Options for change in the Australian cervical cancer screening program in context of HPV detection and vaccination

Shih, Sophy Ting-Fang, Barendregt, Jan, Mihalopoulos, Catherine, Carter, Rob and Vos, Theo 2009, Options for change in the Australian cervical cancer screening program in context of HPV detection and vaccination, in iHEA 2009 : Posters of the 7th World Congress on Health Economics, Harmonising Health and Economics, International Health Economics Association (iHEA), [Beijing, China].


Title Options for change in the Australian cervical cancer screening program in context of HPV detection and vaccination
Author(s) Shih, Sophy Ting-Fang
Barendregt, Jan
Mihalopoulos, Catherine
Carter, Rob
Vos, Theo
Conference name iHEA World Congress on Health Economics, Harmonising Health and Economics (7th : 2009 : Beijing, China)
Conference location Beijing, China
Conference dates 12-15 July 2009
Title of proceedings iHEA 2009 : Posters of the 7th World Congress on Health Economics, Harmonising Health and Economics
Publication date 2009
Publisher International Health Economics Association (iHEA)
Place of publication [Beijing, China]
Summary Introduction:
Cervical cancer screening has been implemented for over a decade in Australia and has significantly reduced the mortality and morbidity of the disease. The emergence of new technologies for cervical cancer, such as the Human Papillomavirus (HPV) vaccine and DNA testing has encouraged debate regarding the effective use of resources in cervical cancer prevention. The present study evaluates the cost-effectiveness, from a health sector perspective, of various screening strategies in the era of these new technologies.

Methods:
A stochastic epidemiological model using a discrete event and continuous algorithm was developed to describe the natural history of cervical cancer. By allowing one member of the cohort into the model at a time, this micro-simulation model encompasses the characteristics of heterogeneity and can track individual life histories. To evaluate the cost-effectiveness of the HPV vaccine a Markov model was built to simulate the effect on the incidence of HPV and subsequent cervical cancer. A number of proposed screening strategies were evaluated with the stochastic model for the application of HPV DNA testing, with changes in the screening interval and target population. Health outcomes were measured by Disability-Adjusted Life-Years (DALYs), adjusted for application within an evaluation setting (i.e. the mortality component of the DALY was adjusted by a disability weight when early mortality due to cervical cancer is avoided). Costs in complying with the Australian updated guidelines were assessed by pathway analysis to estimate the resources associated with cervical cancer and its pre-cancerous lesion treatment. Sensitivity analyses were performed to investigate the key parameters that influenced the cost-effectiveness results.

Results:
Current practice has already brought huge health gain by preventing more than 4,000 deaths and saving more than 86,000 life-years in a cohort of a million women. Any of the alternative screening strategies alter the total amount of health gain by a small margin compared to current practice. The results of incremental analyses of the alternative screening strategies compared to current practice suggest the adoption of the HPV DNA test as a primary screening tool every 3 years commencing at age 18, or the combined pap smear/HPV test every 3 years commencing at age 25, are more costly than current practice but with reasonable ICERs (AUD$1,810 per DALY and AUD$18,600 per DALY respectively). Delaying commencement of Pap test screening to age 25 is less costly than current practice, but involves considerable health loss. The sensitivity analysis shows, however, that the screening test accuracy has a significant impact on these conclusions. Threshold analysis indicates that a sensitivity ranging from 0.80 to 0.86 for the combined test in women younger than 30 is required to produce an acceptable incremental cost-effectiveness ratio.

Conclusions:
The adoption of HPV and combined test with an extended screening interval is more costly but affordable, resulting in reasonable ICERs. They appear good value for money for the Australian health care system, but need more information on test accuracy to make an informed decision. Potential screening policy change under current Australian HPV Vaccination Program is current work in progress. A Markov model is built to simulate the effect on the incidence of HPV and subsequent cervical cancer. Adoption of HPV DNA test as a primary screening tool in the context of HPV vaccination is under evaluation.
Notes Poster Presentation. Conference website : http://ihea2009.abstractbook.org/
Language eng
Field of Research 140208 Health Economics
Socio Economic Objective 920507 Women's Health
HERDC Research category EN.1 Other conference paper
Copyright notice ©2009, International Health Economics Association (iHEA)
Persistent URL http://hdl.handle.net/10536/DRO/DU:30025149

Document type: Conference Paper
Collection: Public Health Research, Evaluation, and Policy Cluster
Connect to link resolver
 
Link to Related Work
 
Unless expressly stated otherwise, the copyright for items in DRO is owned by the author, with all rights reserved.

Versions
Version Filter Type
Access Statistics: 431 Abstract Views  -  Detailed Statistics
Created: Fri, 12 Mar 2010, 15:58:40 EST

Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.