PREHDICT

health-economic modelling of PREvention strategies for Hpv-related Diseases in European CounTries

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 Obiettivo del progetto (Objective)

'The goals of the PREHDICT study are to determine prerequisites and strategies for vaccination in European countries and to predict the impact of vaccination on screening programmes. To achieve these goals, a multiple HPV type transmission model will be built to describe the type-specific incidence and clearance of HPV infections. This model will be linked to an individual-based simulation model used for modelling the impact of screening. For HPV-related diseases other than cervical cancer and genital warts, Markov models will be developed after critical review of the role of HPV. In the PREHDICT study, country-specific cost-effectiveness analyses will be performed for the vaccination and include determination of the vaccination age, the number of doses, the vaccination population, and the optimal catch-up vaccination age. Furthermore, the impact of vaccination on screening programmes will be assessed. This involves determination of the screening technology, screening frequency, and follow-up management of test-positive women. Special attention will be given to screening attendance and its relation to vaccination attendance. To have models with strong empirical support, the PREHDICT team will collect the most updated data on HPV infection, HPV-related disease, life-style factors, and demographics. Furthermore, HPV-type specific analyses will be performed on the outcomes of a vaccination trial, 3 large screening trials, and one self-sampling trial for screening non-attenders. By meta-analytical techniques, results will be pooled. The costs involved in the calculations will include the costs of organizing, running, and monitoring a vaccination and/or screening programme. The results of the PREHDICT study will be published in international peer-reviewed journals, posted on the WHO HPV information centre website and will also be systematically disseminated to all major stakeholders, in particular to decision makers at European, national and sub-national levels.'

Introduzione (Teaser)

Cervical cancer (CC) is an important health problem in Europe. To better prevent CC, new strategies to estimate the impact of vaccination and novel screening methods are required.

Descrizione progetto (Article)

Persistent human papillomavirus (HPV) infection causes CC. There are at least fourteen different HPV types. However, types 16 and 18 are responsible for the majority of CC. HPV is also implicated in penile cancer in men, vaginal and vulvar cancer in women and in oropharyngeal and anal cancer in both men and women.

The aetiological link between HPV and CC has prompted the development of vaccines and new screening tests. The EU-funded 'Health-economic modelling of prevention strategies for HPV-related diseases in European countries' (http://www.hpvcentre.net/prehdict (PREHDICT)) consortium worked on determining prerequisites and strategies for HPV vaccination and cervical screening in European countries.

The consortium recognised that the variations across European countries in CC control strategies require objective data-supported criteria for cancer prevention. Researchers have created a large evidence base on HPV-related disease by systematically collecting and summarising data on incidence of HPV infections and disease. The database includes information on effectiveness of vaccination, performance of novel screening methods, screening practice, life style and demographics. The results of the survey will be used to highlight strengths and weaknesses of existing prevention efforts.

An important part of PREHDICT has been the development of mathematical models for the transmission of HPV between males and females. The models clearly indicated that both vaccinated and unvaccinated women benefit from a female HPV16/18 vaccination programme. The models predicted substantial herd immunity effects which will guide further work on implementing HPV vaccination programmes.

Both simple and more complex individual-based Markov models were used to analyse cost-effectiveness. The impact of vaccinating adolescent girls to minimise HPV spread in the population was assessed as well as the additional impact of vaccinating boys. HPV16/18 vaccination of 12-year-old girls proved to be very cost-effective in the countries where prevention against CC is scarce and the disease burden is high.

A major result of the project was that from the evidence base, the scientists were able to demonstrate the HPV-based screening provides 60-70% greater protection against cervical cancer than cytology (Lancet 2014). Cost-effectiveness of vaccination in Eastern European countries had not previously been established and the results of PREHDICT could guide creation of new prevention policies. In addition, the modelling results can be used to design integrated vaccination and screening programs using novel screening instruments.