) vaccine protects against multiple HPV types, increasing the level of protection against cervical cancer. The impact of nonavalent vaccination on cervical screening in the United States, New Zealand, Australia, and England was evaluated here. Analyses suggest that screening is likely to remain cost‐effective in cohorts offered the nonavalent vaccine, even in countries with high vaccination coverage. The findings provide critical insight for the optimization of future cervical cancer prevention strategies.