The cost-effectiveness of human papillomavirus screening for cervical cancer

Abstract

We compared findings from recent studies modelling the cost-effectiveness of screening for cervical cancer using human papillomavirus (HPV) testing and alternative strategies. Data were standardized to facilitate comparison of costs per life year or costs per QALY gained in six studies. Absolute changes in costs, life years and QALYs for each strategy were normalized to a comparison with no screening. Costs were standardized to US$ in 2000 values. Most models assume screening starts at age 18 or 20 years. Assumed prevalence of HPV ranges from 10% for those aged 18 years to 20% for those aged 20-25 years and drops substantially after age 30. All except one model assume sensitivity to LSIL of 83% or higher. Two models distinguish the increasing specificity of HPV testing in older age groups (up to 95% for LSIL in women aged 55 years or older). All the models include consultation costs as well as screening and treatment costs, but costs for follow-up diagnosis and treatment vary considerably. Two models also include patient time costs. Despite these differences all strategies involving HPV testing have cost per quality-adjusted life-year (QALY) ratios in the range of USD 12,400-16,600. Costs per life year vary more widely, the highest being USD 19,246 (annual screening with liquid cytology and HPV). However, excluding strategies using liquid cytology, the highest costs per life year for a strategy including HPV testing are under USD 14,000 (simultaneous conventional cytology and HPV every two years). The cost per life year for HPV testing alone triennially is lower than for Pap smear testing alone biennially. Costs per QALY are generally lower than costs per life year (given the reported modelling assumptions and settings). Even with inclusion of patient costs, no strategies involving HPV testing cost more than USD 16,600 per QALY. Adoption of the ACOG guidelines to include HPV testing with cytology as a screening option for women aged 30 years or older therefore appears to be cost-effective.

Screening for Cervical Cancer with the Human Papillomavirus Test in an Area of Central Italy with No Previous Active Cytological Screening Programme

“…Only the group of probes designed to detect high-risk HPV types 16,18,31,33,35,39,45, 51, 52, 56, 59 and 68 was used. HC2 results were expressed as the ratio of the specimen's light emission to that of three concurrently tested 1 pg/mL HPV-DNA controls (relative light units [RLU]).…”

Direct Costs of Cervical Cancer Management in Morocco

“…In the literature, the majority of studies on the cost of cervical cancer only consider screening (Zappa et al, 1998;Holmes et al, 2005). The costs of care for cervical cancer are often approached with overall estimates of the utilized resources (Schaffer et al, 1994) or models based on treatment protocols that may be different from clinical practices (Fahs et al, 1992;Rocconi et al, 2005).…”

Cost‐effectiveness of primary cytology and HPV DNA cervical screening

“…46 By contrast, studies using liquid based cytology and HPV DNA testing have reported costs from 121 USD to 184,000 USD per life year saved or per quality-adjusted life-year (QALY). [11][12][13][14][15][16][17][18][19][20][21][22] Possible reasons for discrepancies include the fact that we did not include screening of young women in our model, the setting with organized screening, the setting with midwives (who have lower salaries than doctors) for taking smears, population-based real-life input data and analysis using a probabilistic state transition model.…”

“…[3][4][5] Several studies have evaluated the economic impact of cervical screening with and without HPV testing, but have reported variable results. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Possible reasons for discrepancies include different modeling methodologies, use of surrogate endpoints and use of input data based on clinical studies that may not have been representative of the population as a whole. However, most modeling studies have consistently found similar reductions of the cumulative lifetime risk of invasive cervical cancer as a result of cytology and HPV DNA screening.…”

“…However, most modeling studies have consistently found similar reductions of the cumulative lifetime risk of invasive cervical cancer as a result of cytology and HPV DNA screening. 6,11,12,19,[23][24][25] State transition models are used in more than 85% of all costeffectiveness analyses and several cervical cancer state transition models have been reported previously. 26,27 The long-term effects and cost of cytology and HPV screening cannot be captured in clinical trials, where all studies have used surrogate endpoints, such as CIN grade 2 or 3 (CIN2-3).…”