HPV-Vaccinated Women Need Less Frequent Cervical Cancer Screening to Stay Cost-Effective

Cervical cancer prevention has long relied on organized screening, but the arrival of HPV-vaccinated birth cohorts into screening programs is reshaping the benefit-harm calculus. The Netherlands—where HPV vaccination began in 2010 with ~60% coverage using the bivalent vaccine—offers an instructive case: its existing program is already among Europe's least intensive, raising the question of whether further de-intensification is safe and economical as vaccinated cohorts age into eligibility.

Researchers combined a deterministic compartmental model of type-specific HPV transmission (covering 14 high-risk types) with a microsimulation model of cervical carcinogenesis to evaluate 16 alternative screening strategies for the first 10 vaccinated birth cohorts (1993–2002), who entered Dutch screening between 2023 and 2032. The natural history model was updated from a linear CIN progression structure to a more biologically accurate framework distinguishing regressive from non-regressive lesions, then recalibrated against real-world HPV prevalence, CIN detection, and cancer incidence data from 2015–2019. Vaccine efficacy was set at 95% for HPV-16/18, with cross-protection of 75%, 50%, and 80% for HPV-31, -33, and -45 respectively, assumed lifelong.

Cost-effectiveness was measured as net monetary benefit (NMB) relative to the current policy, using a willingness-to-pay threshold applied to quality-adjusted life years (QALYs). Two strategies without vaccination-status stratification yielded positive NMBs. The first—inviting women at age 30 then basing the age-35 invitation on the age-30 HPV result—generated an NMB of EUR 1.6 million per 100,000 women. The second—inviting all women at 30, then re-inviting every 10 years if HPV-negative and every 5 years if HPV-positive or untested—generated the highest NMB of EUR 1.8 million per 100,000 women. Starting screening later (at age 35 instead of 30) was generally less cost-effective. When reduced screening was restricted to vaccinated women only, the best NMB reached EUR 1.3 million per 100,000 women—lower than non-stratified approaches—suggesting that the administrative and logistical complexity of linking vaccination registries to screening programs is not justified by additional health-economic gains.

These findings carry direct policy implications. Countries with moderate HPV vaccination rates need not stratify screening by vaccination status to achieve cost-effective de-intensification. A universal risk-stratified approach—anchored at age 30 with 10-year intervals for HPV-negative women and 5-year intervals for others—appears both simpler to implement and more cost-effective. Caveats include reliance on modeled rather than observed outcomes in vaccinated cohorts, and uncertainty around the durability of cross-protective immunity.