Cost-effectiveness of cervical cancer screening with primary human papillomavirus testing in Norway

Abstract

Background:New screening technologies and vaccination against human papillomavirus (HPV), the necessary cause of cervical cancer, may impact optimal approaches to prevent cervical cancer. We evaluated the cost-effectiveness of alternative screening strategies to inform cervical cancer prevention guidelines in Norway.Methods:We leveraged the primary epidemiologic and economic data from Norway to contextualise a simulation model of HPV-induced cervical cancer. The current cytology-only screening was compared with strategies involving cytology at younger ages and primary HPV-based screening at older ages (31/34+ years), an option being actively deliberated by the Norwegian government. We varied the switch-age, screening interval, and triage strategies for women with HPV-positive results. Uncertainty was evaluated in sensitivity analysis.Results:Current cytology-only screening was less effective and more costly than strategies that involve switching to primary HPV testing in older ages. For unvaccinated women, switching at age 34 years to primary HPV testing every 4 years was optimal given the Norwegian cost-effectiveness threshold ($83 000 per year of life saved). For vaccinated women, a 6-year screening interval was cost-effective. When we considered a wider range of strategies, we found that an earlier switch to HPV testing (at age 31 years) may be preferred.Conclusions:Strategies involving a switch to HPV testing for primary screening in older women is expected to be cost-effective compared with current recommendations in Norway.

A Systematic Review of Economic Aspects of Cervical Cancer Screening Strategies Worldwide: Discrepancy between Economic Analysis and Policymaking

“…Methods for calculating the ICER in six articles were; cost/ QALY (Mandelblatt et al, 2002b, Berkhof et al, 2010Chuck, 2010;Chow et al, 2010;Vijayaraghavan et al, 2009;2010a), in 13 studies the ICER were estimated by cost/LYG (Brown and Garber, 1999;Maxwell et al, 2002;Mandelblatt et al, 2002a;Goldie et al, 2001;2004;Kim et al, 2005;Bidus et al, 2006;Andres-Gamboa et al, 2008;Kulasingam et al, 2009;Levin et al, 2010;Sroczynski et al, 2011;Burger et al, 2012). Two studies did not report their ICER (Bistoletti et al, 2008;de Kok et al, 2012).…”

“…Four articles in four high income countries (Goldie et al, 2001;2004;Mandelblatt et al, 2002a;Bistoletti et al, 2008;Burger et al, 2012;de Kok et al, 2012), nine middle income countries from seven articles Andres-Gamboa et al, 2008;Vijayaraghavan et al, 2009;Chow et al, 2010;Levin et al, 2010) and 1 article in low income countries suggested starting age after age 30 (Table 1).…”

“…Goldie in the USA, declared that a two-to three-year interval for screening with a co-screening strategy was best (Goldie et al, 2004). Burger in Norway, suggested screening with cytology for younger women and HPV DNA testing strategy every four years after the age of 34 years (Burger et al, 2012). Seven papers suggested a five-year interval with various strategies such as HPV DNA testing (Andres-Gamboa et al, 2008;Kulasingam et al, 2009;Levin et al, 2010), HPV DNA triage (Berkhof et al, 2010;Chow et al, 2010), and primary HPV DNA in both types of co-screening or triage (de Kok et al, 2012).…”

“…Six articles proposed 3-5 years interval (Brown and Garber, 1999;Maxwell et al, 2002;Kim et al, 2005;Chuck, 2010;Vijayaraghavan et al, 2010b;Burger et al, 2012) and three articles showed that 5 years interval between screenings was cost effective (Kulasingam et al, 2009;Berkhof et al, 2010;de Kok et al, 2012). We just found one article in Sweden indicating that 9 years interval was cost effective (Bistoletti et al, 2008)…”

“…The table clearly shows that the various strategies were found to be the most cost-effective based on Markov modeling in each setting. The most recommended strategy by authors was HPV DNA testing (Goldie et al, 2001;Andres-Gamboa et al, 2008;Kulasingam et al, 2009;Levin et al, 2010;Sroczynski et al, 2011;Burger et al, 2012;de Kok et al, 2012). However, the most cost-effective strategy in three articles was not related to our PICOD (Goldie et Mandelblatt et al, 2002a;Goldie et al, 2005).…”