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

Kok, Inge M.C.M. de; Korfage, Ida J.; Hout, Wilbert B. van den; Helmerhorst, Theo J.M.; Habbema, J. Dik F.; Essink‐Bot, Marie‐Louise; Ballegooijen, Marjolein van

doi:10.1002/ijc.31265

Cited by 15 publications

(16 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… Quality of life: The assumed impact of positive HPV tests, colposcopies and treatment for neoplasia on quality of life can influence cost-effectiveness. 50 …”

Section: Cost-effectiveness Of Cytology and Hpv Dna For Primary Cervical Cancer Screeningmentioning

confidence: 99%

Cervical screening: ESGO-EFC position paper of the European Society of Gynaecologic Oncology (ESGO) and the European Federation of Colposcopy (EFC)

Kyrgiou

Arbyn

Bergeron³

et al. 2020

Br J Cancer

View full text Add to dashboard Cite

This paper summarises the position of ESGO and EFC on cervical screening based on existing guidelines and opinions of a team of lead experts. HPV test is replacing cytology as this offers greater protection against cervical cancer and allows longer screening intervals. Only a dozen of HPV tests are considered as clinically validated for screening. The lower specificity of HPV test dictates the use of triage tests that can select women for colposcopy. Reflex cytology is currently the only well validated triage test; HPV genotyping and p16 immunostaining may be used in the future, although methylation assays and viral load also look promising. A summary of quality assurance benchmarks is provided, and the importance to audit the screening histories of women who developed cancer is noted as a key objective. HPV-based screening is more cost-effective than cytology or cotesting. HPV-based screening should continue in the post-vaccination era. Only a fraction of the female population is vaccinated, and this varies across countries. A major challenge will be to personalise screening frequency according to vaccination status. Still the most important factor for successful prevention by screening is high population coverage and organised screening. Screening with self-sampling to reach under-screened women is promising.

show abstract

“… Quality of life: The assumed impact of positive HPV tests, colposcopies and treatment for neoplasia on quality of life can influence cost-effectiveness. 50 …”

Section: Cost-effectiveness Of Cytology and Hpv Dna For Primary Cervical Cancer Screeningmentioning

confidence: 99%

Cervical screening: ESGO-EFC position paper of the European Society of Gynaecologic Oncology (ESGO) and the European Federation of Colposcopy (EFC)

Kyrgiou

Arbyn

Bergeron³

et al. 2020

Br J Cancer

View full text Add to dashboard Cite

show abstract

“…All costs presented are in euros (€) and are indexed to the year 2019. 22,23 The utilities for screening and disease are obtained from an empirical Dutch study by de Kok et al 24 using the SF-6D questionnaire. Costs and effects were discounted annually by 3% as suggested by Sanders et al 25 in their recommendations for cost-effectiveness analyses.…”

Section: Model Assumptionstest Characteristics Costs and Utilitiesmentioning

confidence: 99%

Cost‐effectiveness of HPV‐based cervical screening based on first year results in the Netherlands: a modelling study

Jansen

Naber

Aitken

et al. 2020

BJOG

Self Cite

View full text Add to dashboard Cite

Objective We aim to compare the cost-effectiveness of the old cytology programme with the new high-risk human papillomavirus (hrHPV) screening programme, using performance indicators from the new Dutch hrHPV screening programme.Design Model-based cost-effectiveness analysis.Setting The Netherlands.Population Dutch 30-year-old unvaccinated females followed up lifelong.Methods We updated the microsimulation screening analysis (MISCAN) model using the most recent epidemiological and screening data from the Netherlands. We simulated both screening programmes, using the screening behaviour and costs observed in each programme. Sensitivity analyses were performed on screening behaviour, utility losses and discount rates.Main outcome measures Cervical cancer incidence and mortality rates, number of screening tests and repeat tests, colposcopy referrals by lesion grade, costs from a societal perspective, qualityadjusted life years (QALYs) gained and cost-effectiveness. ResultsThe new Dutch cervical cancer screening programme decreased the cervical cancer mortality by 4% and the incidence by 1% compared with the old programme. Colposcopy referrals of women without cervical intra-epithelial neoplasia grade 2 or worse, increased by 172%, but 13% more QALYs were still achieved. Total costs were reduced by 21%, mainly due to fewer screening tests. Per QALY gained, the hrHPV programme cost 46% less (€12,225) than the cytology programme (€22,678), and hrHPV-based screening remained more cost-effective in all sensitivity analyses.Conclusions The hrHPV-based screening programme was found to be more effective and cost-effective than the cytology programme. Alternatives for the current triage strategy should be considered to lower the number of unnecessary referrals.

show abstract

“…Because of the broad variation in elicitation methods, HSUVs for lung cancer have been reported to vary drastically across the literature [7]. Using different HSUVs can lead to different policies being ranked as cost effective [8]. Therefore, it is important to systematically identify appropriate and high-quality HSUVs for economic evaluations [9].…”

Section: Introductionmentioning

confidence: 99%

Systematic Review and Meta-Analysis of Community- and Choice-Based Health State Utility Values for Lung Cancer

2020

View full text Add to dashboard Cite

Background Using appropriate health state utility values (HSUVs) is critical for economic evaluation of new lung cancer interventions, such as low-dose computed tomography screening and immunotherapy. Therefore, we provide a systematic review and meta-analysis of community-and choice-based HSUVs for lung cancer. Methods On 6 March 2017, we conducted a systematic search of the following databases: Embase, Ovid MEDLINE, Web of Science, Cochrane CENTRAL, Google Scholar, and the School of Health and Related Research Health Utility Database. The search was updated on 17 April 2019. Studies reporting mean or median lung cancer-specific HSUVs including a measure of variance were included and assessed for relevance and validity. Studies with high relevance (i.e. community-and choicebased) were further analysed. Mean HSUVs were pooled using random-effects models for all stages, stages I-II, and stages III-IV. For studies with a control group, we calculated the disutility due to lung cancer. A sensitivity analysis included only the methodologically most comparable studies (i.e. using the EQ-5D instrument and matching tariff). Subgroup analyses were conducted by time to death, histology, sex, age, treatment modality, treatment line, and progression status. Results We identified and analysed 27 studies of high relevance. The pooled HSUV was 0.68 (95% confidence interval [CI] 0.61-0.75) for all stages, 0.78 (95% CI 0.70-0.86) for stages I-II, and 0.69 (95% CI 0.65-0.73) for stages III-IV (p = 0.02 vs. stage I-II). Heterogeneity was present in each pooled analysis (p < 0.01; I 2 = 92-99%). Disutility due to lung cancer ranged from 0.11 (95% CI 0.05-0.17) to 0.27 (95% CI 0.18-0.36). In the sensitivity analysis with the methodologically most comparable studies, stage-specific HSUVs varied by country. Such studies were only identified for Canada, China, Spain, the UK, the USA, Denmark, Germany, and Thailand. In the subgroup analysis by time to death, HSUVs for metastatic non-small-cell lung cancer ranged from 0.83 (95% CI 0.82-0.85) at ≥ 360 days from death to 0.56 (95% CI 0.46-0.66) at < 30 days from death. Among patients with metastatic non-small-cell lung cancer, HSUVs were lower for those receiving third-or fourth-line treatment and for those with progressed disease. Results of subgroup analyses by histology, sex, age, and treatment modality were ambiguous. Conclusions The presented evidence supports the use of stage-and country-specific HSUVs. However, such HSUVs are unavailable for most countries. Therefore, our pooled HSUVs may provide the best available stage-specific HSUVs for most countries. For metastatic non-small-cell lung cancer, adjusting for the decreased HSUVs in the last year of life may be considered, as may further stratification of HSUVs by treatment line or progression status. If required, HSUVs for other health states may be identified using our comprehensive breakdown of study characteristics.

show abstract

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

Cited by 15 publications

References 44 publications

Cervical screening: ESGO-EFC position paper of the European Society of Gynaecologic Oncology (ESGO) and the European Federation of Colposcopy (EFC)

Cervical screening: ESGO-EFC position paper of the European Society of Gynaecologic Oncology (ESGO) and the European Federation of Colposcopy (EFC)

Cost‐effectiveness of HPV‐based cervical screening based on first year results in the Netherlands: a modelling study

Systematic Review and Meta-Analysis of Community- and Choice-Based Health State Utility Values for Lung Cancer

Contact Info

Product

Resources

About