BACKGROUND: Screening and vaccination against human papillomavirus (HPV) can help protect against the development of cervical cancer (CC). Neither alone can provide 100% protection against CC. Selecting the most efficient combination of screening and vaccination to prevent CC is therefore an important question to address. OBJECTIVES: To identify the mix of CC prevention strategies (screening and/or vaccination against HPV) that minimize CC burden within a fixed budget in Brazil. METHODS: The optimal mix of strategies for CC prevention was determined using an optimisation program. The evaluation uses two models. One is a Markov cohort model, adapted to the Brazilian setting, used as the evaluation model. It estimates the costs and outcomes of 52 different prevention strategies combining screening and vaccination. The other is an optimisation model in which the results of each prevention strategy of the previous model are entered as input data. The latter model determines the combination of prevention options to minimize CC under budget, screening and vaccination coverage constraints. The base-case constraints were current budget, screening of 50% women aged 18 to 65 every 3 years, and a maximum 80% vaccination coverage. Sensitivity analyses were conducted on the optimization constraints. RESULTS: The base-case optimal prevention strategy would be to have 30% vaccinated only at age 12, 50% both vaccinated and screened with a screening interval extended to 5 years and 20% without any prevention strategy. This would result in a 54% CC reduction from pre-vaccination levels with no budget increase. A sharp reduction in CC is seen when the vaccine coverage exceeds the maximum screening coverage, or when screening coverage exceeds the maximum vaccine coverage, while maintaining the budget. CONCLUSIONS: Our models predicted that implementation of vaccination combined with adjusting the screening interval would optimize CC prevention budget allocation to minimize the CC burden in Brazil.
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