Clinical & Cost Effectiveness Of HPV Vaccination In The US

Sue J Goldie
Health Policy And Managementharvard University (sch Of Public Hlth)

Grant 5R01CA093435-05 from National Cancer Institute, IRG: HSOD

Abstract: Several factors are changing the landscape of cervical cancer control, including a better understanding of the natural history of HPV, promising new screening approaches using HPV DNA testing, and the recent licensure of the first prophylactic HPV vaccine targeting the two most common high-risk types of HPV, 16 and 18. We propose to refine our Cervical Cancer Screening Model to be capable of assessing the costs, benefits, and cost-effectiveness of primary prevention (vaccination), secondary prevention (screening), and strategies that combine both. Our specific aims are (1) to refine a natural history model to function as an open population- based simulation model capable of forecasting incidence, mortality, and costs associated with different cervical cancer control strategies. This model will be calibrated to the United States population using the best available data, including observed patterns in HPV type-specific prevalence, invasive cancer, and temporal variation in factors such as sexual behavior and smoking; (2) to develop a dynamic transmission model of HPV 16 and 18 to estimate the population-level impact of a type-specific vaccination taking into account biological and host factors, vaccine properties, behavioral issues, and herd immunity. We will assess the incremental benefit of vaccinating boys in addition to girls under different scenarios; compare the costs and benefits of policies restricting vaccination to young girls not yet sexually active with policies extending vaccination to women in their late 20s; explore how uncertain assumptions about sexual mixing patterns affect results; and project temporal trends in type-specific HPV prevalence; (3) to assess the cost-effectiveness of alternative cervical cancer prevention strategies for a the general U.S. population as well as for subgroups that differ in their socioeconomic, demographic, and cervical cancer risk profile. We will explore how the cost-effectiveness of a combined screening and vaccination program could change over time, evaluate the effect of vaccination on the test performance of current HPV diagnostics; and assess how vaccine delivery (target age, upper age limit, coverage by age and risk group), vaccine characteristics, and programmatic features influence projected benefits and cost-effectiveness

Project start date: 2002-05-07

Project end date: 2010-07-31

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Clinical & Cost-Effectiveness Of Cervical CA Screening

Sue J Goldie
Harvard University (sch Of Public Hlth) Public Health Campus Boston, Ma 02115

Grant 5R01CA093435-03 from National Cancer Institute, IRG: ZRG1

Abstract: Cervical cancer is the third most common malignancy in women worldwide. New information on the causal role of human papillomavirus (HPV) infection, and the availability of new cervical cancer screening options, raise important clinical and policy questions. The purpose of this project is to develop a Global Cervical Cancer Policy Model to address such questions in both developed and developing countries, in which differences in disease burden, health-care priorities, and economic resources will mandate consideration of different cancer control strategies. In the U.S., cervical cytology screening has reduced cancer incidence, however, has not been equally accessible to all groups of women. For women who are older, poor, or from select cultural minorities, there is a need to evaluate new strategies for increasing screening coverage. On the national level, the most pressing policy questions relate to the economic consequences of current screening programs and how to best utilize newer screening technologies, such as enhanced cytologic methods and HPV DNA testing. In developing countries, such as South and East Africa, the critical policy issue is how to realistically implement cervical cancer screening programs in the setting of competing health issues and limited healthcare and monetary resources. Recent clinical studies have shown promising results for less complex screening strategies, such as simple visual screening methods or HPV DNA testing followed by immediate treatment without colposcopic triage However, these noncytological screening strategies need to be formally evaluated to determine if they can be implemented and sustained for a cost acceptable to developing countries. The specific aims of this project are (1) To develop a probabilistic cervical cancer model incorporating new epidemiological data on the natural history of HPV; (2) To evaluate the health and economic consequences of alternative cervical cancer screening strategies in the U.S., focusing on subpopulations at particularly high-risk and readdressing optimal target ages, screening intervals and use of new technology; (3) To assess the cost-effectiveness of alternative cervical cancer screening and prevention strategies for previously unscreened women in South Africa and Zimbabwe, incorporating the impact of REV, and considering the health-infrastructure and per-capita health expenditure in each country. This project will bring together a team of diverse investigators with complementary areas of expertise to develop a comprehensive, state-of-the-art, Global Cervical Cancer Policy Model. The proposed analyses will provide important information to clinicians, public health providers, and policy makers in both the national and international arena.

Keywords: cervix neoplasm, cost effectiveness, disease /disorder etiology, disease /disorder model, health care service evaluation, human papillomavirus, mass screening, model design /development, neoplasm /cancer epidemiology, Africa, cancer prevention, cancer risk, comorbidity, health care cost /financing, health care policy, health care service availability, human immunodeficiency virus, international cooperation, medically underserved population, neoplasm /cancer diagnosis, pathologic process, statistics /biometry, behavioral /social science research tag, clinical research, health services research tag, human data

Project start date: 2002-05-07

Project end date: 2006-02-28

5R01CA093435-03 (2004): $323688

5R01CA093435-02 (2003): $325246

Clinical & Cost Effectiveness Of HPV Vaccination In The US

Sue J Goldie
Health Policy And Managementharvard University (sch Of Public Hlth)
public Health Campus
boston, Ma 02115

Grant 2R01CA093435-04A1 from National Cancer Institute, IRG: HSOD

Abstract: Several factors are changing the landscape of cervical cancer control, including a better understanding of the natural history of HPV, promising new screening approaches using HPV DNA testing, and the recent licensure of the first prophylactic HPV vaccine targeting the two most common high-risk types of HPV, 16 and 18. We propose to refine our Cervical Cancer Screening Model to be capable of assessing the costs, benefits, and cost-effectiveness of primary prevention (vaccination), secondary prevention (screening), and strategies that combine both. Our specific aims are (1) to refine a natural history model to function as an open population- based simulation model capable of forecasting incidence, mortality, and costs associated with different cervical cancer control strategies. This model will be calibrated to the United States population using the best available data, including observed patterns in HPV type-specific prevalence, invasive cancer, and temporal variation in factors such as sexual behavior and smoking; (2) to develop a dynamic transmission model of HPV 16 and 18 to estimate the population-level impact of a type-specific vaccination taking into account biological and host factors, vaccine properties, behavioral issues, and herd immunity. We will assess the incremental benefit of vaccinating boys in addition to girls under different scenarios; compare the costs and benefits of policies restricting vaccination to young girls not yet sexually active with policies extending vaccination to women in their late 20s; explore how uncertain assumptions about sexual mixing patterns affect results; and project temporal trends in type-specific HPV prevalence; (3) to assess the cost-effectiveness of alternative cervical cancer prevention strategies for a the general U.S. population as well as for subgroups that differ in their socioeconomic, demographic, and cervical cancer risk profile. We will explore how the cost-effectiveness of a combined screening and vaccination program could change over time, evaluate the effect of vaccination on the test performance of current HPV diagnostics; and assess how vaccine delivery (target age, upper age limit, coverage by age and risk group), vaccine characteristics, and programmatic features influence projected benefits and cost-effectiveness

Project start date: 2002-05-07

Project end date: 2010-07-31

2R01CA093435-04A1 (2007): $369929