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Potential health and economic impact of adding a human papillomavirus vaccine to screening programs.

Publication ,  Journal Article
Kulasingam, SL; Myers, ER
Published in: JAMA
August 13, 2003

CONTEXT: Recently published results suggest that effective vaccines against cervical cancer-associated human papillomavirus (HPV) may become available within the next decade. OBJECTIVE: To examine the potential health and economic effects of an HPV vaccine in a setting of existing screening. DESIGN, SETTING, AND POPULATION: A 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 MEASURES: Incremental cost per life-year gained. RESULTS: Vaccination 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 dollars) 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 dollars 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. CONCLUSIONS: 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. Identifying the optimal age for vaccination should be a top research priority.

Duke Scholars

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Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

August 13, 2003

Volume

290

Issue

6

Start / End Page

781 / 789

Location

United States

Related Subject Headings

  • Viral Vaccines
  • Vaginal Smears
  • Vaccination
  • Uterine Cervical Neoplasms
  • Uterine Cervical Dysplasia
  • Tumor Virus Infections
  • Quality-Adjusted Life Years
  • Papillomavirus Vaccines
  • Papillomavirus Infections
  • Papillomaviridae
 

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Kulasingam, S. L., & Myers, E. R. (2003). Potential health and economic impact of adding a human papillomavirus vaccine to screening programs. JAMA, 290(6), 781–789. https://doi.org/10.1001/jama.290.6.781
Kulasingam, Shalini L., and Evan R. Myers. “Potential health and economic impact of adding a human papillomavirus vaccine to screening programs.JAMA 290, no. 6 (August 13, 2003): 781–89. https://doi.org/10.1001/jama.290.6.781.
Kulasingam, Shalini L., and Evan R. Myers. “Potential health and economic impact of adding a human papillomavirus vaccine to screening programs.JAMA, vol. 290, no. 6, Aug. 2003, pp. 781–89. Pubmed, doi:10.1001/jama.290.6.781.
Journal cover image

Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

August 13, 2003

Volume

290

Issue

6

Start / End Page

781 / 789

Location

United States

Related Subject Headings

  • Viral Vaccines
  • Vaginal Smears
  • Vaccination
  • Uterine Cervical Neoplasms
  • Uterine Cervical Dysplasia
  • Tumor Virus Infections
  • Quality-Adjusted Life Years
  • Papillomavirus Vaccines
  • Papillomavirus Infections
  • Papillomaviridae