Cost-Effectiveness Analysis of HPV Extended versus Partial Genotyping for Cervical Cancer Screening in Singapore

Abstract

Human papillomavirus (HPV) partial genotyping (PGT) identifies HPV16 and HPV18 individually, alongside 12 other high-risk HPV genotypes (hrHPV) collectively. HPV extended genotyping (XGT) identifies four additional hrHPV individually (HPV31, 45, 51, and 52), and reports the remaining eight in three groups (HPV33|58; 56|59|66; 35|39|68). Quality-adjusted life years (QALY), health care resource use, and costs of XGT were compared to PGT for cervical cancer screening in Singapore using DICE simulation. Women with one of the three hrHPV identified by XGT (HPV35|39|68; 56|59|66; 51), and atypical squamous cells of undetermined significance (ASCUS) on cytology, are recalled for a repeat screening in one year, instead of undergoing an immediate colposcopy with PGT. At the repeat screening, the colposcopy is performed only for persistent same-genotype infections in XGT, while with PGT, all the women with persistent HPV have a colposcopy. Screening 500,122 women, aged 30–69, with XGT, provided an incremental cost-effectiveness ratio (ICER) versus PGT of SGD 16,370/QALY, with 7130 (19.4%) fewer colposcopies, 6027 (7.0%) fewer cytology tests, 9787 (1.6%) fewer clinic consultations, yet 2446 (0.5%) more HPV tests. The XGT ICER remains well below SGD 100,000 in sensitivity analyses, (-SGD 17,736/QALY to SGD 50,474/QALY). XGT is cost-effective compared to PGT, utilizes fewer resources, and provides a risk-based approach as the primary cervical cancer screening method.

Cost‐effectiveness of primary human papillomavirus triage approaches among vaccinated women in Norway: A model‐based analysis

“…We identified two studies (the United States and Singapore) that found extended genotyping (three HPV groups) was likely to be considered cost-effective over partial genotyping; however, they did not consider the potential of age-specific algorithms alongside extended genotyping. 7,8 Under the majority of our sensitivity analyses, including for a vaccine-naive cohort, we found that age-based triage remained preferred, except when we assumed imperfect screening adherence.…”

“…To our knowledge, our study is one of the first to explicitly quantify the efficient gains through age‐ and genotype‐specific algorithms under uniform primary HPV testing for a vaccinated cohort. We identified two studies (the United States and Singapore) that found extended genotyping (three HPV groups) was likely to be considered cost‐effective over partial genotyping; however, they did not consider the potential of age‐specific algorithms alongside extended genotyping 7,8 …”

“…Following their first adolescent-vaccinated cohort entering screening in 2022, Norway is considering extended HPV genotyping and age-specific triage approaches. To our knowledge, although extended genotyping has been examined, [6][7][8] there are no cost-effectiveness analyses or harm-benefit evaluations that combine both age and multiple extended genotyping triage algorithms.…”

“…Following their first adolescent‐vaccinated cohort entering screening in 2022, Norway is considering extended HPV genotyping and age‐specific triage approaches. To our knowledge, although extended genotyping has been examined, 6–8 there are no cost‐effectiveness analyses or harm–benefit evaluations that combine both age and multiple extended genotyping triage algorithms. Therefore, the aim of this study was to estimate the health impact, harms and cost‐effectiveness of novel primary HPV triage approaches for a highly vaccinated cohort of women initiating screening in 2023.…”

Cost-effectiveness of single-visit cervical cancer screening in KwaZulu-Natal, South Africa: a model-based analysis accounting for the HIV epidemic

“…found that the cost of single-visit screening strategies at an HIV clinic in Kenya was lower than two-visit strategies, and HPV DNA testing was the most effective strategy when screening and treatment were provided in a single visit ( 66 ). Conversely, alternative strategies such as HPV genotyping and visual inspection with acetic acid may be optimal in other contexts ( 37 , 67 – 70 ). Lew et al.…”