SS 04-02Modelled evaluation of screen-and-vaccinate strategies in high and low resource settings

29. Economics and modelling
K. Simms 1, J. Killen 2, M. Hall 2, J.B. Lew 3, M. Smith 4, K. Canfell 4.
1Cancer Research Division, Cancer Council NSW, 153 Dowling Street, Woolloomooloo, Sydney, NSW, 2011, Australia and Prince of Wales Clinical School, The University of New South Wales, Australia (UNSW is a previous affiliation for KS, MS and KC) (Australia), (Australia), 2Cancer Research Division, Cancer Council NSW, 153 Dowling Street, Woolloomooloo, Sydney, NSW, 2011, Australia (Australia), 3Cancer Research Division, Cancer Council NSW, 153 Dowling Street, Woolloomooloo, Sydney, NSW, 2011, Australia and Prince of Wales Clinical School, The University of New South Wales, Australia (Australia), 4Cancer Research Division, Cancer Council NSW, 153 Dowling Street, Woolloomooloo, Sydney, NSW, 2011, Australia, Prince of Wales Clinical School, The University of New South Wales, Australia (UNSW is a previous affiliation for KS, MS and KC) and School of Public Health, University of Sydney, Australi (Australia)

Background / Objectives

Background: ‘Screen-and-vaccinate’ refers to the possibility of integrating cervical screening and vaccination approaches in adult women (aged 25-45 years), and is a subset of a larger group of notional strategies for vaccinating broader population groups known as ‘HPV-FASTER’. With screen-and-vaccinate, women would receive primary HPV screening (potentially with partial genotyping for HPV16/18) and then unvaccinated women could be offered vaccination, with the offer potentially contingent on HPV DNA status as determined via the screening test. Modelling will play an important role in assessing the effectiveness and cost-effectiveness of vaccination in this context. 

Objective: To discuss some key considerations in modelling screen-and-vaccinate strategies and to present some initial findings, for a number of high and medium-low income countries.


Methods

We used a comprehensive dynamic modelling platform of HPV vaccination and cervical screening to evaluate the outcomes and cost-effectiveness of screen-and-vaccinate strategies, in relation to (1) no intervention; (2) screening- alone; and (3) vaccination of all women in this age group, irrespective of HPV DNA status.


Results

Conclusion

The risks of acquiring a new HPV infection that then progresses to invasive cervical cancer in a women’s lifetime is lower in adult women than in adolescent girls, and therefore the lifetime benefits of vaccination in this group is lower than in pre-adolescents. This implies that the vaccination price for vaccination of adult women would need to be lower in order for vaccination of this group to become cost-effective. Targeted vaccination of HPV-negative women (as determined via a primary HPV screening test) may increase cost-effectiveness somewhat.


References