ArticlePloS one2016
Cervical Cancer Screening in Partly HPV Vaccinated Cohorts - A Cost-Effectiveness Analysis.
Article in PloS one, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
22 citing papers in PubMed, 1 synthesis or guideline pooled it, 44 citations in OpenAlex.
- Systematic review of cost-effectiveness analyses for combinations of prevention strategies against human papillomavirus (HPV) infection: a general trend.BMC public health · 2017Pooled it
- Cost-effectiveness of risk-stratified screening for cervical cancer in cohorts vaccinated against human papillomavirus with moderate vaccination coverage.International journal of cancer · 2026Article
- Optimizing the Harms and Benefits of Cervical Screening in a Partially Vaccinated Population in Ontario, Canada: A Modeling Study.Medical decision making : an international journal of the Society for Medical Decision Making · 2025Article
- Cervical cancer screening by cotesting method for Vietnamese women 25-55 years old: a cost-effectiveness analysis.BMJ open · 2025Article
- Cost-Effectiveness of Computer-Assisted Cytology in a Primary hrHPV-Based Cervical Cancer Screening Programme.Cancer medicine · 2024Article
- Cervical screening among Chinese females in the era of HPV vaccination: a population-based survey on screening uptake and regular screening following an 18-year organized screening program.Journal of gynecologic oncology · 2024Article
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- Article
- Rapid elimination of cervical cancer while maintaining the harms and benefits ratio of cervical cancer screening: a modelling study.BMC medicine · 2022Article
- Shift in harms and benefits of cervical cancer screening in the era of HPV screening and vaccination: a modelling study.BJOG : an international journal of obstetrics and gynaecology · 2022Article
- COVID-19 disruption to cervical cancer screening in England.Journal of medical screening · 2022Article
- The Differential Risk of Cervical Cancer in HPV-Vaccinated and -Unvaccinated Women: A Mathematical Modeling Study.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2021Article
- Cost-effectiveness of HPV-based cervical screening based on first year results in the Netherlands: a modelling study.BJOG : an international journal of obstetrics and gynaecology · 2021Article
- Projected time to elimination of cervical cancer in the USA: a comparative modelling study.The Lancet. Public health · 2020Article
- Introduction of primary screening using high-risk HPV DNA detection in the Dutch cervical cancer screening programme: a population-based cohort study.BMC medicine · 2019Article
- HPV-FRAME: A consensus statement and quality framework for modelled evaluations of HPV-related cancer control.Papillomavirus research (Amsterdam, Netherlands) · 2019Article
- Cost-utility analysis of germline BRCA1/2 testing in women with high-grade epithelial ovarian cancer in Spain.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2019Article
- Cervical Cancer Screening Programs in Europe: The Transition Towards HPV Vaccination and Population-Based HPV Testing.Viruses · 2018Review
- Adapting cervical cancer screening for women vaccinated against human papillomavirus infections: The value of stratifying guidelines.European journal of cancer (Oxford, England : 1990) · 2018Article
- What cervical screening is appropriate for women who have been vaccinated against high risk HPV? A simulation study.International journal of cancer · 2018Article
Corrections and comments
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundVaccination against the oncogenic human papillomavirus (HPV) types 16 and 18 will reduce the prevalence of these types, thereby also reducing cervical cancer risk in unvaccinated women. This (measurable) herd effect will be limited at first, but is expected to increase over time. At a certain herd immunity level, tailoring screening to vaccination status may no longer be worth the additional effort. Moreover, uniform screening may be the only viable option. We therefore investigated at what level of herd immunity it is cost-effective to also reduce screening intensity in unvaccinated women.
methodsWe used the MISCAN-Cervix model to determine the optimal screening strategy for a pre-vaccination population and for vaccinated women (~80% decreased risk), assuming a willingness-to-pay of €50,000 per quality-adjusted life year gained. We considered HPV testing, cytology testing and co-testing and varied the start age of screening, the screening interval and the number of lifetime screens. We then calculated the incremental cost-effectiveness ratio (ICER) of screening unvaccinated women with the strategy optimized to the pre-vaccination population as compared to with the strategy optimized to vaccinated women, assuming different herd immunity levels.
resultsPrimary HPV screening with cytology triage was the optimal strategy, with 8 lifetime screens for the pre-vaccination population and 3 for vaccinated women. The ICER of screening unvaccinated women 8 times instead of 3 was €28,085 in the absence of herd immunity. At around 50% herd immunity, the ICER reached €50,000.
conclusionFrom a herd immunity level of 50% onwards, screening intensity based on the pre-vaccination risk level becomes cost-ineffective for unvaccinated women. Reducing the screening intensity of uniform screening may then be considered.
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