Cost Effectiveness of Human Papillomavirus-16/18 Genotyping in Cervical Cancer Screening

Abstract

BackgroundThere is limited understanding of the health economic implications of cervical screening with human papillomavirus (HPV)-16/18 genotyping.ObjectiveThe aim of this study was to evaluate the cost effectiveness of cervical cancer primary screening with a HPV-16/18 genotyping test which simultaneously detects 12 other high-risk HPV types.MethodsA Markov cohort model compared four strategies: (1) cytology with reflex HPV testing for atypical squamous cells of undetermined significance (ASC-US); (2) co-testing with cytology and HPV testing; (3) HPV with reflex to cytology; and (4) HPV with 16/18 genotyping and reflex cytology (ASC-US threshold). Screening began at age 30 and was performed triennially over 40 years. Screening sensitivity and specificity values for cervical intraepithelial neoplasia (CIN) 3 were obtained from the Addressing THE Need for Advanced HPV Diagnostics (ATHENA) trial. Outcomes for a 1-year follow-up scenario wherein persistent disease was detected were estimated. Screening and cancer treatment costs were calculated from a US payer’s perspective in 2013. Costs and quality-adjusted life-years (QALYs) were discounted at 3 % annually.ResultsApplying a US$50,000/QALY threshold, strategy (4) dominated strategies (2) and (3) by reducing costs and cancer incidence and improving QALYs, and was cost effective versus strategy (1). Accounting for persistent ≥CIN 3 at 1 year, strategy (4) was cost effective versus all other strategies. Detecting HPV-16/18 resulted in earlier diagnosis of clinically relevant ≥CIN 3 at initial screening and efficient use of follow-up resources. Outcomes were most influenced by strategy performance.ConclusionsIncorporating HPV-16/18 genotyping is cost effective and may improve detection of CIN, thereby preventing cervical cancer.

A cross‐sectional study on HPV testing with type 16/18 genotyping for cervical cancer screening in 11,064 Chinese women

“…The strategy of primary HPV testing with cytology triage revealed the highest specificity and PPV, resulting in fewer performed cytology tests and colposcopies to detect one case of high-risk CIN, but it showed the lowest sensitivity and NPV in the first round of screening, which may be associated with poor effectiveness of triage by cytology due to its low sensitivity. It has been reported that HPV 16/18 genotyping demonstrates optimal triage performance in American women who are HPV positive [5,7,31,32]. In the study, we also found that primary HPV testing with type 16/18 genotyping showed the highest sensitivity and NPV and promised similar specificity and PPV for detecting highgrade CIN compared with co-testing screening.…”

Feasibility of thermocoagulation in a screen-and-treat approach for the treatment of cervical precancerous lesions in sub-Saharan Africa

“…This type of management was applied in an effort to reduce the rate of overtreatment by selecting, among HPV-positive women, those who have a higher risk of presenting CIN [14]. …”

Human papillomavirus E7 protein detection as a method of triage to colposcopy of HPV positive women, in comparison to genotyping and cytology. Final results of the PIPAVIR study

“…To minimize this effect, it is necessary to implement an appropriate triage method for women tested positive for HPV to identify among them those with an already existing precancerous cervical lesion or cancer. An accurate and quite cost‐effective HPV‐based screening and triage strategy is the one incorporating HPV16/18 genotyping and cytology for hrHPV (non16/18) positive women . Based on this algorithm, which refers HPV16/18 positive women directly to colposcopy, in this article, we tried to evaluate the effect of further triage of these women using a novel hrHPVE7 oncoprotein detection method.…”

“…The interim clinical guidance for cervical cancer screening proposed by most of the relevant American Societies and Colleges (SGO, ASCCP, ACOG, ACS, ASCytopathol, CAP and ASCP), after the accumulating evidence on primary HPV screening and the US Food and Drug Administration (FDA) approval of the Cobas HPV test [Roche Molecular Systems, Incorporated, Pleasanton, California (http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm3947http://73.htm)] for this purpose, incorporates HPV primary screening with HPV 16/18 genotyping and reflex cytology for hrHPV (non16/18) positive women. This screening algorithm has proven more effective, and in some cases less expensive than others …”