[Impact of vaccination against oncogenic human papillomavirus on the incidence and mortality of cervical cancer in Germany]

Abstract

Background and purpose: Human papillomavirus (HPV) is a necessary cause for cervical cancer. HPV vaccines covering genotypes 16 and 18 for the prevention of cervical cancer are or will be available soon (status: May 2007). Vaccination against HPV in order to reduce the burden of cervical cancer is recommended by the Standing Committee on Vaccination (STIKO) for female adolescents aged 12-17 years in Germany. The study aims to evaluate the achievable long-term impact of HPV vaccination on invasive cervical cancer (ICC) incidence and mortality in Germany, a country with an opportunistic Pap screening program and suboptimal participation.

Methods: The authors developed a decision-analytic discrete-event model and used Monte Carlo simulation to assess the impact of vaccination on ICC incidence and life expectancy of a cohort of 399,400 10-year-old girls. HPV-16 and HPV-18 account for 73.5% of cancers. In the model, a 100% vaccination rate between 10 and 25 years, and a vaccine efficacy of 95.1% were assumed.

Results: Without vaccination, 4,563 ICC cases occur in the cohort (cumulative lifetime incidence: 1.14%), 1,376 women will die from ICC (fatality: 30.2%). Vaccination at age 10 can reduce incidence and mortality by 70% resulting in a gain of 17,819 life-years. 416 girls have to be vaccinated to prevent one death from ICC. Delaying vaccination to women aged 25 years still leads to a 50% reduction of deaths.

Conclusion: Despite cytological screening, a high disease burden of cervical cancer remains in Germany. Vaccination in early adolescence can drastically reduce the disease burden. Vaccination of adult women still offers significant benefits. Therefore, HPV vaccination should be added to existing cancer prevention strategies.