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

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• 作者：Beate Sander^a ; ^b ; ^c ; ^d ; ^{beate.sander@oahpp.ca" class="auth_mail" title="E-mail the corresponding author} ; William W.L. Wong^b ; ^d ; Man Wah Yeung^a ; Orges Ormanidhi^d ; Karen Atkin^e ; Joan Murphy^b ; ^e ; ^f ; Murray Krahn^b ; ^c ; ^d ; ^f ; Shelley L. Deeks^a ; ^b
• 关键词：Pap ; Papanicolaou ; HR ; high-risk ; HPV ; human papillomavirus ; LR ; low risk ; PHU ; public health unit ; MOHLTC ; Ontario Ministry of Health and Long-Term Care ; QALY ; quality-adjusted life years ; HSIL ; high-grade cervical squamous intraepithelial lesion ; CIN ; cervical intraepithelial neoplasia ; ICER ; incremental cost-effectiveness ratio ; NHB ; net health benefit ; OHR ; other high risk ; SIRS ; susceptible-infectious-recovered-susceptible ; NHANES ; National Health and Nutrition Examination Survey ; ASCCP ; Am
• 刊名：Vaccine
• 出版年：2016
• 出版时间：7 April 2016
• 年：2016
• 卷：34
• 期：16
• 页码：1936-1944
• 全文大小：1572 K

文摘

A universal, publicly funded, school-based human papillomavirus (HPV) vaccination program in grade eight girls was initiated in Ontario in 2007. We present a cost-utility analysis of integrated cervical cancer prevention programs from the healthcare payer perspective.

Methods

Our analysis was based on linked HPV transmission and disease history models. We obtained data from the literature, provincial surveys and Ontario population-based linked health administrative datasets. We modeled combinations of vaccination and screening strategies. We considered vaccination based on the Ontario experience, as well as conservative and optimistic scenarios, varying coverage, vaccine effectiveness and duration of protection. We considered 900 screening scenarios (screening start age: 21–70 years, screening interval: 3–20 years; 1-year time steps). The current schedule screens every 3 years starting at age 21 years. We examined (1) first vaccinated cohort (low herd-immunity), and (2) steady state, i.e. all cohorts were vaccinated (high herd-immunity).

Results

Adding vaccination to the current screening schedule was cost-effective (<C$10,000/quality-adjusted life year (QALY)) across all scenarios. Delaying screening start and/or extending screening intervals increased both expected QALYs and cost, and increased overall NHB for screening schedules with a start age of 25–35 years and 3–10-year intervals for most scenarios.

Conclusion

Delaying screening start age and/or extending screening intervals in vaccinated cohorts is likely to be cost-effective. Consideration should be given to both the short- and long-term implications of health policy decisions, particularly for infectious disease interventions that require long time intervals to reach steady state.