Emily Annika Burger

• Silvestre, Jacopo Di; Salgado, M. Victoria; Jeon, Jihyoun; Mok, Yoonseo; Holford, Theodore R. & Vedøy, Tord Finne [Show all 9 contributors for this article] (2026). Age- and sex-specific smoking trends by birth cohort in Norway, 1978–2024: an analysis of cross-sectional survey data. The Lancet Regional Health - Europe. 71. doi: 10.1016/j.lanepe.2026.101886. Full text in Research Archive
• Bekkevold, Terese; Laake, Ida; Feiring, Berit; Søreng, Kristiane; Presthus, Gro & Alfsen, Glenny Cecilie [Show all 14 contributors for this article] (2026). HPV Genotype Distribution in Cervical Cancer and High-Grade Lesions in Norway, and Early Vaccine Impact. International Journal of Cancer. ISSN 0020-7136. doi: 10.1002/ijc.70712.
• Wu, Yansi; Burger, Emily Annika; Holmboe, Fredrik; Bangum, Magnus; Oteiza, Francisco & Bugge, Christoffer [Show all 8 contributors for this article] (2026). Integrating Structured Expert Elicitation with External Evidence to Inform Earlier Reimbursement Decisions: A Norwegian Case Study of Selpercatinib for Non-Small Cell Lung Cancer. PharmacoEconomics - Open. ISSN 2509-4262. 10(4), p. 679–694. doi: 10.1007/s41669-026-00656-9. Full text in Research Archive Show summary

  Background The Norwegian public–private partnership, CONNECT, identified the reimbursement submission case of selpercatinib—a first-line targeted therapy for RET fusion-positive non-small cell lung cancer (NSCLC)—as a unique opportunity to assess the role of structured expert elicitation (SEE) in conjunction with phase II evidence. Objective This study aims to compare the potential of using SEE and other sources of external evidence with phase III clinical trial results to explore the possibility of facilitating earlier (conditional) reimbursement decisions. Methods We conducted a series of cost-effectiveness analyses, grouping different sources of evidence (i.e., published clinical evidence and SEE) to estimate the long-term health and economic consequences of selpercatinib versus pembrolizumab plus pemetrexed and platinum-based chemotherapy for patients with advanced RET fusion-positive NSCLC in Norway. We developed a probabilistic partitioned survival model to estimate and compare costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) associated with evidence potentially available early in the product lifecycle, including SEE, with those using phase III evidence. Results ICERs consistently ranged between $8257 and $19,819 per QALY gained when we used SEE, either alone or in combination with additional external evidence, or when we used the phase III randomized controlled trial (RCT) evidence. Conclusions The consistent cost-effectiveness results between pre-submission and post-submission phases support the potential of SEE to complement health technology assessment (HTA) and potentially inform earlier (conditional) reimbursement decisions for this single case study. However, future research should focus on refining SEE protocols for continued methodological development and validation to improve generalizability and applicability.

• Khalife, Ghida; Baldwin, David; Koivunen, Jussi; Hardardottir, Hronn; Stenger, Michael & Johansson, Mikael [Show all 11 contributors for this article] (2026). Lung cancer screening in transition: highlights from the 3rd Oslo Lung Cancer Symposium, 2025. European Clinical Respiratory Journal. 13(1). doi: 10.1080/20018525.2026.2674339. Full text in Research Archive Show summary

  The 3rd Annual Lung Cancer Symposium (Oslo Cancer Cluster, 25 September 2025) gathered experts from all the Nordic countries, Norway, Finland, Iceland, Denmark, Sweden, as well as Germany, the UK and the USA to present new evidence and implementation experiences in low-dose chest tomography lung cancer screening, with cross-cutting attention to risk stratification, health economics, AI-enabled workflows, and equity. The symposium was organized by Oslo Cancer Cluster, Levanger Hospital and the Norwegian University of Science and Technology, as a continuation of previous years´ annual efforts to gather and showcase the experiences and the progress of the Nordic countries with lung cancer screening. Across settings, LDCT screening is associated with stage shift and potential mortality reduction, consistent with large trials (NLST, NELSON) and maturing real-world experience (HANSE pilot study, programs in Croatia, Taiwan, the UK, and the US). Emerging Nordic pilots demonstrate feasibility, early-stage detection, and high adherence, while European coordination (SOLACE) is accelerating guideline harmonization and implementation pilots. Key themes included: (1) superiority of multivariable risk models over categorical criteria; (2) the necessity of integrating smoking cessation; (3) program economics that are likely acceptable under Nordic decision thresholds; (4) capacity and downstream pathway planning; and (5) equity-by-design to avoid widening disparities. This report synthesizes country updates and implications for Nordic and European scale-up.

• Pedersen, Kine; Silvestre, Jacopo Di; Sy, Stephen; Portnoy, Allison; Castle, Philip E. & Kim, Jane J. [Show all 7 contributors for this article] (2026). Optimizing Cervical Cancer Screening by Age at Vaccination for Human Papillomavirus: Health and Resource Implications. Annals of Internal Medicine. ISSN 0003-4819. 179(4), p. 497–505. doi: 10.7326/ANNALS-25-03192. Full text in Research Archive
• Burger, Emily A.; Laprise, Jean-François; Spencer, Jennifer C.; Sy, Stephen; Regan, Mary Caroline & Drolet, Melanie [Show all 9 contributors for this article] (2026). Single-dose HPV vaccination in the United States — a multi-modeling analysis. The Lancet Regional Health - Americas. 55, p. 101361–101361. doi: 10.1016/j.lana.2025.101361. Full text in Research Archive Show summary

  Background: Evidence supporting the non-inferior efficacy of single-dose human papillomavirus (HPV) vaccination has prompted reconsideration of existing multi-dose HPV vaccination schedules. We evaluated the long-term health impact of adopting single-dose HPV vaccination in the United States to inform policy deliberations. Methods: We applied two validated individual-based simulation models of HPV transmission and cervical cancer to project the impact of switching from a two-dose to a single-dose HPV vaccination schedule in 2025 in the context of historical HPV vaccination uptake in the United States. Four scenarios were simulated: continuation of two-dose vaccination (or equivalent single-dose efficacy of 98%) and three alternative pessimistic single-dose strategies with lower vaccine efficacy (90%) and/or duration of protection (average of 25 years). Outcomes included age-standardized incidence rates of HPV-16 infection and cervical cancer from years 2005-2099. Additional analyses examined effects under lower vaccination coverage observed in select U.S. regions. Findings: Maintaining two doses or switching to a non-inferior single-dose HPV vaccination schedule was projected to nearly eliminate HPV-16 infections and reduce cervical cancer incidence by over 90% by the end of the century. Scenarios assuming a lower efficacy or waning protection showed increases in cervical cancer incidence of less than 2 percentage points decades after a switch to single-dose vaccination with no impact on the timeframe to cervical cancer elimination. Interpretation: Switching to a single-dose HPV vaccination schedule is projected to maintain reductions in cervical cancer, even under pessimistic efficacy and durability assumptions. Continued monitoring of single-dose HPV vaccine efficacy over time remains critical. Funding: PATH on behalf of the Single-Dose HPV Vaccine Evaluation Consortium; Bill and Melinda Gates Foundation (grant No. OPP48979), and the US National Institutes of Health/National Cancer Institute (Grant Number U01 CA253912).

• Groot, Carin A. Uyl-de; Xander, Nicolas S.H.; Belleman, Tom; Burger, Emily Annika; Doeswijk, Robin & Durand-Zaleski, Isabelle [Show all 23 contributors for this article] (2026). Bridging affordability and sustainability of health innovations via novel pricing, cost-effectiveness, and reimbursement models to improve patient access: The ASCERTAIN project. Health Policy and Technology. ISSN 2211-8837. 15(2). doi: 10.1016/j.hlpt.2026.101155. Full text in Research Archive Show summary

  Objectives Disparities in access to potential innovative health technologies (pIHTs) persist across Europe due to differing healthcare budgets, pricing policies, and health technology assessment (HTA) practices. The ASCERTAIN project aims to reduce these inequalities by developing integrated pricing, cost-effectiveness, and reimbursement approaches that enhance affordability, long-term sustainability, and timely patient access. Methods The project applies a mixed-methods approach, including literature review, stakeholder surveys, interviews, and focus groups, to ensure relevance across diverse health systems. It integrates access-based pricing, value-driven HTA, and adaptable reimbursement models into a practical, open-access ACCESS2MEDS Toolbox. This includes access-based pricing frameworks, cost-effectiveness models, and budget impact and reimbursement analyses, all adaptable to country-specific conditions to reduce uncertainty and improve transparency. Tools are co-created with patients, developers, clinicians, and policymakers and will be tested and validated using three use cases representing high-impact areas of innovation: precision oncology medicines, cell and gene therapies, and next-generation sequencing tests. Results Outputs will include validated tools enabling improved evaluation of clinical benefit, cost-effectiveness, and financial sustainability, strengthening value-based decision-making across Europe. Innovative access- and outcome-based pricing strategies will support responsible innovation while encouraging fair reimbursement and improved budget control. Policy roadmaps will guide the adoption of equitable access models and support system-level implementation. Conclusions ASCERTAIN will provide a harmonized framework that balances cost control, innovation incentives, and patient-centered care. By facilitating consistent, evidence-based pricing and reimbursement decisions, the project supports fair and sustainable access to pIHTs across Europe, with continued multi-stakeholder collaboration driving its wider adoption and real-world impact.

• Burger, Emily A; Jansen, Erik E L; Bondt, Daniël de; Killen, James; Spencer, Jennifer C & Regan, Mary Caroline [Show all 12 contributors for this article] (2025). Disparities in cervical cancer elimination time frames in the United States: a comparative modeling study. Journal of the National Cancer Institute. ISSN 0027-8874. 117(7), p. 1502–1502. doi: 10.1093/jnci/djae319. Full text in Research Archive Show summary

  Abstract Population-level estimates in time frames for reaching cervical cancer elimination (ie, <4 cases per 100 000 women) in the United States may mask potential disparities in achieving elimination among subpopulations. We used 3 independent Cancer Intervention and Surveillance Modeling Network models to estimate differences in the time to cervical cancer elimination across 7 strata of correlated screening and human papillomavirus vaccination uptake, based on national survey data. Compared with the average population, elimination was achieved at least 22 years earlier for the high-uptake strata and at least 27 years later for the most extreme low-uptake strata. Accounting for correlated uptake impacted the population average time frame by no more than 1 year. Consequently, national average elimination time frames mask substantial disparities in reaching elimination among subpopulations. Addressing inequalities in cervical cancer control could shorten elimination time frames and would ensure more equitable elimination across populations. Furthermore, country-level elimination monitoring could be supplemented by monitoring progress in subpopulations.

• Landy, Rebecca; Haber, Gregory W; Graubard, Barry I; Fakhry, Carole; Campos, Nicole G & Burger, Emily A [Show all 10 contributors for this article] (2025). Impact of screening for human papillomavirus-positive oropharyngeal cancers: a microsimulation-based modeling study. Journal of the National Cancer Institute. ISSN 0027-8874. 117(6), p. 1217–1217. doi: 10.1093/jnci/djaf033. Full text in Research Archive Show summary

  Abstract Background We estimated the impact of screening on morbidity and mortality of human papillomavirus (HPV)16-positive oropharyngeal cancer among US men aged 45-79 years. Methods We developed an individual-level, state-transition natural history microsimulation model to estimate the impact of screening using oral HPV16 detection, HPV16-E6 antibody detection, and transcervical ultrasound of neck/oropharynx. We compared clinical detection to counterfactual screen detection for cancer stage, single- vs multiple-modality treatment, and survival. Screening scenarios encompassed 4 progression speeds across cancer stages (very slow, slow, fast, and very fast) and 4 screening frequencies. Results Among US men aged 45-79 years in 2021 (n = 54 881 311), 163 958 clinically diagnosed human papillomavirus (HPV)-positive oropharyngeal cancers and 32 009 deaths would occur through age 84 in the absence of screening. Assuming very-fast progression, 4%, 20%, 31%, and 60% of these cancers would be detected by one-off, 5-yearly, 3-yearly, and annual screening. Annual screening (very-fast progression) could reduce the number of cancers diagnosed at advanced stages (American Joint Committee on Cancer, 7th edition, stages III/IV: 90.0% with no screening vs 59.1%) and treated by multiple modalities (80.6% with no screening vs 50.6%). Cancer mortality would also be reduced by 36.2%, with a gain of 106 000 life-years. Annual screening would have a number needed to screen (NNS) of 561 per screen-detected cancer, 1118 per additional cancer treated by single modality, 4740 per death prevented, and 520 per life-year gained; such high NNS reflect potential inefficiency of population-level screening. Conclusions If proven efficacious in randomized trials and cost-effective, screening for HPV-positive oropharyngeal cancers could provide considerable population-level reductions in advanced stage cancers, treatment-related morbidities, and mortality.

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• Aas, Eline; Kinge, Jonas Minet; Burger, Emily Annika; Pedersen, Kine; Iversen, Tor & Godager, Geir [Show all 14 contributors for this article] (2025). Feil tallgrunnlag kan koste liv i helsetjenesten. Full text in Research Archive

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