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Women are also invited at age 45, 55 and 65\u2009years if they did not test HPV\u2010negative 5\u2009years earlier (risk\u2010based invitation). With influx of birth cohorts vaccinated against HPV, de\u2010intensification may be needed to maintain a cost\u2010effective program. We used an updated and recalibrated model of type\u2010specific HPV transmission and cervical carcinogenesis to estimate the cost\u2010effectiveness of 16 strategies with reduced screening intensity. Strategies varied by starting age, screening interval, and number of risk\u2010based invitations, possibly stratified for HPV vaccination status. Cost\u2010effectiveness was measured by net monetary benefit (NMB). A positive NMB indicates that a strategy is cost\u2010effective compared to the current policy. Two strategies without stratification for HPV vaccination status had a positive NMB. An NMB of EUR 1.6 million per 100,000 women was obtained when, compared to current screening, the invitation at age 35 was based on the HPV\u2010test result at age 30. An NMB of EUR 1.8 million per 100,000 women was obtained when women were re\u2010invited every 5\u2009years if they were HPV\u2010positive or had not been tested 5\u2009years earlier. If reduced screening was only applied to vaccinated women, the highest NMB was EUR 1.3 million per 100,000 women. Thus, reducing screening in HPV\u2010vaccinated cohorts is cost\u2010effective when re\u2010inviting women after 10\u2009years if they test HPV\u2010negative. Stratification for HPV vaccination status does not improve the cost\u2010effectiveness of screening.<\/jats:p>","DOI":"10.1002\/ijc.70377","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T08:39:03Z","timestamp":1770626343000},"page":"389-400","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost\u2010effectiveness of risk\u2010stratified screening for cervical cancer in cohorts vaccinated against human papillomavirus with moderate vaccination coverage"],"prefix":"10.1002","volume":"159","author":[{"given":"Tiago M.","family":"de Carvalho","sequence":"first","affiliation":[{"name":"Department Epidemiology and Data Science Amsterdam UMC, Location Vrije Universiteit Amsterdam  Amsterdam The Netherlands"},{"name":"Amsterdam Public Health Research Institute  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Berkhof","sequence":"additional","affiliation":[{"name":"Department Epidemiology and Data Science Amsterdam UMC, Location Vrije Universiteit Amsterdam  Amsterdam The Netherlands"},{"name":"Amsterdam Public Health Research Institute  Amsterdam The Netherlands"},{"name":"Cancer Center Amsterdam  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3389-5141","authenticated-orcid":false,"given":"Johannes A.","family":"Bogaards","sequence":"additional","affiliation":[{"name":"Department Epidemiology and Data Science Amsterdam UMC, Location Vrije Universiteit Amsterdam  Amsterdam The Netherlands"},{"name":"Amsterdam Public Health Research Institute  Amsterdam The Netherlands"},{"name":"Amsterdam Institute for Immunology and Infectious Diseases  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,9]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsr2030640"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/14760584.2018.1547196"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1917338"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2025.101327"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2019.04.099"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djw216"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2017.12.018"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.33207"},{"key":"e_1_2_10_10_1","unstructured":"World Health Organization.Human Papillomavirus (HPV) vaccination coverage.2023https:\/\/immunizationdata.who.int\/pages\/coverage\/hpv.html. 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