The cost-utility of integrated cervical cancer prevention strategies in the Ontario setting – Can we do better?

Sander, Beate; Wong, William; Yeung, Man Wah; Ormanidhi, Orges; Atkin, Karen; Murphy, Joan; Krahn, Murray; Deeks, Shelley L.

doi:10.1016/j.vaccine.2016.02.016

Cited by 6 publications

(4 citation statements)

References 28 publications

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“…Sander et al 2016 recently considered 900 combinations of vaccination and screening strategies [50]. The most cost-effective option may depend on the initial set of options considered, with the potential for the comparison of each strategy to a common comparator leading to a sub-optimal decision.…”

Section: Discussionmentioning

confidence: 99%

“…Existing analyses in this article, and the recent ones not included in our review [48, 50], focus on a 3-doses HPV vaccine and/or a vaccine that protects against 70% of cervical cancer and are probably obsolete [48]. New analyses considering changes in screening programs in a context of a nonavalent vaccine that protects against 90% of cervical cancers and using more realistic vaccination programmes in term of costs (2 dose schedule instead of 3 dose) and coverage rate (vaccinated and unvaccinated population) are needed.…”

Section: Discussionmentioning

confidence: 99%

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Systematic review of cost-effectiveness analyses for combinations of prevention strategies against human papillomavirus (HPV) infection: a general trend

et al. 2017

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BackgroundDue to the arrival of multi-valent HPV vaccines, it is more and more important to have a better understanding of the relationship between vaccination and screening programmes. This review aimed to: (1) collect published evidence on the cost-effectiveness profile of different HPV prevention strategies and, in particular, those combining vaccination with changes in screening practices; (2) explore the cost-effectiveness of alternative preventive strategies based on screening and vaccination.MethodsA systematic literature review was conducted in order to identify the relevant studies regarding the cost-effectiveness of prevention strategies against HPV infection. Analysis comparing the modelling approaches between studies was made along with an assessment of the magnitude of impact of several factors on the cost-effectiveness of different screening strategies.ResultsA total of 18 papers were quantitatively summarised within the narrative. A high degree of heterogeneity was found in terms of how HPV prevention strategies have been assessed in terms of their economic and epidemiological impact, with variation in screening practice and valence of HPV vaccination found to have large implications in terms of cost-effectiveness.ConclusionsThis review demonstrated synergies between screening and vaccination. New prevention strategies involving multi-valence vaccination, HPV DNA test screening, delayed commencement and frequency of screening could be implemented in the future. Strategies implemented in the future should be chosen with care, and informed knowledge of the potential impact of all possible prevention strategies. Highlighted in this review is the difficulty in assessing multiple strategies. Appropriate modelling techniques will need to be utilised to assess the most cost-effective strategies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Systematic review of cost-effectiveness analyses for combinations of prevention strategies against human papillomavirus (HPV) infection: a general trend

et al. 2017

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Section: Editorialmentioning

confidence: 99%

“…With the increasing demand under pressing health logistics for less screening in well-HPV-vaccinated cohorts (ie, those vaccinated primarily before becoming sexually active), strategies that combine HPV vaccination with simplified protocols of HPV screening and cytology triage, at least for women aged >30, will be of interest in many settings in the foreseeable future [19,23,24]. Besides, as herd immunity levels increase, the core design of screening schedules (e.g., screening intervals or screening start age) evolves, highlighting the importance of jointly optimizing both primary and secondary prevention strategies [25,26].Finally as El-Zein and colleagues argue, decision-making nowadays on cancer screening incorporates not only the extent of benefit in mortality reduction but also the potential harms from screening [27]. Policymakers need to assess related costs, utilities, infrastructures, political risks of inaction and patient choices [27].…”

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confidence: 99%

Crossroads of Primary and Secondary Cervical Cancer Prevention Strategies in Resource-Constrained Settings

Georgios¹

2017

JCPCR

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EditorialJ Cancer Prev Curr Res 2017, 7(4): 00246 cancer prevention. Besides, overtreatment of patients when clinicians fear future noncompliance leads to heightened patient anxiety and community mistrust of the health care system [1]. Nonetheless, lower socioeconomic status and inequalities represent fundamental problems which must be addressed in the new integrated strategies [3].More than 10 years have elapsed since the global launch of the first vaccine targeting an STI, namely the quadrivalent VLP HPV vaccine. Despite being highly successful, HPV vaccination programs have been particularly well executed in special settings where their implementation has been school-based [4]. The patchy coverage of vaccination target groups and the huge debate over HPV vaccination essentially stemmed from physicians and people's mixed attitudes towards vaccination, inaccurate information in the electronic and social media and the robust antivaccination movement among others. In hindsight, anecdotally some would argue that if the quadrivalent vaccine was globally marketed as an anti-wart vaccine without reference to cervical "precancer", it might have enjoyed more success.In the meanwhile, the inherent drawbacks of cytology (subjective nature, low sensitivity for detecting true cervical precancer requiring frequent re-screening) have been partially addressed with the wider implementation of HPV-related biomarkers which represent objective and more repetitive methods to screen for precancerous lesions [5]. Several DNA and mRNA HPV assays have gained FDA approval, other biomarkers (p16/Ki67 dual stain, viral genotyping, methylation markers) are being successfully used in daily clinical practice, and several others are still being validated in the assessment of HPV positive women [6]. This progress in HPV science has been the basis of calibrated cervical screening and triage options, and guidelines endorsed by the scientific committees. Therefore, the two approaches for controlling cervical cancer incidence have paved in parallel routes for a while; secondary prevention implementing cytology and HPV-related biomarkers for identifying precancer lesions, with subsequent resort to colposcopy; and HPV vaccination -virtually the incarnation of primary prevention. Even in the western world however, cervical screening is commonly opportunistic; or might be organized inconsistently across and within countries and regions. 7 In an excellent review addressing the flaws of secondary cervical prevention, the authors point at the differences between organized and opportunistic screening; in the former the basic principle is that the more women screened (as differentiated from the more tests done), the less morbidity and mortality from cervical cancer [7]. In contrast, opportunistic screening is often characterized by the over-screening of a minority of (some privileged) women, while those women most at risk tend to be screened rarely or not at all [7]. Thus, across all levels of screening coverage, increases in test sensitivity provide gre...

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Accounting for Adverse Events Following Immunization in Economic Evaluation: Systematic Review of Economic Evaluations of Pediatric Vaccines Against Pneumococcus, Rotavirus, Human Papillomavirus, Meningococcus and Measles-Mumps-Rubella-Varicella

2023

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The cost-utility of integrated cervical cancer prevention strategies in the Ontario setting – Can we do better?

Cited by 6 publications

References 28 publications

Systematic review of cost-effectiveness analyses for combinations of prevention strategies against human papillomavirus (HPV) infection: a general trend

Systematic review of cost-effectiveness analyses for combinations of prevention strategies against human papillomavirus (HPV) infection: a general trend

Crossroads of Primary and Secondary Cervical Cancer Prevention Strategies in Resource-Constrained Settings

Accounting for Adverse Events Following Immunization in Economic Evaluation: Systematic Review of Economic Evaluations of Pediatric Vaccines Against Pneumococcus, Rotavirus, Human Papillomavirus, Meningococcus and Measles-Mumps-Rubella-Varicella

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