Modeling Cost-Effectiveness of Cervical Cancer Screening in Hungary

Vokó, Zoltán; Nagyjánosi, László; Margitai, Barnabás; Kövi, Rita; Tóth, Zoltán; László, Dániel; Kaló, Zoltán

doi:10.1016/j.jval.2011.10.003

Cited by 13 publications

(21 citation statements)

References 12 publications

(12 reference statements)

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“…The disease progression part of the cost-effectiveness model was based on a previously published model (Figure 1) [7-9]. The boxes represent health states, and the arrows represent transition routes between the health states.…”

Section: Methodsmentioning

confidence: 99%

“…The time horizon of the model was 88 years, i.e., the accumulated costs and QALY differences were estimated at age 99 years. Data on quality-of-life (QoL) weights were taken from a previously published Hungarian model assessing the cost-effectiveness of different screening strategies (Table 1) [7]. …”

Section: Methodsmentioning

confidence: 99%

“…In the default setting, we set the proportion of women starting and stopping screening at each round of the screening in such a way that the participation rates were in line with the current age-specific participation rate figures (Table 2) [11]. The data on the test characteristics of the combined test of cytologic and colposcopic examinations were taken from our model for cervical screening (Table 3) [7]. …”

Section: Methodsmentioning

confidence: 99%

“…The cost of the screening process and cancer treatment was taken from a previously published model (Table 5) [7]. The nominal prices paid by the National Sick Fund for the units of in- and outpatient services have increased by 2.74% since the cost estimation was performed for the previous model.…”

Section: Methodsmentioning

confidence: 99%

“…Improving the effectiveness of the cervical cancer prevention program is on the agenda of Hungarian health policy makers. We have recently developed a health economic model to study the cost-effectiveness of different possible screening strategies [7]. …”

Section: Introductionmentioning

confidence: 99%

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Cost-effectiveness of adding vaccination with the AS04-adjuvanted human papillomavirus 16/18 vaccine to cervical cancer screening in Hungary

Vokó

Nagyjánosi²,

Kaló

2012

BMC Public Health

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BackgroundThe cervical cancer screening program implemented in Hungary to date has not been successful. Along with screening, vaccination is an effective intervention to prevent cervical cancer. The aim of this study was to assess the cost-effectiveness of adding vaccination with the human papillomavirus 16/18 vaccine to the current cervical cancer screening program in Hungary.MethodsWe developed a cohort simulation state-transition Markov model to model the life course of 12-year-old girls. Eighty percent participation in the HPV vaccination program at 12 years of age was assumed. Transitional probabilities were estimated using data from the literature. Local data were used regarding screening participation rates, and the costs were estimated in US $. We applied the purchasing power parity exchange rate of 129 HUF/$ to the cost data. Only direct health care costs were considered. We used a 3.7% discount rate for both the cost and quality-adjusted life years (QALYs). The time horizon was 88 years.ResultsInclusion of HPV vaccination at age 12 in the cervical cancer prevention program was predicted to be cost-effective. The incremental cost-effectiveness ratio (ICER) of adding HPV vaccination to the current national cancer screening program was estimated to be 27 588 $/QALY. The results were sensitive to the price of the vaccine, the discount rate, the screening participation rate and whether herd immunity was taken into account.ConclusionsOur modeling analysis showed that the vaccination of 12-year-old adolescent girls against cervical cancer with the AS04-adjuvanted human papillomavirus 16/18 vaccine would be a cost-effective strategy to prevent cervical cancer in Hungary.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cost-effectiveness of adding vaccination with the AS04-adjuvanted human papillomavirus 16/18 vaccine to cervical cancer screening in Hungary

Vokó

Nagyjánosi²,

Kaló

2012

BMC Public Health

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Quality of life assumptions determine which cervical cancer screening strategies are cost‐effective

Kok

Korfage

Hout

et al. 2018

Intl Journal of Cancer

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Quality-adjusted life years are used in cost-effectiveness analyses (CEAs). To calculate QALYs, a "utility" (0-1) is used for each health state induced or prevented by the intervention. We aimed to estimate the impact of quality of life (QoL) assumptions (utilities and durations of health states) on CEAs of cervical cancer screening. To do so, 12 alternative sets of utility assumptions were retrieved from published cervical cancer screening CEAs. Two additional sets were based on empirical QoL data that were integrally obtained through two different measures (SF-6D and EQ-5D) from eight groups of women (total n = 3,087), from invitation for screening to diagnosis with cervical cancer. Per utility set we calculated the number of quality-adjusted days lost (QADL) for each relevant health state in cervical cancer screening, by multiplying the study-specific assumed disutilities (i.e., 1-utility) with study-specific durations of the loss in QoL, resulting in 14 "QADL-sets." With microsimulation model MISCAN we calculated cost-effectiveness of 342 alternative screening programs (varying in primary screening test [Human Papillomavirus (HPV) vs. cytology], starting ages, and screening interval) for each of the 14 QADL-sets. Utilities used in CEAs appeared to differ largely. We found that ten QADL-sets from the literature resulted in HPV and two in cytology as preferred primary test. The SF-6D empirical QADL-set resulted in cytology and the EQ-5D one in HPV as preferred primary test. In conclusion, assumed utilities and health state durations determine cost-effectiveness of cervical cancer screening. Also, the measure used to empirically assess utilities can be crucial for CEA conclusions.

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A systematic review of the cost-effectiveness of interventions to increase cervical cancer screening among underserved women in Europe

Sun,

Patel,

Fiorina

et al. 2023

Eur J Health Econ

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Background This study aimed to conduct a systematic review of the cost-effectiveness studies of interventions to increase cervical cancer screening uptake rates in underserved women in Europe. Methods A search of Embase, Medline, Global Health, PsychINFO, and NHS Economic Evaluation Database was conducted for studies published between January 2000 and September 2022. Studies were eligible if they analysed the cost-effectiveness of any interventions to improve participation in cervical cancer screening among underserved women of any age eligible to participate in cervical cancer screening in European countries, in any language. Study characteristics and cost-effectiveness results were summarised. Study quality was assessed using the Drummond Checklist, and methodological choices were further compared. Results The searches yielded 962 unique studies, with 17 of these (from twelve European countries) meeting the eligibility criteria for data extraction. All studies focused on underscreened women as an overarching group, with no identified studies focusing on specific subgroups of underserved women. Generally, self-HPV testing and reminder interventions were shown to be cost-effective to increase the uptake rates. There was also research showing that addressing access issues and adopting different screening modalities could be economically attractive in some settings, but the current evidence is insufficient due to the limited number of studies. Conclusion This systematic review has revealed a gap in the literature on the cost-effectiveness of interventions to improve uptake rates of cervical cancer screening through tailored provision for specific groups of underserved women.

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Modeling Cost-Effectiveness of Cervical Cancer Screening in Hungary

Cited by 13 publications

References 12 publications

Cost-effectiveness of adding vaccination with the AS04-adjuvanted human papillomavirus 16/18 vaccine to cervical cancer screening in Hungary

Cost-effectiveness of adding vaccination with the AS04-adjuvanted human papillomavirus 16/18 vaccine to cervical cancer screening in Hungary

Quality of life assumptions determine which cervical cancer screening strategies are cost‐effective

A systematic review of the cost-effectiveness of interventions to increase cervical cancer screening among underserved women in Europe

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