Moving toward the elimination of cervical cancer: modelling the health and economic benefits of increasing uptake of human papillomavirus vaccines

A. Smith, N. Baines, S. Memon, N. Fitzgerald, J. Chadder, C. Politis, E. Nicholson, C. Earle, H. Bryant

Abstract


Background The human papillomavirus (HPV) is a common sexually transmitted infection and a primary cause of cervical cancer. The Government of Canada has set a target of reaching 90% HPV vaccine coverage among adolescents by 2025. Here, we examine HPV vaccine uptake in school-based immunization programs across Canada and explore how achieving the 90% target could affect the future incidence of cervical cancer, mortality, and health system expenditures in a cohort of Canadian women.

Methods Data for HPV vaccine uptake in the most recent reported school year available in each jurisdiction were provided in 2017 by jurisdictional school-based immunization programs and were used to estimate a national weighted average of 67%. The OncoSim microsimulation model (version 2.5) was used to compare 3 different levels of HPV vaccine uptake (0%, 67%, 90%) on health and economic outcomes for a hypothetical cohort of all 5- to 10-year old girls in Canada in 2015.

Results Vaccine uptake for girls in school-based programs varied from 55.0% to 92.0% in the jurisdictions reviewed. The OncoSim model projects that increasing uptake to 90% from 67% would result in a 23% reduction in cervical cancer incidence rates (to 3.1 cases from 4.0 cases per 100,000, averaged across the lifetime of the cohort) and a 23% decline in the average annual mortality rate (to 1.0 deaths from 1.3 deaths per 100,000). Finally, the model projects that the health system will incur a cost of $9 million (1% increase) during the lifetime of the cohort if uptake is increased to 90% from 67%. Costs are discounted (1.5%) and expressed in 2016 Canadian dollars. Costs reflect the payer perspective.

Conclusions Our model shows that increasing HPV vaccine uptake to 90% from current levels for girls in schoolbased immunization programs could result in substantial reductions in the future incidence and mortality rates for cervical cancer in Canada.


Keywords


HPV vaccination; cervical cancer; OncoSim, cancer modelling; cancer outcome projections; cancer control

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DOI: http://dx.doi.org/10.3747/co.26.4795






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ISSN: 1198-0052 (Print) ISSN: 1718-7729 (Online)