How to screen for cervical cancer after HPV16/18 vaccination in The Netherlands

Vaccine. 2009 Aug 13;27(37):5111-9. doi: 10.1016/j.vaccine.2009.06.043. Epub 2009 Jun 28.

Abstract

In The Netherlands, vaccination against HPV16/18 has been recommended for all 12-year-old girls. Because screening of vaccinated women remains important, we evaluated the model-based cost-effectiveness of cervical cancer screening strategies. We considered cytology and the HPV DNA test as primary screening instrument, varied the number of screening rounds from 7 to 4, and set the screening starting age at 30 and 35 years. Our model predicted reductions in cervical cancer mortality between 60 and 81% (from 199 deaths to 37-79) when adding screening to vaccination (assumptions for vaccination: 95% efficacy, 100% compliance, lifelong protection). Screening 5 times with HPV DNA (euro11,133/QALY) or 7 times with cytology (euro17,627/QALY) were scenarios with comparable costs and effects and incremental cost-effectiveness ratios below the threshold in The Netherlands (euro20,000 per QALY).

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Computer Simulation
  • Cost-Benefit Analysis / economics
  • Early Detection of Cancer
  • Female
  • Humans
  • Markov Chains
  • Mass Screening / economics*
  • Models, Statistical
  • Netherlands
  • Papillomavirus Infections / economics
  • Papillomavirus Infections / prevention & control
  • Papillomavirus Vaccines / administration & dosage*
  • Papillomavirus Vaccines / economics
  • Quality-Adjusted Life Years
  • Sensitivity and Specificity
  • Uterine Cervical Neoplasms / diagnosis*
  • Uterine Cervical Neoplasms / prevention & control
  • Uterine Cervical Neoplasms / virology
  • Vaccination / economics

Substances

  • Papillomavirus Vaccines