Primary HPV testing versus cytology-based cervical screening in women in Australia vaccinated for HPV and unvaccinated: effectiveness and economic assessment for the National Cervical Screening Program

Abstract

Department of Health, Australia.

Will cervical screening remain cost‐effective in women offered the next generation nonavalent HPV vaccine? Results for four developed countries

“…^ National cancer registries informed the rates for USA, New Zealand, Australia and England . * Estimates based on model predictions for England, Australia and New Zealand . For the USA, we assumed ∼40% reduction of HPV4‐included types based on vaccine uptake and that HPV4‐included types are responsible for 78% of cervical cancers, resulting in a decrease in CLR incidence of 30%.…”

“…An extensively validated dynamic model of HPV transmission, HPV vaccination, cervical precancer, cancer survival, screening, diagnosis and treatment (“Policy1‐Cervix”) was used for the evaluation (see Fig. and Appendix 1 for more information) The model incorporates demographic, health economic, HPV attributable fractions in cervical cancer and vaccine uptake assumptions from each of the four countries, as detailed in Table (more details on data sources for demographic parameters and health economic parameters can be found in Appendix 1).…”

“…In New Zealand, Australia and England we considered two benchmarks–one in the context of the current cytology‐based screening program, and one in the context of an HPV‐based screening program (implemented from 2017 in Australia and being evaluated through pilot experiences in New Zealand and England). For benchmark 2, we compared the model predicted CLR in cohorts offered first generation vaccines to rates predicted for each of the four countries, which is based on model predictions as previously described for Australia, England and New Zealand, and estimated for the USA. For both benchmarks, we performed probabilistic sensitivity analyses to assess the impact of uncertainties in screening attendance rates, screening test accuracy, natural history parameters and costs for each of the four countries (described in detail in Appendix 1).…”

“…We presented cost‐effectiveness for baseline parameters, and also presented probabilistic acceptability curves, which show the probability a screening strategy is the most likely option to be selected at each WTP level. Effectiveness was estimated using life‐years saved (LYS) rather than quality‐adjusted life‐years saved (QALYs), because of a paucity of data to inform the choice of QALY weights for HPV screening and the subsequent referral and management processes, and our previous findings that outcomes are not robust to different data sources to inform utility weight choices . One way sensitivity analysis was also performed to assess the impact of each input parameter on cost‐effectiveness, and is shown in Appendix 2.…”

How will transitioning from cytology to HPV testing change the balance between the benefits and harms of cervical cancer screening? Estimates of the impact on cervical cancer, treatment rates and adverse obstetric outcomes in Australia, a high vaccination coverage country

“…To estimate the impact of primary HPV screening on cervical cancer incidence and mortality and on treatment rates, we used a dynamic model of sexual behaviour, HPV transmission, natural history, cervical screening and HPV vaccination in females and males in the Australian population. The model platform has been extensively validated against a range of screening outputs and other national/nationally representative data sources . A detailed description of its development, parameterisation and calibration has been described previously .…”