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Vaccination against Human Papillomavirus (HPV)

Health Technology Assessment on the Role of Vaccination against Human Papillomavirus (HPV) in Reducing the Risk of Cervical Cancer in Ireland

Cervical cancer is the 8th most frequently diagnosed cancer in women in Ireland. In 2004, 200 women were diagnosed with cervical cancer in Ireland, with more than 90 women dying from the disease. On average, these women are 56 years old at the time of death, and 44 years at the time of diagnosis. Infection with the human papillomavirus (HPV) is the main cause of cervical cancer, without which cervical cancer does not arise.

Two vaccines, Gardasil ® and Cervarix ®, are now licensed in Ireland for the prevention of high-grade cervical intraepithelial neoplasia (CIN grades 2 and 3) and cervical cancer associated with HPV types 16 and 18. These vaccines have been shown to be effective in preventing cervical dysplasia (the condition that can lead to cervical cancer) in follow-up studies over a five-year period of women that did not have HPV at the time of vaccination. Vaccination against HPV, therefore, provides the potential to reduce the incidence of, and mortality from cervical cancer in Ireland.

The Health Information and Quality Authority undertook a health technology assessment on this topic in response to a request by the National Cancer Screening Service Board. The purpose of the assessment was to establish the cost-effectiveness of a combined national HPV vaccination and cervical cancer screening programme compared to a cervical screening programme alone in the prevention of high grade cervical dysplasia (CIN 2+) and cervical cancer association with HPV types 16 and 18.

The results of this cost-effectiveness analysis show that universal HPV vaccination of 12-year-old females would be cost-effective technology in the Irish healthcare setting. The report also recommends a once-off vaccination programme for 13- to 15-year-old females. The report highlights the need for ongoing cervical cancer screening as currently available HPV vaccines do not offer protection against all types of HPV that can cause cervical cancer. Screening is also essential to protect adult women who have not been vaccinated. The report concludes that it is important for women to be informed and motivated to attend for screening when invited to do so, even if they have received a HPV vaccine.

The final report, the findings of which have been approved by the Expert Advisory Group which was convened by the Authority, and the Board of the Authority, was submitted to the Minister for Health and Children, the National Cancer Screening Service Board and the National Immunisation Advisory Committee. A decision on the adoption and implementation of a HPV vaccine as part of the national immunisation schedule will be taken by the Minister for Health and Children following due consideration of the available evidence.

Note: No recommendation was made as part of the HTA as to which of the two licensed HPV vaccines should be offered.



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