Economic modelling assessment of cervical cancer screening and HPV vaccination in Brazil
Vanni, Tazio;
(2012)
Economic modelling assessment of cervical cancer screening and HPV vaccination in Brazil.
PhD thesis, London School of Hygiene & Tropical Medicine.
DOI: https://doi.org/10.17037/PUBS.01343275
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More than 85% of the global burden of cervical cancer occurs in developing countries, where it
is the second most common cancer among women. In Brazil alone, a total of 17,500 new cases
and 3,300 deaths of cervical cancer are expected in 2012. Despite the investments in cytologybased
screening in the country, the reduction of cervical cancer incidence has been less than
expected. The aim of this thesis was to investigate the cost-effectiveness of alternative cervical
cancer screening and HPV vaccination strategies in Brazil. This was achieved by focusing on
three specific objectives: 1) To evaluate the cost-effectiveness of cervical cancer screening
strategies for women presenting equivocal cytological results, 2) To evaluate the costeffectiveness
of cervical cancer screening strategies for HIV-infected women, 3) To evaluate
the cost-effectiveness of HPVvaccination for pre-adolescent women. An additional objective
was to review and provide guidance on the use of model calibration methods in economic
modelling assessments,as they are particularly important in screening and vaccination studies.
The first empirical analysis found that HPV triage for women above 30 years-old presenting
equivocal cytology results was likely to be very cost-effective. The second empirical analysis
found that to screen HIV-infected women with HPVtesting followed by cytology annually was
also likely to be very cost-effective. The third empirical analysis demonstrated that adding the
quadrivalent vaccination of pre-adolescent girls to the current efforts to control cervical cancer
in Brazil was very cost-effective for most of the scenarios analyzed. The vaccine was even cost
saving when considering low coverage and cost of vaccination. This thesis presents findings
that will inform cervical cancer screening and HPV vaccination policies in middle-income
countries like Brazil and also provides guidance to help improve the standards of model
calibration approaches used in cost-effectiveness analysis.