The Potential Clinical and Economic Value of a Human Papillomavirus Primary Screening Test That Additionally Identifies Genotypes 31, 45, 51, and 52 Individually

Asti, Lindsey; Hopley, Colin; Avelis, Cameron; Bartsch, Sarah M.; Mueller, Leslie E.; Domino, Molly; Cox, Sarah N; Andrews, Jeffrey C; Randall, Samuel; Stokes-Cawley, Owen J.; Asjes, Caitlin; Lee, Bruce Y.

doi:10.1097/olq.0000000000001327

Cited by 6 publications

(8 citation statements)

References 28 publications

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“…Findings from this study suggest that using XGT is cost-effective for the national cervical cancer screening program in Singapore. Our findings are consistent with previous research in the US [ 60 ], where significant resource savings were also observed for colposcopy, cytology, and treatment of CIN2/3. We found a greater reduction in colposcopy (19.4% vs 9.5%) because only PSGI required colposcopy, while those with a change in genotype were managed as a new HPV infection.…”

Section: Discussionsupporting

confidence: 92%

Cost-Effectiveness Analysis of HPV Extended versus Partial Genotyping for Cervical Cancer Screening in Singapore

Chua

Lim

et al. 2023

Cancers

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Human papillomavirus (HPV) partial genotyping (PGT) identifies HPV16 and HPV18 individually, alongside 12 other high-risk HPV genotypes (hrHPV) collectively. HPV extended genotyping (XGT) identifies four additional hrHPV individually (HPV31, 45, 51, and 52), and reports the remaining eight in three groups (HPV33|58; 56|59|66; 35|39|68). Quality-adjusted life years (QALY), health care resource use, and costs of XGT were compared to PGT for cervical cancer screening in Singapore using DICE simulation. Women with one of the three hrHPV identified by XGT (HPV35|39|68; 56|59|66; 51), and atypical squamous cells of undetermined significance (ASCUS) on cytology, are recalled for a repeat screening in one year, instead of undergoing an immediate colposcopy with PGT. At the repeat screening, the colposcopy is performed only for persistent same-genotype infections in XGT, while with PGT, all the women with persistent HPV have a colposcopy. Screening 500,122 women, aged 30–69, with XGT, provided an incremental cost-effectiveness ratio (ICER) versus PGT of SGD 16,370/QALY, with 7130 (19.4%) fewer colposcopies, 6027 (7.0%) fewer cytology tests, 9787 (1.6%) fewer clinic consultations, yet 2446 (0.5%) more HPV tests. The XGT ICER remains well below SGD 100,000 in sensitivity analyses, (-SGD 17,736/QALY to SGD 50,474/QALY). XGT is cost-effective compared to PGT, utilizes fewer resources, and provides a risk-based approach as the primary cervical cancer screening method.

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Section: Discussionsupporting

confidence: 92%

Cost-Effectiveness Analysis of HPV Extended versus Partial Genotyping for Cervical Cancer Screening in Singapore

Chua

Lim

et al. 2023

Cancers

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“…To our knowledge, our study is one of the first to explicitly quantify the efficient gains through age‐ and genotype‐specific algorithms under uniform primary HPV testing for a vaccinated cohort. We identified two studies (the United States and Singapore) that found extended genotyping (three HPV groups) was likely to be considered cost‐effective over partial genotyping; however, they did not consider the potential of age‐specific algorithms alongside extended genotyping 7,8 …”

Section: Discussionmentioning

confidence: 99%

“…Following their first adolescent‐vaccinated cohort entering screening in 2022, Norway is considering extended HPV genotyping and age‐specific triage approaches. To our knowledge, although extended genotyping has been examined, 6–8 there are no cost‐effectiveness analyses or harm–benefit evaluations that combine both age and multiple extended genotyping triage algorithms. Therefore, the aim of this study was to estimate the health impact, harms and cost‐effectiveness of novel primary HPV triage approaches for a highly vaccinated cohort of women initiating screening in 2023.…”

Section: Introductionmentioning

confidence: 99%

Cost‐effectiveness of primary human papillomavirus triage approaches among vaccinated women in Norway: A model‐based analysis

Portnoy,

Pedersen,

et al. 2023

Intl Journal of Cancer

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As Norway considers revising triage approaches following their first adolescent cohort with human papillomavirus (HPV) vaccination entering the cervical cancer screening program, we analyzed the health impact and cost‐effectiveness of alternative primary HPV triage approaches for women initiating cervical cancer screening in 2023. We used a multimodeling approach that captured HPV transmission and cervical carcinogenesis to evaluate the health benefits, harms and cost‐effectiveness of alternative extended genotyping and age‐based triage strategies under five‐yearly primary HPV testing (including the status‐quo screening strategy in Norway) for women born in 1998 (ie, age 25 in 2023). We examined 35 strategies that varied alternative groupings of high‐risk HPV genotypes (“high‐risk” genotypes; “medium‐risk” genotypes or “intermediate‐risk” genotypes), number and types of HPV included in each group, management of HPV‐positive women to direct colposcopy or active surveillance, wait time for re‐testing and age at which the HPV triage algorithm switched from less to more intensive strategies. Given the range of benchmarks for severity‐specific cost‐effectiveness thresholds in Norway, we found that the preferred strategy for vaccinated women aged 25 years in 2023 involved an age‐based switch from a less to more intensive follow‐up algorithm at age 30 or 35 years with HPV‐16/18 genotypes in the “high‐risk” group. The two potentially cost‐effective strategies could reduce the number of colposcopies compared to current guidelines and simultaneously improve health benefits. Using age to guide primary HPV triage, paired with selective HPV genotype and follow‐up time for re‐testing, could improve both the cervical cancer program effectiveness and efficiency.

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“…Taken together, these suggest that risk-based CCS guidelines that considers HPV genotypes beyond HPV16/18 have a growing role in CCS programs. While further evaluations are required to ensure the cost-effective implementation of these algorithms in Singapore, an evaluation in the US has shown that they can be cost-effective in comparison to HPV16/18-only based screening algorithms ( 41 ).…”

Section: Discussionmentioning

confidence: 99%

Health care provider's experience and perspective of cervical cancer screening in Singapore: A qualitative study

Chua

Neo

Yan³

et al. 2022

Front. Public Health

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BackgroundIn Singapore, the current cervical cancer screening (CCS) coverage rate of 48% falls below the national target of 70%. Health care providers (HCPs) play a critical role in promoting CCS uptake. However, there is limited understanding of the perspectives of HCPs regarding CCS. Hence, we aimed to understand the challenges encountered by HCPs delivering CCS in different care settings in the Singapore health system. We also aimed to explore perspectives on newer features of CCS such as self-sampling and HPV genotyping.MethodsPhysicians, nurses, program administrators and laboratory technicians involved with CCS were invited for a one-on-one semi-structured interview conducted over Zoom between May to August 2021. The interviews were transcribed and analyzed using thematic analysis.ResultsEighteen HCPs from 12 institutions were interviewed. Most participants were women (61.1%) and worked in public health institutions (72.2%). For factors influencing CCS, nine key themes were identified and organized into four categories: (1) patient factors, (2) HCP factors, (3) health system factors and (4) health promotion factors. Key themes commonly highlighted by study participants were related to patients' preferences and acceptance for screening, the processes of delivering CCS, the national priority for cervical cancer and the effectiveness of existing health promotion efforts. Five key themes were identified for CCS innovations. Self-sampling was viewed favorably to increase CCS uptake, while primary HPV screening with HPV partial genotyping had higher sensitivities to detect pre-cancers and cancers compared to cytology. Extended HPV genotyping beyond HPV16/18 could play an important role in CCS with increasing HPV vaccination coverage, as well as in the management of persistent HPV infection.ConclusionIn Singapore, HCPs face multiple challenges for CCS in practice. Insights from this study are directly relevant to, and useful for developing policies around national CCS programs and treatment guidelines.

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The Potential Clinical and Economic Value of a Human Papillomavirus Primary Screening Test That Additionally Identifies Genotypes 31, 45, 51, and 52 Individually

Cited by 6 publications

References 28 publications

Cost-Effectiveness Analysis of HPV Extended versus Partial Genotyping for Cervical Cancer Screening in Singapore

Cost-Effectiveness Analysis of HPV Extended versus Partial Genotyping for Cervical Cancer Screening in Singapore

Cost‐effectiveness of primary human papillomavirus triage approaches among vaccinated women in Norway: A model‐based analysis

Health care provider's experience and perspective of cervical cancer screening in Singapore: A qualitative study

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