Development of a quality framework for models of cervical screening and its application to evaluations of the cost-effectiveness of HPV vaccination in developed countries |
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| Affiliation: | 1. Saw Swee Hock School of Public Health, National University of Singapore, Singapore;2. Lowy Cancer Research Centre, Prince of Wales Clinical School, The University of NSW, Sydney, Australia;1. Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, Canada M5G 1V2;2. Dalla Lana School of Public Health, University of Toronto , 155 College St, Toronto, ON, Canada M5T 3M7;3. Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto , Medical Sciences Building, 1 King''s College Circle, Toronto, ON, Canada M5S 1A8;1. State University of Rio de Janeiro, Rio de Janeiro, Brazil;2. Federal University of Goiás, Goiânia, Goiás, Brazil;1. The Kirby Institute, UNSW Australia, Sydney, NSW 2052, Australia;1. Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, The Netherlands;2. Department of Medical Microbiology, Tumor Virology and Cancer Immunotherapy, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;3. Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;4. Institute of Science in Healthy Aging & healthcaRE (SHARE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;1. Expanded Immunization Program, Health Secretariat, Tegucigalpa, Honduras;2. Pan American Health Organization, Tegucigalpa, Honduras;3. National Program for the Control of Cancer and Chronic Diseases, Health Secretariat, Tegucigalpa, Honduras;4. ProVac National Consultant, Tegucigalpa, Honduras;5. Comprehensive Family Immunization, Pan American Health Organization, Washington, DC, USA;1. Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, USA;2. Merck & Co., Inc., Kenilworth, NJ, USA |
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| Abstract: | BackgroundHPV vaccination has now been introduced in most developed countries, but this has occurred in the context of established cervical cancer screening mechanisms which provide population-level protection against the most common HPV-related cancer. Therefore, estimating the cost-effectiveness of HPV vaccination to further reduce HPV-related disease depends in large part on the estimation of the effectiveness of the cervical screening ‘background’. The aim of this study was to systematically review and assess methods for simulating cervical screening in decision analytic models used for evaluation of HPV vaccination.MethodsExisting quality frameworks for economic models were extended to develop a specific quality framework for models of cervical screening. This involved domains for model structure, parameterisation (data sources) and validation (consistency). A systematic review of economic evaluations of HPV vaccination was then conducted, and assessment of cervical screening model components was then performed via application of the new quality framework.ResultsGenerally, models took into account population-level cervical screening participation, but were inconsistent in their approach to modelling abnormal smear management, diagnostic evaluation and treatment of precancerous disease. There was also considerable variability in the accuracy of modelling clinical pathways and the scope of validation performed for screening-related outcomes, with focus directed towards cervical cancer targets. Only a few models comprehensively validated against observed pre-cancerous abnormalities.ConclusionModels of HPV vaccination in developed countries can be improved by further attention to the ‘background’ modelling of secondary protection via cervical screening. The quality framework developed for this review can be used to inform future HPV vaccination evaluations, including evaluations of the cost-effectiveness of male vaccination and next generation HPV vaccines, and to assess models used to evaluate new cervical screening technologies and recommendations. |
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| Keywords: | HPV vaccination Cervical screening Systematic review Quality framework |
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