Potential health and economic impact of adding a human papillomavirus vaccine to screening programs.
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TLDR
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, and identifying the optimal age for vaccination should be a top research priority.Abstract:
ContextRecently published results suggest that effective vaccines against cervical
cancer—associated human papillomavirus (HPV) may become available within
the next decade.ObjectiveTo examine the potential health and economic effects of an HPV vaccine
in a setting of existing screening.Design, Setting, and PopulationA 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 MeasuresIncremental cost per life-year gained.ResultsVaccination 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) 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
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.ConclusionsVaccination 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.read more
Citations
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Journal ArticleDOI
American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer
Debbie Saslow,Diane Solomon,Herschel W. Lawson,Maureen Killackey,Shalini L Kulasingam,Joanna M. Cain,Francisco A.R. Garcia,Ann T. Moriarty,Alan G. Waxman,David C. Wilbur,Nicolas Wentzensen,Levi S. Downs,Mark Spitzer,Anna-Barbara Moscicki,Eduardo L. Franco,Mark H. Stoler,Mark Schiffman,Philip E. Castle,Evan R. Myers +18 more
TL;DR: An update to the ACS guideline regarding screening for the early detection of cervical precancerous lesions and cancer is presented, addressing age‐appropriate screening strategies, including the use of cytology and high‐risk human papillomavirus (HPV) testing.
Journal Article
Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP).
Lauri E. Markowitz,Eileen F. Dunne,Mona Saraiya,Herschel W. Lawson,Harrell W. Chesson,Elizabeth R. Unger +5 more
TL;DR: The first statement by the Advisory Committee on Immunization Practices (ACIP) on the use of a quadrivalent human papillomavirus (HPV) vaccine was made by the U.S. Food and Drug Administration on June 8, 2006 as mentioned in this paper.
Journal ArticleDOI
The epidemiology of human papillomavirus infections.
TL;DR: Significant issues surrounding the natural history of HPV infection, including viral persistence versus clearance, immune response, development of lesions and development of cancer are discussed.
References
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Journal ArticleDOI
Human papillomavirus is a necessary cause of invasive cervical cancer worldwide.
Jan M. M. Walboomers,M. V. Jacobs,M. M. Manos,Franz X. Bosch,J. A. Kummer,Keerti V. Shah,Peter J.F. Snijders,Julian Peto,Chris J.L.M. Meijer,Nubia Muñoz +9 more
TL;DR: The presence of HPV in virtually all cervical cancers implies the highest worldwide attributable fraction so far reported for a specific cause of any major human cancer, and the rationale for HPV testing in addition to, or even instead of, cervical cytology in routine cervical screening.
Journal ArticleDOI
Epidemiologic Classification of Human Papillomavirus Types Associated with Cervical Cancer
Nubia Muñoz,F. Xavier Bosch,Silvia de Sanjosé,Rolando Herrero,Xavier Castellsagué,Keerti V. Shah,Peter J.F. Snijders,Chris J.L.M. Meijer +7 more
TL;DR: In addition to HPV types 16 and 18, types 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82Should be considered carcinogenic, or high-risk, types, and types 26, 53, and 66 should be considered probably carcinogenic.
Book
Cost-effectiveness in health and medicine
TL;DR: 1. Cost-Effectiveness Analysis as a Guide to Resource Allocation in Health: Roles and Limitations 2. Theoretical Foundations of Cost-effectiveness Analysis 3. Framing and Designing the Cost- Effectiveness Analysis 4. Identifying and Valuing Outcomes 5. Assessing the Effectiveness of Health Interventions
Journal ArticleDOI
Prevalence of Human Papillomavirus in Cervical Cancer: a Worldwide Perspective
Francesc Xavier Bosch,M. M. Manos,Nubia Muñoz,Mark E. Sherman,Angela M. Jansen,Julian Peto,Mark Schiffman,Victor Moreno,Robert J. Kurman,Keerti V. Shah +9 more
TL;DR: The results confirm the role of genitalHPVs, which are transmitted sexually, as the central etiologic factor in cervical cancer worldwide and suggest that most genital HPVs are associated with cancer, at least occasionally.
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The 2001 Bethesda System: terminology for reporting results of cervical cytology.
Diane Solomon,Diane D. Davey,Robert J. Kurman,Marianne U. Prey,Stephen S. Raab,Mark E. Sherman,David C. Wilbur,Nancy A. Young +7 more
TL;DR: The 2001 Bethesda System terminology reflects important advances in biological understanding of cervical neoplasia and cervical screening technology.
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