Potential health and economic impact of adding a human papillomavirus vaccine to screening programs

JAMA. 2003 Aug 13;290(6):781-9. doi: 10.1001/jama.290.6.781.

Abstract

Context: Recently published results suggest that effective vaccines against cervical cancer-associated human papillomavirus (HPV) may become available within the next decade.

Objective: To examine the potential health and economic effects of an HPV vaccine in a setting of existing screening.

Design, setting, and population: A Markov model was used to estimate the lifetime (age 12-85 years) costs and life expectancy of a hypothetical cohort of women screened for cervical cancer in the United States. Three strategies were compared: (1) vaccination only; (2) conventional cytological screening only; and (3) vaccination followed by screening. Two of the strategies incorporated a vaccine targeted against a defined proportion of high-risk (oncogenic) HPV types. Screening intervals of 1, 2, 3, and 5 years and starting ages for screening of 18, 22, 24, 26, and 30 years were chosen for 2 of the strategies (conventional cytological screening only and vaccination followed by screening).

Main outcome measures: Incremental cost per life-year gained.

Results: Vaccination only or adding vaccination to screening conducted every 3 and 5 years was not cost-effective. However, at more frequent screening intervals, strategies combining vaccination and screening were preferred. Vaccination plus biennial screening delayed until age 24 years had the most attractive cost-effectiveness ratio (44 889 dollars) compared with screening only beginning at age 18 years and conducted every 3 years. However, the strategy of vaccination with annual screening beginning at age 18 years had the largest overall reduction in cancer incidence and mortality at a cost of 236 250 dollars per life-year gained compared with vaccination and annual screening beginning at age 22 years. The cost-effectiveness of vaccination plus delayed screening was highly sensitive to age of vaccination, duration of vaccine efficacy, and cost of vaccination.

Conclusions: Vaccination for HPV in combination with screening can be a cost-effective health intervention, but it depends on maintaining effectiveness during the ages of peak oncogenic HPV incidence. Identifying the optimal age for vaccination should be a top research priority.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cervical Intraepithelial Neoplasia / pathology
  • Cervical Intraepithelial Neoplasia / prevention & control*
  • Cervical Intraepithelial Neoplasia / virology
  • Colposcopy / economics
  • Cost-Benefit Analysis
  • Disease Progression
  • Female
  • Humans
  • Life Expectancy
  • Markov Chains
  • Mass Screening / economics
  • Middle Aged
  • Models, Theoretical
  • Papillomaviridae* / immunology
  • Papillomaviridae* / isolation & purification
  • Papillomavirus Infections / pathology
  • Papillomavirus Infections / prevention & control*
  • Papillomavirus Vaccines*
  • Quality-Adjusted Life Years
  • Tumor Virus Infections / pathology
  • Tumor Virus Infections / prevention & control*
  • Uterine Cervical Neoplasms / pathology
  • Uterine Cervical Neoplasms / prevention & control*
  • Uterine Cervical Neoplasms / virology
  • Vaccination / economics*
  • Vaginal Smears / economics
  • Viral Vaccines / administration & dosage
  • Viral Vaccines / economics*

Substances

  • Papillomavirus Vaccines
  • Viral Vaccines