• M Sharma, J Ortendahl, E van der Ham, S Sy, and J J Kim.
• Department of Health Policy and Management, Center for Health Decision Science, Harvard School of Public Health, Boston, MA 02115, USA. msharma04@gmail.com
• BJOG. 2012 Jan 1; 119 (2): 166-76.

ObjectiveTo assess the health and economic outcomes of various screening and vaccination strategies for cervical cancer prevention.DesignCost-effectiveness analysis from a societal perspective.SettingThailand.PopulationFemales aged 9 years and older.MethodsUsing a mathematical model of human papillomavirus (HPV) infection and cervical cancer, calibrated to epidemiological data from Thailand, we estimated the cost-effectiveness of pre-adolescent HPV vaccination, screening [visual inspection with acetic acid (VIA), HPV DNA testing, and cytology] between one and five times per lifetime in adulthood, and combined pre-adolescent vaccination and screening. Vaccine efficacy, coverage, cost, and screening frequency were varied in sensitivity analyses.Main Outcome MeasuresIncremental cost-effectiveness ratios, expressed as cost per year of life saved (YLS).ResultsAssuming lifelong efficacy and 80% coverage, pre-adolescent HPV vaccination alone was projected to reduce the lifetime risk of cervical cancer by 55%, which was greater than any strategy of screening alone. When cost per vaccinated girl was I$10 (approximately $2 per dose) or less, HPV vaccination alone was cost saving. Pre-adolescent vaccination and HPV DNA testing five times per lifetime, starting at age 35 years, reduced the lifetime cervical cancer risk by 70%, and had a cost-effectiveness ratio less than Thailand's GDP per capita (I$8100), provided the cost per vaccinated girl was I$200 or less.ConclusionsLow cost pre-adolescent HPV vaccination followed by HPV screening five times per lifetime is an efficient strategy for Thailand. Costs may need to be lower, however, for this strategy to be affordable. If vaccination is not feasible, HPV DNA testing five times per lifetime is efficient.© 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

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