Abstract
In Norway, cervical cancer is the third most common cancer among mid-adult women who are in their productive social and working years. This is despite substantial reductions in cervical cancer incidence following more than two decades of organized cytology-based screening. The discovery of human papillomavirus (HPV) as a carcinogen has led to new technologies that are changing the landscape of cervical cancer prevention, including HPV-based screening approaches and HPV vaccination. This thesis addresses knowledge gaps related to the value of implementing these technologies in clinical practice, and whether to adapt the screening program for HPV-vaccinated women. To evaluate candidate strategies for current and future cervical cancer screening policies, the thesis includes four decision-analytic studies that employ mathematical simulation modeling. Each study identifies attractive strategies that improve the cost-effectiveness and help balance the health benefits and resource use associated with these policies. These findings provide knowledge to help decision-makers in their continuous and complex work to refine cervical cancer prevention policies in Norway.
List of papers
I. Pedersen K, Sørbye SW, Kristiansen IS, Burger EA. Using novel biomarkers to triage young adult women with minor cervical lesions: A cost-effectiveness analysis. BJOG: An International Journal of Obstetrics and Gynaecology. 2017 Feb; 124(3):474-484. doi: 10.1111/1471-0528.14135. Epub 2016 Jun 6. The paper is not available in DUO due to publisher restrictions. The published version is available at: https://doi.org/10.1111/1471-0528.14135 |
II. Pedersen K, Burger EA, Sy S, Kristiansen IS, Kim JJ. Cost-effective management of women with minor cervical lesions: Revisiting the application of HPV DNA testing. Gynecologic Oncology. 2016 Nov; 143(2):326-333. doi: 10.1016/j.ygyno.2016.08.231. Epub 2016 Aug 17. An author version of this paper is available in DUO: http://hdl.handle.net/10852/51753 |
III. Burger EA, Pedersen K, Sy S, Kristiansen IS, Kim JJ. Choosing wisely: A model-based analysis evaluating the trade-offs in cancer benefit and diagnostic referrals among alternative HPV testing strategies in Norway. British Journal of Cancer. 2017 Aug 3; 11:783-790. doi: 10.1038/bjc.2017.248. The paper is available in DUO: http://hdl.handle.net/10852/60030 |
IV. Pedersen K, Burger EA, Nygård M, Kristiansen IS, Kim JJ. Adapting cervical cancer screening for women vaccinated against human papillomavirus infections: The value of stratifying guidelines. European Journal of Cancer 91 (2018): 68-75. doi: 10.1016/j.ejca.2017.12.018 An author version of this paper is available in DUO: http://hdl.handle.net/10852/60031 |