A model to evaluate the costs and clinical effectiveness of human papilloma virus screening compared with annual papanicolaou cytology in Germany

Petry, Karl Ulrich; Barth, Cordula; Wasem, Jürgen; Neumann, Anja

doi:10.1016/j.ejogrb.2017.03.029

Cited by 21 publications

(18 citation statements)

References 29 publications

(34 reference statements)

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“…It improves the detection of CIN2-3 and CxCa, displays better clinical outcomes and creates substantial cost-savings for the Portuguese healthcare system. The results are in line with similar health economic outcome research (HECON) studies [36][37][38][39] and support the current clinical consensus on the move towards molecular screening for cervical cancer not just in Portugal but also other European countries. Nevertheless, as this study is based on a computer-based model cohort, a randomized clinical trial or real-world studies with randomized samples and appropriate methodologies are needed as further research to generalize these results to the population.…”

Section: Discussionsupporting

confidence: 88%

Budget impact analysis of cervical cancer screening in Portugal: comparison of cytology and primary HPV screening strategies

Pista¹,

Costa²,

Saldanha³

et al. 2019

BMC Public Health

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Background: Primary Human Papilloma Virus (HPV) testing is the currently recommended cervical cancer (CxCa) screening strategy by the Portuguese Society of Gynecology (SPG) clinical consensus. However, primary HPV testing has not yet been adopted by the Portuguese organized screening programs. This modelling study compares clinical benefits and costs of replacing the current practice, namely cytology with ASCUS HPV triage, with 2 comparative strategies: 1) HPV (pooled) test with cytology triage, or 2) HPV test with 16/18 genotyping and cytology triage, in organized CxCa screenings in Portugal. Methods: A budget impact model compares screening performance, clinical outcomes and budget impact of the 3 screening strategies. A hypothetical cohort of 2,078,039 Portuguese women aged 25-64 years old women is followed for two screening cycles. Screening intervals are 3 years for cytology and 5 years for the HPV strategies. Model inputs include epidemiological, test performance and medical cost data. Clinical impacts are assessed with the numbers of CIN2-3 and CxCa detected. Annual costs, budget impact and cost of detecting one CIN2+ were calculated from a public healthcare payer's perspective. Results: HPV testing with HPV16/18 genotyping and cytology triage (comparator 2) shows the best clinical outcomes at the same cost as comparator 1 and is the most cost-effective CxCa screening strategy in the Portuguese context. Compared to screening with cytology, it would reduce annual CxCa incidence from 9.3 to 5.3 per 100,000, and CxCa mortality from 2.7 to 1.1 per 100,000. Further, it generates substantial cost savings by reducing the annual costs by €9. 16 million (− 24%). The cost of detecting CIN2+ decreases from the current €15,845 to €12,795. On the other hand, HPV (pooled) test with cytology triage (comparator 1) reduces annual incidence of CxCa to 6.9 per 100,000 and CxCa mortality to 1.6 per 100,000, with a cost of €13,227 per CIN2+ detected with annual savings of €9.36 million (− 24%). The savings are mainly caused by increasing the length of routine screening intervals from three to five years. Conclusion: The results support current clinical recommendations to replace cytology with HPV with 16/18 genotyping with cytology triage as screening algorithm.

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Section: Discussionsupporting

confidence: 88%

Budget impact analysis of cervical cancer screening in Portugal: comparison of cytology and primary HPV screening strategies

Pista¹,

Costa²,

Saldanha³

et al. 2019

BMC Public Health

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“…A German study that assessed costs and clinical effectiveness showed that HR-HPV (HPV 16/18) tests performed in conjunction with p16/Ki-67 dual-stained cytology can improve the detection rate of cervical cancer compared to the Pap test alone, with lower total annual cost. 33 In addition, an Australian study demonstrated that HPV tests performed every 5 years are more effective for cervical cancer screening and cost-savings than Pap tests performed every 2 years. This Australian National Cervical Screening Program switched to primary HPV screening with partial genotyping as of 2017.…”

Section: Current Status Of Cervical Cancer Screeningmentioning

confidence: 99%

“…Gardasil (Merck, NJ, USA) showed limited effects against specific viruses including HPV 6,11,16, and 18. Gardasil 9 (Merck) showed limited effects against HPV 6,11,16,18,31,33,45,52, and 58, while Cervarix (GSK, London, UK) showed limited effects against HPV 16 and 18. HPV types 16 and 18 account for between 55% and 70% of cancers and mainly cause cervical cancers.…”

Section: Future Perspectives On Cervical Cancer Screening In Koreamentioning

confidence: 99%

Current Status of and Perspectives on Cervical Cancer Screening in Korea

Lim¹,

Yoo

2019

J Pathol Transl Med

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Since the introduction of the Papanicolaou (Pap) smear system in 1943, cervicovaginal cytology has been used as a standard screening test for cervical cancer. The dissemination of this test contributed to reductions of the incidence and mortality of cervical cancer worldwide. In Korea, regular health checkups for industrial workers and their family members were introduced in 1988 and were performed as part of the National Cancer Screening Program in 1999. As a result, the incidence of cervical cancer in Korea has been steadily decreasing. However, about 800 cases of cervical cancer-related deaths are reported each year due to false-negative test results. Hence, new screening methods have been proposed. Liquid-based cytology (LBC) was introduced in 1996 to overcome the limitations of conventional Pap smears. Since then, other LBC methods have been developed and utilized, including the human papilloma virus test-a method with higher sensitivity that requires fewer screenings. In this study, we review current issues and future perspectives related to cervical cancer screening in Korea.

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“…In Germany, a recent study revealed that combined HPV 16/18 testing and p16/Ki-67 resulted in lower cost and clinically efficient CC screening, compared with conventional annual Pap cytology [76]. As described earlier, several evidences on the utility of p16/ Ki-67 have accumulated; therefore, p16/Ki-67 will definitely play an important role in the secondary prevention of CC.…”

Section: Ink4amentioning

confidence: 99%

Secondary Prevention of Uterine Cervical Cancer

Sato¹,

Itamochi²

2018

Cervical Cancer - Screening, Treatment and Prevention - Universal Protocols for Ultimate Control

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Secondary prevention by cervical cytology has clearly improved the mortality rate of uterine cervical cancer (CC) by enabling early detection and treatment of high-grade squamous intraepithelial lesion (HSIL) or cervical intraepithelial neoplasia (CIN), which is a precancerous lesion. In the past two decades, HPV-DNA testing, including HPV typing, has clearly brought about positive effects on secondary prevention of CC. However, in practice, CC remains a fatal disease and is the second leading cause of cancer deaths in women aged 20-39 years. Although elucidation of the mechanisms of HPV carcinogenesis and development of a prophylactic vaccine have made CC a preventable disease, eradication of CC is expected to take several decades. Therefore, primary screening to decrease the mortality rate of CC will remain important for a while. In addition, the clinical application of simple biomarkers to stratify HPV-positive women is important for maintenance of medical economy and avoidance of overtreatment in women in the reproductive age. Therefore, the development of an inexpensive therapy or vaccine that can be used worldwide is necessary to overcome cancer deaths due to CC.

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A model to evaluate the costs and clinical effectiveness of human papilloma virus screening compared with annual papanicolaou cytology in Germany

Abstract: Screening strategies including primary HPV testing for high-risk subtypes (HPV-16/18) in conjunction with p16/Ki-67 dual-stained cytology can improve the detection of cervical cancer at a lower total annual cost than conventional Pap cytology screening.

Cited by 21 publications

References 29 publications

Budget impact analysis of cervical cancer screening in Portugal: comparison of cytology and primary HPV screening strategies

Budget impact analysis of cervical cancer screening in Portugal: comparison of cytology and primary HPV screening strategies

Current Status of and Perspectives on Cervical Cancer Screening in Korea

Secondary Prevention of Uterine Cervical Cancer

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