The cost–effectiveness of HPV vaccination in addition to screening: a Dutch perspective

Abstract

Addition of the HPV vaccine to available cytological screening has been proposed to increase HPV-related cancer prevention. A comprehensive review on this combined strategy implemented in the Netherlands is lacking. For this review, we therefore analyzed all relevant studies on cost–effectiveness of HPV vaccines in combination with cervical screening in the Netherlands. Most of the studies agree that vaccination in pre-sexual-activity periods of life is cost-effective. Based on published sensitivity analyses, the incremental cost–effectiveness ratio was found to be mainly driven by vaccine cost and discount rates. Fewer vaccine doses, inclusion of additional benefits of these vaccines to prevent HPV-related non-cervical cancers and vaccination of males to further reduce the burden of HPV-induced cancers are three relevant options suggested to be investigated in upcoming economic evaluations.

Keywords:

• cervical cancer
• cervical cancer screening
• cost–effectiveness
• HPV vaccination
• The Netherlands

Financial & competing interests disclosure

D Setiawan was supported by Directorate General of Higher Education (DIKTI) Scholarship, Ministry of National Education, Indonesia and Ministry of National Education. TA Westra is an employee at GlaxoSmithKline and is a visiting research at the University of Groningen. GlaxoSmithKline is the manufacturer of bivalent HPV vaccine Cervarix. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The cost–effectiveness of HPV vaccination has been modeled extensively in previous studies and those studies show that vaccination of 12–16 years old girls is cost-effective.

• HPV vaccination of older women in the Netherlands is potentially cost-effective.

• Vaccine price and discount rates are the most sensitive parameters for cost–effectiveness identified in this review.

• Taking cross-protection and herd immunity into account will further reduce incremental cost–effectiveness ratio. Yet, such models require more complex data.