Authors' objectives:

This HTA report concerns the reduction in the risk of cervical cancer by vaccination and illustrates status about HPV infection, cervical cancer and the vaccines.

Authors' recommendations: Cervical cancer is a disease where many cases will most likely be efficiently preventable through vaccination. Whether this prevention potential is to be used in a publicly financedprogramme remains an open question.Speaking against the use is the fact that an offer already exists today - via the screening programme - which can prevent most cases of cervical cancer. The screenings have resulted in more than a halving of the number of cases of cervical cancer during the last 40 years. The HPV vaccination is a new technology, the long-term effects of which are not yet known, and there is no experience from using the vaccines in large prevention programmes. Thus, the total net effect in terms of public health is not yet established. Finally, a general offer of vaccination involves considerable costs, which naturally depend on the price of a vaccine and how a vaccination offer may be organised. The effect and cost savings will not be seen for many years.Speaking for the use is the fact that the first vaccine has been approved by the authorities as safe and efficient, and the disease burden and costs as a consequence of cervical cancer and the involved interventions in the screening programme (follow-up after cell changes and conisation) are quite considerable. In the longer term, the health gain from vaccinating a large proportion of girls in the age group 10-12 years will be significant. The screening programme is furthermore far from perfect, and in Denmark, the participation ratevaries between 65% and 80%, depending on region. This is due to the fact that the programme is based on the examination of women every third year, and there may be practicalreasons connected with coming to these regular examinations. There may furthermore be uncertainty in connection with examinations and follow-up after the detection of possible cell changes. Participation in the existing screening programme is socially lopsided, and a well-structured vaccination programme could be a more "democratic" offer if it is made uniformly available across demographic and social groups. Even with the best screening programme, there will still be occurrences of cervical cancer (58). If vaccinated women choose not to participate in the screening programme against cervical cancer, cancer cases will develop (from HPV types that are not covered by vaccination),which could have been discovered had they participated. The beneficial effect may thus be significantly reduced. Consequently, it is paramount that the screening programme against cervical cancer continues in its present form for the time being. Vaccinated women should be informed of the importance of continuing in this programme. Depending on the selection of vaccine and target group, the use of the HPV vaccine might potentially lead to a reduction in other HPV-related diseases, including cancer of the vagina, vulva, anus and penis as well as venereal warts and respiratory papillomatosis. It should also be stressed that the present lack of knowledge about the duration of the protection of the vaccine, the occurrence of rare adverse effects that may be seen in thelonger term as well as the net effect in terms of public health will only be known in years to come. Probably only by means of large population studies, can these issues be documented in greater detail. The basis for decision, which this HTA contributes to, is related to some uncertainties and the remaining unanswered questions can hardly be clarifiedwithin a short time frame.On the basis of this assessment, it may be appropriate to offer the vaccination to 12-yearold girls, possibly supplemented by a catch-up programme, if it is decided to introduce theHPV vaccine in the Danish vaccination programme. A possible offer of vaccination to boys will hardly be cost effective but may be further analysed and considered.

Authors' methods: Overview

Project Status: Completed

Year Published: 2007

URL for published report: http://www.sst.dk/publ/Publ2007/MTV/HPV/HPV_vaccination.pdf

URL for additional information: http://www.sst.dk/publ/Publ2007/MTV/HPV/HPV_vaccination_smfatn_en.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Denmark

Organisation Name: Danish Centre for Evaluation and Health Technology Assessment

Contact Address: National Board of Health, PO Box 1881, Islands Brygge 67, DK-2300 Copenhagen S, Denmark. Tel: 45 72 22 74 48; Fax: 45 72 22 74 07/67

Contact Name: dacehta@sst.dk

Contact Email: dacehta@sst.dk

Copyright: Danish Centre for Evaluation and Health Technology Assessment (DACEHTA)