Modeling Preventative Strategies Against HPV-Related Disease in Developed Countries

This review article is part of a special supplement on “Comprehensive Control of HPV Infections and Related Diseases.” At the time of its writing, prophylactic vaccination against human papillomavirus (HPV) in pre-adolescent females had been introduced in most developed countries, supported by modeled evaluations that had almost universally found vaccination of pre-adolescent females to be cost-effective. Vaccination of pre-adolescent males had been shown to be cost-effective at a cost per vaccinated individual of ~US$400-500 if vaccination coverage in females could not be increased above ~50%; but increasing coverage in females appeared to be a better return on investment.

The authors report that comparative evaluation of the quadrivalent (HPV16,18,6,11) and bivalent (HPV16,18) vaccines centered around the potential trade-off between protection against anogenital warts and vaccine-specific levels of cross-protection against infections not targeted by the vaccines. They propose that future evaluations will also need to consider the cost-effectiveness of a next generation nonavalent vaccine designed to protect against ~90% of cervical cancers and that the timing of the effect of vaccination on cervical screening programs will be country-specific, and will depend on vaccination catch-up age range and coverage and the age at which screening starts.

They conclude that comprehensive evaluation of new approaches to screening would need to consider the population-level effects of vaccination over time, and that future evaluations of screening would also need to focus on the effects of disparities in screening and vaccination uptake, the potential effects of vaccination on screening participation, and the effects of imperfect compliance with screening recommendations.