Time for change? An economic evaluation of integrated cervical screening and HPV immunization programs in Canada

Many jurisdictions have implemented universal human papillomavirus (HPV) immunization programs in preadolescent females. However, the cost-effectiveness of modified cervical screening guidelines and/or catch-up immunization in older females in Canada has not been evaluated. We conducted a cost-utility analysis of screening and immunization with the bivalent vaccine for the Canadian setting from the Ministry of Health perspective. We used a dynamic model to capture herd immunity and included cross-protection against strains not included in the vaccine. We found that adding catch-up immunization to the current program would be cost-effective, and that combining catch-up immunization with delaying the age at which screening is first initiated could result in cost savings and net health gains.

► We conduct a cost utility analysis of HPV catch-up immunization and cervical screening strategies. ► The analysis uses a dynamic model that captures herd immunity and vaccine cross-protection. ► Adding catch-up immunization to an existing program in pre-adolescent females is cost-effective. ► Combining catch-up immunization with a delay in the age of initial screening is cost-saving.