Louiza S Velentzis1, Megan A Smith2, Kate T Simms3, Jie-Bin Lew3, Michaela Hall3, Suzanne Hughes4, Susan Yuill4, James Killen4, Adam Keane4, Katherine Butler4, Jessica Darlington-Brown4, Harriet Hui4, Julia M L Brotherton5, Rachel Skinner6, Alison Brand7, Lara Roeske8, Stella Heley8, Jonathan Carter9, Deborah Bateson10, Ian Frazer11, Suzanne M Garland12, Rebecca Guy13, Ian Hammond14, Paul Grogan15, Marc Arbyn16, Philip E Castle17, Marion Saville18, Bruce K Armstrong19, Karen Canfell20. 1. Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia. Electronic address: louizav@nswcc.org.au. 2. Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; School of Public Health, University of Sydney, NSW, Australia. 3. Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; Prince of Wales Clinical School, University of New South Wales, Australia. 4. Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia. 5. Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia; Victorian Cytology Service Ltd, Carlton, Victoria, Australia. 6. Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia; Children's Hospital Westmead, Westmead, NSW, Australia. 7. Discipline of Obstetrics, Gynaecology and Neonatology, Westmead Clinical School, University of Sydney, NSW, Australia; Department of Gynaecological Oncology, Westmead Hospital, Westmead, NSW, Australia. 8. Victorian Cytology Service Ltd, Carlton, Victoria, Australia. 9. Chris O'Brien Lifehouse, Sydney, NSW, Australia. 10. Family Planning NSW, NSW, Australia; Sydney Medical School, Discipline of Gynaecology & Neonatology, University of Sydney, NSW, Australia. 11. The University of Queensland Diamantina Institute, Queensland, Australia. 12. Department of Microbiology & Infectious Diseases, Royal Women's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, 50 Flemington Road, Parkville, 3052, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville 3052, Victoria, Australia. 13. Kirby Institute, University of NSW, Sydney, NSW, Australia. 14. Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Australia. 15. Cancer Council Australia, Sydney, NSW, Australia. 16. Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium. 17. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, USA. 18. Victorian Cytology Service Ltd, Carlton, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville 3052, Victoria, Australia. 19. School of Public Health, University of Sydney, NSW, Australia; School of Population and Global Health, University of Western Australia, Perth, Australia. 20. Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; School of Public Health, University of Sydney, NSW, Australia; Prince of Wales Clinical School, University of New South Wales, Australia.
Abstract
OBJECTIVE: Australia's HPV vaccination and HPV-based cervical screening programs are changing the landscape in cervical cancer prevention. We aim to identify areas which can make the biggest further impact on cervical cancer burden. This protocol describes the first stage of a program of work called Pathways-Cervix that aims to generate evidence from modelled evaluations of interventions across the cervical cancer spectrum. METHODS: Based on evidence from literature reviews and guidance from a multi-disciplinary Scientific Advisory Committee (SAC), the most relevant evaluations for prevention, diagnosis and treatment were identified. RESULTS: Priority evaluations agreed by the SAC included: increasing/decreasing and retaining vaccination uptake at the current level; vaccinating older women; increasing screening participation; methods for triaging HPV-positive women; improving the diagnosis of cervical intraepithelial neoplasia (CIN) and cancer; treating cervical abnormalities and cancer; and vaccinating women treated for CIN2/3 to prevent recurrence. Evaluations will be performed using a simulation model, Policy1-Cervix previously used to perform policy evaluations in Australia. Exploratory modelling of interventions using idealised scenarios will initially be conducted in single birth cohorts. If these have a significant impact on findings then evaluations with more realistic assumptions will be conducted. Promising strategies will be investigated further by multi-cohort simulations predicting health outcomes, resource use and cost outcomes. CONCLUSIONS: Pathways-Cervix will assess the relative benefits of strategies and treatment options in a systematic and health economic framework, producing a list of 'best buys' for future decision-making in cervical cancer control.
OBJECTIVE:Australia's HPV vaccination and HPV-based cervical screening programs are changing the landscape in cervical cancer prevention. We aim to identify areas which can make the biggest further impact on cervical cancer burden. This protocol describes the first stage of a program of work called Pathways-Cervix that aims to generate evidence from modelled evaluations of interventions across the cervical cancer spectrum. METHODS: Based on evidence from literature reviews and guidance from a multi-disciplinary Scientific Advisory Committee (SAC), the most relevant evaluations for prevention, diagnosis and treatment were identified. RESULTS: Priority evaluations agreed by the SAC included: increasing/decreasing and retaining vaccination uptake at the current level; vaccinating older women; increasing screening participation; methods for triaging HPV-positive women; improving the diagnosis of cervical intraepithelial neoplasia (CIN) and cancer; treating cervical abnormalities and cancer; and vaccinating women treated for CIN2/3 to prevent recurrence. Evaluations will be performed using a simulation model, Policy1-Cervix previously used to perform policy evaluations in Australia. Exploratory modelling of interventions using idealised scenarios will initially be conducted in single birth cohorts. If these have a significant impact on findings then evaluations with more realistic assumptions will be conducted. Promising strategies will be investigated further by multi-cohort simulations predicting health outcomes, resource use and cost outcomes. CONCLUSIONS: Pathways-Cervix will assess the relative benefits of strategies and treatment options in a systematic and health economic framework, producing a list of 'best buys' for future decision-making in cervical cancer control.
Authors: Eleonora Feletto; Jie-Bin Lew; Joachim Worthington; Emily He; Michael Caruana; Katherine Butler; Harriet Hui; Natalie Taylor; Emily Banks; Karen Barclay; Kate Broun; Alison Butt; Rob Carter; Jeff Cuff; Anita Dessaix; Hooi Ee; Jon Emery; Ian M Frayling; Paul Grogan; Carol Holden; Christopher Horn; Mark A Jenkins; James G Kench; Maarit A Laaksonen; Barbara Leggett; Gillian Mitchell; Susan Morris; Bonny Parkinson; D James St John; Linda Taoube; Katherine Tucker; Melanie A Wakefield; Robyn L Ward; Aung Ko Win; Daniel L Worthley; Bruce K Armstrong; Finlay A Macrae; Karen Canfell Journal: BMJ Open Date: 2020-06-21 Impact factor: 2.692