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
Grants awarded to Sue J Goldie
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
2R01CA093435-04A1 (2007): $369929
Related Publications
Keeping the noise down: common random numbers for disease simulation modeling. Health Care Manag Sci. 2008 Dec; 11( 4): 399-406. PMID: 18998599 Recommendations for cervical cancer prevention in Asia Pacific. Vaccine. 2008 Aug 19; 26 Suppl 12: M89-98. PMID: 18945418 Mathematical models of cervical cancer prevention in the Asia Pacific region. Vaccine. 2008 Aug 19; 26 Suppl 12: M17-29. PMID: 18945411 Cost Effectiveness of Alternative Surveillance Strategies for Hepatocellular Carcinoma in Patients With Cirrhosis. Clin Gastroenterol Hepatol. 2008 Aug 19. [Epub ahead of print] PMID: 18848905 Modeling cervical cancer prevention in developed countries. Vaccine. 2008 Aug 19; 26 Suppl 10: K76-86. PMID: 18847560 Exploring the cost-effectiveness of Helicobacter pylori screening to prevent gastric cancer in China in anticipation of clinical trial results. Int J Cancer. 2008 Sep 29; 124( 1): 157-166. [Epub ahead of print] PMID: 18823009 Trade-offs in cervical cancer prevention: balancing benefits and risks. Arch Intern Med. 2008 Sep 22; 168( 17): 1881-9. PMID: 18809815 Health and economic implications of HPV vaccination in the United States. N Engl J Med. 2008 Aug 21; 359( 8): 821-32. PMID: 18716299 Cost-effectiveness of rapid point-of-care prenatal syphilis screening in sub-Saharan Africa. Sex Transm Dis. 2008 Sep; 35( 9): 775-84. PMID: 18607319 Exploring the cost-effectiveness of HPV vaccination in Vietnam: insights for evidence-based cervical cancer prevention policy. Vaccine. 2008 Jul 29; 26( 32): 4015-24. Epub 2008 Jun 4. PMID: 18602731 Health and economic outcomes of HPV 16,18 vaccination in 72 GAVI-eligible countries. Vaccine. 2008 Jul 29; 26( 32): 4080-93. Epub 2008 May 15. PMID: 18550229 Development of an empirically calibrated model of gastric cancer in two high-risk countries. Cancer Epidemiol Biomarkers Prev. 2008 May; 17( 5): 1179-87. PMID: 18483340 
Scaling up antiretroviral therapy in South Africa: the impact of speed on survival. J Infect Dis. 2008 May 1; 197( 9): 1324-32. PMID: 18422445 Cost-effectiveness of cervical cancer screening with human papillomavirus DNA testing and HPV-16,18 vaccination. J Natl Cancer Inst. 2008 Mar 5; 100( 5): 308-20. Epub 2008 Feb 26. PMID: 18314477 Cost-effectiveness analyses of vaccination programmes : a focused review of modelling approaches. Pharmacoeconomics. 2008; 26( 3): 191-215. Review. PMID: 18282015 
Economic evaluation of hepatitis B vaccination in low-income countries: using cost-effectiveness affordability curves. Bull World Health Organ. 2007 Nov; 85( 11): 833-42. PMID: 18038073 Modeling human papillomavirus and cervical cancer in the United States for analyses of screening and vaccination. Popul Health Metr. 2007 Oct 29; 5: 11. PMID: 17967185 The costs, benefits, and cost-effectiveness of interventions to reduce maternal morbidity and mortality in Mexico. PLoS ONE. 2007 Aug 15; 2( 1): e750. PMID: 17710149 [PubMed] Cost-effectiveness of HPV 16, 18 vaccination in Brazil. Vaccine. 2007 Aug 14; 25( 33): 6257-70. Epub 2007 Jun 15. PMID: 17606315 Multiparameter calibration of a natural history model of cervical cancer. Am J Epidemiol. 2007 Jul 15; 166( 2): 137-50. Epub 2007 May 25. PMID: 17526866