Impact and cost-effectiveness of strategies to accelerate cervical cancer elimination: A model-based analysis

Portnoy, Allison; Pedersen, Kine; Trogstad, Lill; Hansen, Bo T.; Feiring, Berit; Laake, Ida; Smith, Megan A.; Sy, Stephen; Nygård, Mari; Kim, Jane J.; Burger, Emily A.

doi:10.1016/j.ypmed.2020.106276

Cited by 25 publications

(61 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Modelling of elimination timing in HIC suggests that the fastest means of achieving this is to increase cervical screening coverage and/or transition from cytology to HPV screening [6,7]. Managing the transition to primary HPV screening and evaluating and updating triaging approaches according to emergent evidence will be the challenge moving forward.…”

Section: Summary Of Implications and Conclusionmentioning

confidence: 99%

Eliminating Cervical Cancer: Progress and Challenges for High-income Countries

Davies-Oliveira¹,

Smith²,

Grover³

et al. 2021

Clinical Oncology

View full text Add to dashboard Cite

In 2020, the World Health Organization launched a major initiative to eliminate cervical cancer globally. The initiative is built around the three key pillars of human papillomavirus (HPV) vaccination, cervical screening and treatment, with associated intervention targets for the year 2030. The '90-70-90' targets specify that 90% of adolescent girls receive prophylactic HPV vaccination, 70% of adult women receive a minimum twice-in-a-lifetime cervical HPV test and 90% receive appropriate treatment for preinvasive or invasive disease. Modelling has shown that if these targets are met, the elimination of cervical cancer, defined as fewer than four cases per 100 000 women per annum, will be achieved within a century. Many high-income countries are well positioned to eliminate cervical cancer within the coming decades, but few have achieved '90-70-90' and many challenges must still be addressed to deliver these critical interventions effectively. This review considers the current status of cervical cancer control in relation to each of the three elimination pillars in high-income countries and discusses some of the developments that will assist countries in reaching these ambitious targets by 2030.

show abstract

Section: Summary Of Implications and Conclusionmentioning

confidence: 99%

Eliminating Cervical Cancer: Progress and Challenges for High-income Countries

Davies-Oliveira¹,

Smith²,

Grover³

et al. 2021

Clinical Oncology

View full text Add to dashboard Cite

show abstract

“…We conducted a model-based cost-effectiveness analysis using a previously developed microsimulation model of HPV and cervical carcinogenesis, 18 adapted to reflect Norwegian epidemiologic and costing data. 19,20 The study setting was within the Norwegian Cervical Cancer Screening Program (NCCSP), which currently involves three-yearly cytology-based screening for women aged 25 to 33 years and ongoing implementation of a switch from primary cytology to five-yearly primary HPV testing for women aged 34 to 69 years. Since the resource-demanding switch to primary HPV testing is ongoing, decision-makers are unlikely to introduce major changes to the NCCSP before implementation is complete.…”

Section: Analytic Overviewmentioning

confidence: 99%

“…The 2008-cohort was offered routine 2vHPV at age 12 years (in 2020), reflecting the most recently vaccinated cohort. 20 Cohortspecific coverage rates are available in Appendix E in Supporting Information.…”

Section: Analytic Overviewmentioning

confidence: 99%

“…In a previous study, we identified a range of NOK385 000 and NOK495 000 to reflect willingness-to-pay for preventive efforts targeting cervical cancer, 20 corresponding to a range of approximately US$40 000 to 55 000 per QALY. Subsequently, we considered the strategy with an ICER below $55 000 per QALY to represent the most cost-effective (ie, optimal) strategy.…”

Section: Analytic Overviewmentioning

confidence: 99%

“…The static simulation model has been previously described 18 and adapted to reflect HPV and cervical cancer epidemiology in Norway. 19,20 In short, we applied the model to simulate hypothetical women from age 9 years over their lifetime. Women transition through health states (at monthly intervals) reflecting HPV infection status (no HPV infection, HPV types 16, 18, 31, 33, 45, 52, 58, pooled other high-risk HPV types and pooled low-risk types), cervical precancer (by cervical intraepithelial neoplasia grade 2 or 3 [CIN2 or CIN3]) and squamous cell carcinoma (by stages local, regional and distant cancer).…”

Section: Simulation Modelmentioning

confidence: 99%

See 2 more Smart Citations

Switching clinic‐based cervical cancer screening programs to human papillomavirus self‐sampling: A cost‐effectiveness analysis of vaccinated and unvaccinated Norwegian women

Pedersen

Portnoy²,

Sy³

et al. 2021

Intl Journal of Cancer

Self Cite

View full text Add to dashboard Cite

Several countries have implemented primary human papillomavirus (HPV) testing for cervical cancer screening. HPV testing enables home-based, self-collected sampling (self-sampling), which provides similar diagnostic accuracy as clinician-collected samples. We evaluated the impact and cost-effectiveness of switching an entire organized screening program to primary HPV self-sampling among cohorts of HPV vaccinated and unvaccinated Norwegian women. We conducted a model-based analysis to project long-term health and economic outcomes for birth cohorts with different HPV vaccine exposure, that is, preadolescent vaccination (2000-and 2008-cohorts), multiage cohort vaccination (1991-cohort) or no vaccination (1985cohort). We compared the cost-effectiveness of switching current guidelines with clinician-collected HPV testing to HPV self-sampling for these cohorts and considered an additional 44 strategies involving either HPV self-sampling or clinician-collected HPV testing at different screening frequencies for the 2000 -and 2008 Norwegian benchmarks for cost-effectiveness, we considered a strategy with an additional cost per quality-adjusted life-year below $55 000 as cost-effective. HPV selfsampling strategies considerably reduced screening costs (ie, by 24%-40% across cohorts and alternative strategies) and were more cost-effective than cliniciancollected HPV testing. For cohorts offered preadolescent vaccination, cost-effective strategies involved HPV self-sampling three times (2000-cohort) and twice (2008-cohort) per lifetime. In conclusion, we found that switching from cliniciancollected to self-collected HPV testing in cervical screening may be cost-effective among both highly vaccinated and unvaccinated cohorts of Norwegian women.Abbreviations: 2vHPV, bivalent human papillomavirus vaccine; 4vHPV, quadrivalent human papillomavirus vaccine; CIN2/3, cervical intraepithelial neoplasia grade 2 or 3; HPV, human papillomavirus; HPV-CC, human papillomavirus clinician-collected sample/sampling; HPV-SS, human papillomavirus self-sample/sampling; NCCSP, Norwegian Cervical Cancer Screening Program; NOK, Norwegian kroner; QALY, quality-adjusted life year.

show abstract

Cost‐effectiveness of primary human papillomavirus triage approaches among vaccinated women in Norway: A model‐based analysis

Portnoy,

Pedersen,

et al. 2023

Intl Journal of Cancer

Self Cite

View full text Add to dashboard Cite

As Norway considers revising triage approaches following their first adolescent cohort with human papillomavirus (HPV) vaccination entering the cervical cancer screening program, we analyzed the health impact and cost‐effectiveness of alternative primary HPV triage approaches for women initiating cervical cancer screening in 2023. We used a multimodeling approach that captured HPV transmission and cervical carcinogenesis to evaluate the health benefits, harms and cost‐effectiveness of alternative extended genotyping and age‐based triage strategies under five‐yearly primary HPV testing (including the status‐quo screening strategy in Norway) for women born in 1998 (ie, age 25 in 2023). We examined 35 strategies that varied alternative groupings of high‐risk HPV genotypes (“high‐risk” genotypes; “medium‐risk” genotypes or “intermediate‐risk” genotypes), number and types of HPV included in each group, management of HPV‐positive women to direct colposcopy or active surveillance, wait time for re‐testing and age at which the HPV triage algorithm switched from less to more intensive strategies. Given the range of benchmarks for severity‐specific cost‐effectiveness thresholds in Norway, we found that the preferred strategy for vaccinated women aged 25 years in 2023 involved an age‐based switch from a less to more intensive follow‐up algorithm at age 30 or 35 years with HPV‐16/18 genotypes in the “high‐risk” group. The two potentially cost‐effective strategies could reduce the number of colposcopies compared to current guidelines and simultaneously improve health benefits. Using age to guide primary HPV triage, paired with selective HPV genotype and follow‐up time for re‐testing, could improve both the cervical cancer program effectiveness and efficiency.

show abstract

Impact and cost-effectiveness of strategies to accelerate cervical cancer elimination: A model-based analysis

Cited by 25 publications

References 41 publications

Eliminating Cervical Cancer: Progress and Challenges for High-income Countries

Eliminating Cervical Cancer: Progress and Challenges for High-income Countries

Switching clinic‐based cervical cancer screening programs to human papillomavirus self‐sampling: A cost‐effectiveness analysis of vaccinated and unvaccinated Norwegian women

Cost‐effectiveness of primary human papillomavirus triage approaches among vaccinated women in Norway: A model‐based analysis

Contact Info

Product

Resources

About