Impact of vaccine protection against multiple HPV types on the cost-effectiveness of cervical screening

Vaccine. 2012 Feb 27;30(10):1813-22. doi: 10.1016/j.vaccine.2012.01.001. Epub 2012 Jan 10.

Abstract

Cross-protection against non-HPV16/18 types and the emergence of broad spectrum vaccines protecting against multiple HPV types will influence the cost-effectiveness of future screening. To assess this influence we used an individual-based simulation model describing the relation between 14 HPV types and cervical disease, allowing the occurrence of multiple type infections. Screening scenarios for vaccinated women were evaluated, firstly for HPV16/18 vaccination with partial cross-protection against HPV 31, 33, 45 and 58 and secondly, for broad spectrum vaccination against 5-13 HPV types. The vaccine-induced incidence reduction of type-specific infection was varied from 0 to 95% in the cross-protection setting and set at 100% in the setting of broad spectrum vaccines. Scenarios of either cytology or HPV DNA screening were considered under varying lifetime number of screening rounds. At a cost-effectiveness threshold of €20,000/QALY, four times HPV DNA screening between 30 and 60 years was the selected scenario in addition to HPV16/18 vaccination, whether or not cross-protection was conferred (€6707 and €9994/QALY, respectively). In the absence of cross-protection, a fifth screening round might be considered (ICER €22,967/QALY). In addition to broad spectrum vaccination, one screen during lifetime was cost-effective up to an 11-valent vaccine. If the vaccine-induced type-specific incidence reduction was lowered to 99%, one screen during lifetime was cost-effective even in addition to 13-valent vaccination. In conclusion, in a cohort of HPV16/18 vaccinated women, four rounds of HPV DNA screening is cost-effective. One screen during lifetime remains cost-effective in addition to broad spectrum vaccination offering protection against many high-risk HPV types.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cervical Intraepithelial Neoplasia / prevention & control
  • Cervical Intraepithelial Neoplasia / virology
  • Cost-Benefit Analysis
  • Cross Protection*
  • DNA, Viral / isolation & purification
  • Female
  • Humans
  • Mass Screening / economics*
  • Middle Aged
  • Models, Economic*
  • Netherlands
  • Papillomaviridae / classification
  • Papillomaviridae / pathogenicity
  • Papillomavirus Infections / prevention & control*
  • Papillomavirus Vaccines / administration & dosage
  • Papillomavirus Vaccines / classification
  • Papillomavirus Vaccines / economics*
  • Quality-Adjusted Life Years
  • Sensitivity and Specificity
  • Uterine Cervical Neoplasms / prevention & control
  • Uterine Cervical Neoplasms / virology

Substances

  • DNA, Viral
  • Papillomavirus Vaccines