ABSTRACTS E-BOOK
O028 / #1027
Public Health
PUBLIC HEALTH ORAL ABSTRACTS SESSION 03: MODELING THE HEALTH IMPACT AND COSTEFFECTIVENESS OF VACCINATION AND SCREENING
11-13-2024 13:45 - 15:15
COST-EFFECTIVENESS OF CONTINUOUS CATCH-UP VACCINATION AGAINST HPV IN WOMEN FIRST
SCREENED FOR CERVICAL CANCER AT AGE 30 IN THE NETHERLANDS
Lecture Title:
Johannes Bogaards1,2, Birgit Sollie1,2, Tiago De Carvalho2, Johannes Berkhof2,3
1Amsterdam Public Health Institute, Amsterdam, Netherlands, 2Amsterdam UMC, Epidemiology & Data Science,
Amsterdam, Netherlands, 3Cancer Center Amsterdam, Amsterdam, Netherlands
Introduction: HPV vaccine coverage in the Netherlands is only moderate, with an uptake of about 50%-60% among
vaccine-eligible women. Recently, partly vaccinated cohorts have entered the Dutch cervical cancer screening
program. If cost-effective, the first screening visit at age 30 would be an excellent opportunity to offer catch-up
vaccination to unvaccinated women.
Methods: We investigated the cost-effectiveness of continuous catch-up vaccination using a multi-cohort analysis in
women born from 1993 onwards. Health gains and savings in the context of population-based screening were
assessed by microsimulation of cervical carcinogenesis with primary HPV-based screening according to current
policies. Additional gains and savings from prevention of non-cervical cancers were estimated by statistical modelling.
We only considered protection against infection after the age of 30, based on the bivalent HPV16/18 vaccine (2-dose
schedule) with moderate cross-protection. In sensitivity analyses, we varied efficacy for HPV16/18 and cross-protective
types.
Results: While the lifetime risk of HPV infection will strongly decrease for unvaccinated women, our model predicts
that vaccine-preventable HPV incidence remains relatively stable from age 30 onwards. Consequently, the scope for
catch-up vaccination does not diminish over time. Catch-up vaccination at age 30 is predicted to reduce the lifetime
risk of CIN2/3 detection by almost 25% and to prevent about 135 cases of cancer (55 from the cervix) per 100,000
women. It is further predicted to generate nearly 1,200 qualitymillion in monetary savings (Fig. 2) per 100,000 women vaccinated at age 30 (undiscounted). The incremental cost-case analysis. The ICER remained
below the Dutch threshold for cost-effective intervention in all scenarios considered.
Conclusions: Offering HPV vaccination with first cervical screening invitations to unvaccinated women is an efficient
means to intensify HPV-related cancer control in the Netherlands.