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Bergengren L, Ryen L, Flodström C, Fadl H, Udumyen R, Karlsson MG, Helenius G. Effectiveness and costs of an implemented primary HPV cervical screening programme in Sweden – A population based cohort study. Prev Med Rep 2022; 25:101675. [PMID: 35127354 PMCID: PMC8800063 DOI: 10.1016/j.pmedr.2021.101675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 10/27/2022] Open
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Ma L, Wang Y, Gao X, Dai Y, Zhang Y, Wang Z, Wang X, Wang L, Jiang J, Jing X, Yang C, Zhao F, Lang J, Qiao Y. Economic evaluation of cervical cancer screening strategies in urban China. Chin J Cancer Res 2019; 31:974-983. [PMID: 31949399 PMCID: PMC6955165 DOI: 10.21147/j.issn.1000-9604.2019.06.13] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective This study evaluated the feasibility of different cervical cancer screening strategies in urban China. Methods A Markov model was constructed to simulate a hypothetical cohort of 100,000 females aged 30−59 years in a 20-year period. Screening strategies included liquid-based cytology (LBC) every three years, human papillomavirus (HPV) DNA testing every three and five years, respectively, and a combination of HPV DNA testing and LBC (HPV+LBC) every three and five years, respectively. Model outcomes included cumulative incidence over 20 years, cumulative risk of cervical cancer, costs, life year saved (LYS), quality-adjusted life years (QALYs) and benefits. The cost-effectiveness ratios (CERs), incremental cost-effectiveness ratios (ICERs), cost-utility ratios (CURs), and benefit-cost ratios (BCRs) were used as outcomes in the health economic evaluation analysis. Univariate sensitivity analyses were performed to examine the stability of the results. Results The cumulative incidence of the five screening strategies ranged from 833.02 to 1,158.07 cases per 100,000 females. HPV DNA testing was most effective in reducing the cumulative risk of cervical cancer, saving life years and QALYs and gaining benefits. The CERs of HPV DNA testing every three and five years, and LBC every three years were considered to be very cost-effective if they were below China’s GDP per capita. The CERs of HPV+LBC were considered to be cost-effective if they were below three times GDP per capita. The incremental cost-effectiveness analysis showed that HPV DNA testing every three and five years, LBC every three years and HPV+LBC every five years were dominant strategies. Conclusions The findings of this study indicated that HPV DNA testing every five years or LBC every three years should be recommended in urban China.
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Affiliation(s)
- Li Ma
- Department of Epidemiology, School of Public Health, Dalian Medical University, Dalian 116044, China
| | - Yuying Wang
- Department of Epidemiology, School of Public Health, Dalian Medical University, Dalian 116044, China
| | - Xiaohong Gao
- Department of Epidemiology, School of Public Health, Dalian Medical University, Dalian 116044, China
| | - Yi Dai
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100730, China
| | - Yu Zhang
- Department of Epidemiology, School of Public Health, Dalian Medical University, Dalian 116044, China
| | - Zhaojing Wang
- Department of Epidemiology, School of Public Health, Dalian Medical University, Dalian 116044, China
| | - Xiaoxia Wang
- Department of Obstetrics and Gynecology, Wafangdian Maternal and Child Health Care Hospital, Dalian 116300, China
| | - Limin Wang
- Department of Obstetrics and Gynecology, Wafangdian Maternal and Child Health Care Hospital, Dalian 116300, China
| | - Jing Jiang
- Department of Obstetrics and Gynecology, Wafangdian Maternal and Child Health Care Hospital, Dalian 116300, China
| | - Xinhua Jing
- Department of Obstetrics and Gynecology, Wafangdian Maternal and Child Health Care Hospital, Dalian 116300, China
| | - Chunxia Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu 610041, China
| | - Fanghui Zhao
- Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jinghe Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100730, China
| | - Youlin Qiao
- Department of Epidemiology, School of Public Health, Dalian Medical University, Dalian 116044, China.,Department of Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Kitchener HC, Gittins M, Rivero-Arias O, Tsiachristas A, Cruickshank M, Gray A, Brabin L, Torgerson D, Crosbie EJ, Sargent A, Roberts C. A cluster randomised trial of strategies to increase cervical screening uptake at first invitation (STRATEGIC). Health Technol Assess 2018; 20:1-138. [PMID: 27632816 DOI: 10.3310/hta20680] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Falling participation by young women in cervical screening has been observed at a time that has seen an increase in the incidence of cervical cancer in the UK in women aged < 35 years. Various barriers to screening have been documented, including fear, embarrassment and inconvenience. OBJECTIVES To measure the feasibility, clinical effectiveness and cost-effectiveness of a range of interventions to increase the uptake of cervical screening among young women. DESIGN A cluster randomised trial based on general practices performed in two phases. SETTING Primary care in Greater Manchester and the Grampian region in Scotland. PARTICIPANTS Phase 1: 20,879 women receiving their first invitation for cervical screening. Phase 2: 10,126 women who had not attended by 6 months. INTERVENTIONS Phase 1: pre-invitation leaflet or not, and access to online booking (Manchester only). Phase 2: (1) vaginal self-sampling kits (SSKs) sent unrequested (n = 1141); or (2) offered on request (n = 1290); (3) provided with a timed appointment (n = 1629); (4) offered access to a nurse navigator (NN) (n = 1007); or (5) offered a choice between a NN or a SSK (n = 1277); and 3782 women in control practices. MAIN OUTCOME MEASURES Uplift in screening compared with control practices, cost-effectiveness of interventions, and the women's preferences explored in a discrete choice experiment. RESULTS The pre-invitation leaflet and offer of online booking were ineffective when compared with control practices at 3 months, 18.8% versus 19.2% [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.88 to 1.06; p = 0.485] and 17.8% versus 17.2% (OR 1.02, 95% CI 0.87 to 1.20; p = 0.802), respectively. The uptake of screening at 3 months was higher among previously human papillomavirus (HPV)-vaccinated women than unvaccinated women, 23.7% versus 11% (OR 2.07, 95% CI 1.69 to 2.53; p < 0.001). Among non-attenders, the SSK sent intervention showed a statistically significant increase in uptake at 12 months post invitation, 21.3% versus 16.2% (OR 1.51, 95% CI 1.20 to 1.91; p = 0.001), as did timed appointments, 19.8% versus 16.2% (OR 1.41, 95% CI 1.14 to 1.74; p = 0.001). The offer of a NN, a SSK on request, and a choice between timed appointments and NN were ineffective. Overall, there was a gradual rather than prompt response, as demonstrated by uptake among control practices. A discrete choice experiment indicated that women invited who had not yet attended valued the attributes inherent in self-sampling. The health economic analysis showed that both timed appointments and unsolicited SSK sent were likely to be cost-effective at a cost per quality-adjusted life-year (QALY) gained of £7593 and £8434, respectively, if extended across the national 25-year-old cohort throughout the duration of screening. The certainty of these being cost-effective at a ceiling ratio of £20,000 per QALY gained was > 90%. CONCLUSION Women receiving their initial screening invitation frequently delay taking up the offer and the net impact of interventions was small. Timed appointments and SSKs sent to non-attenders at 6 months are likely to be a cost-effective means of increasing uptake and should be considered further. HPV vaccination in the catch-up programme was associated with an increased uptake of cervical screening. Future work should focus on optimising self-sampling in terms of age range, timing of offer for non-attenders and use of urine testing instead of vaginal samples. TRIAL REGISTRATION Current Controlled Trials ISRCTN52303479. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 68. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Henry C Kitchener
- Institute of Cancer Sciences, University of Manchester, St Mary's Hospital, Manchester, UK
| | - Matthew Gittins
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Margaret Cruickshank
- Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, Aberdeen, UK
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Loretta Brabin
- Institute of Cancer Sciences, University of Manchester, St Mary's Hospital, Manchester, UK
| | | | - Emma J Crosbie
- Institute of Cancer Sciences, University of Manchester, St Mary's Hospital, Manchester, UK
| | - Alexandra Sargent
- Virology Department, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Chris Roberts
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
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Zimmermann MR, Vodicka E, Babigumira JB, Okech T, Mugo N, Sakr S, Garrison LP, Chung MH. Cost-effectiveness of cervical cancer screening and preventative cryotherapy at an HIV treatment clinic in Kenya. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2017; 15:13. [PMID: 28725164 PMCID: PMC5513032 DOI: 10.1186/s12962-017-0075-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/04/2017] [Indexed: 12/30/2022] Open
Abstract
Objective This study evaluated the potential cost-effectiveness of cervical cancer screening in HIV treatment clinics in Nairobi, Kenya. Methods A Markov model was used to project health outcomes and costs of cervical cancer screening and cryotherapy at an HIV clinic in Kenya using cryotherapy without screening, visual inspection with acetic acid (VIA), Papanicolaou smear (Pap), and testing for human papillomavirus (HPV). Direct and indirect medical and non-medical costs were examined from societal and clinic perspectives. Results Costs of cryotherapy, VIA, Pap, and HPV for women with CD4 200–500 cells/mL were $99, $196, $219, and $223 from a societal perspective and $19, $94, $124, and $113 from a clinic perspective, with 17.3, 17.1, 17.1, and 17.1 years of life expectancy, respectively. Women at higher CD4 counts (>500 cells/mL) given cryotherapy VIA, Pap, and HPV resulted in better life expectancies (19.9+ years) and lower cost (societal: $49, $99, $115, and $102; clinic: $13, $51, $71, and $56). VIA was less expensive than HPV unless HPV screening could be reduced to a single visit. Conclusions Preventative cryotherapy was the least expensive strategy and resulted in highest projected life expectancy, while VIA was most cost-effective unless HPV could be reduced to a single visit.
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Affiliation(s)
- Marita R Zimmermann
- Department of Pharmacy, University of Washington, 1959 NE Pacific St., HSB H-375, Box 357630, Seattle, WA 98195 USA
| | - Elisabeth Vodicka
- Department of Pharmacy, University of Washington, 1959 NE Pacific St., HSB H-375, Box 357630, Seattle, WA 98195 USA
| | - Joseph B Babigumira
- Department of Global Health, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA 98104 USA
| | - Timothy Okech
- Chandaria School of Business, United States International University-Africa, Nairobi, Kenya
| | - Nelly Mugo
- Department of Obstetrics and Gynecology, Kenyatta National Hospital, Nairobi, Kenya
| | - Samah Sakr
- Coptic Hospital, Coptic Hope Center, Nairobi, Kenya
| | - Louis P Garrison
- Department of Pharmacy, University of Washington, 1959 NE Pacific St., HSB H-375, Box 357630, Seattle, WA 98195 USA
| | - Michael H Chung
- Department of Global Health, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA 98104 USA.,Department of Medicine, University of Washington, Seattle, WA USA.,Department of Epidemiology, University of Washington, Seattle, WA USA
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O'Mahony JF, Naber SK, Normand C, Sharp L, O'Leary JJ, de Kok IMCM. Beware of Kinked Frontiers: A Systematic Review of the Choice of Comparator Strategies in Cost-Effectiveness Analyses of Human Papillomavirus Testing in Cervical Screening. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:1138-1151. [PMID: 26686801 DOI: 10.1016/j.jval.2015.09.2939] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 08/11/2015] [Accepted: 09/30/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To systematically review the choice of comparator strategies in cost-effectiveness analyses (CEAs) of human papillomavirus testing in cervical screening. METHODS The PubMed, Web of Knowledge, and Scopus databases were searched to identify eligible model-based CEAs of cervical screening programs using human papillomavirus testing. The eligible CEAs were reviewed to investigate what screening strategies were chosen for analysis and how this choice might have influenced estimates of the incremental cost-effectiveness ratio (ICER). Selected examples from the reviewed studies are presented to illustrate how the omission of relevant comparators might influence estimates of screening cost-effectiveness. RESULTS The search identified 30 eligible CEAs. The omission of relevant comparator strategies appears likely in 18 studies. The ICER estimates in these cases are probably lower than would be estimated had more comparators been included. Five of the 30 studies restricted relevant comparator strategies to sensitivity analyses or other subanalyses not part of the principal base-case analysis. Such exclusion of relevant strategies from the base-case analysis can result in cost-ineffective strategies being identified as cost-effective. CONCLUSIONS Many of the CEAs reviewed appear to include insufficient comparator strategies. In particular, they omit strategies with relatively long screening intervals. Omitting relevant comparators matters particularly if it leads to the underestimation of ICERs for strategies around the cost-effectiveness threshold because these strategies are the most policy relevant from the CEA perspective. Consequently, such CEAs may not be providing the best possible policy guidance and lead to the mistaken adoption of cost-ineffective screening strategies.
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Affiliation(s)
- James F O'Mahony
- Department of Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - Steffie K Naber
- Department of Public Health, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands
| | - Charles Normand
- Department of Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Linda Sharp
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - John J O'Leary
- Department of Histopathology, Trinity College Dublin, Dublin, Ireland; Department of Pathology, Coombe Women's and Infants University Hospital, Dublin, Ireland
| | - Inge M C M de Kok
- Department of Public Health, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands
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Nahvijou A, Hadji M, BaratiMarnani A, Tourang F, NedaBayat N, Weiderpass E, Daroudi R, AkbariSari A, Zendehdel K. A Systematic Review of Economic Aspects of Cervical Cancer Screening Strategies Worldwide: Discrepancy between Economic Analysis and Policymaking. Asian Pac J Cancer Prev 2014. [DOI: 10.7314/apjcp.2014.15.19.8229] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Broberg G, Strander B, Ellis J, Adolfsson A. Attending cervical cancer screening, opportunities and obstacles: a qualitative study on midwives' experiences telephoning non-attendees in Sweden. Scand J Public Health 2014; 42:691-7. [PMID: 25013212 DOI: 10.1177/1403494814541594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM As part of a research project aimed at increasing participation in the cervical cancer screening program (CCS), we explored midwives' unique experiences of telephoning non-attendees and offering Pap smear appointments. METHODS Twenty midwives, in four focus groups, discussed their experiences of a study investigating ways to increase participation in the CCS. The group discussions were tape-recorded and transcribed verbatim and underwent qualitative content analysis. RESULTS Speaking with more than 1000 non-attendees provided the midwives with new perspective on the CCS and they realised that improving it might address a number of reasons for not participating. These reasons were often related to logistics, such as scheduling flexibility and appointment booking. The telephone conversations revealed that some women required more individual attention, while it was discovered that others did not require screening. The midwives considered the CCS to be life-saving; participating in this screening activity gave them a sense of satisfaction and pride. CONCLUSIONS This study shows that midwives can improve access and prevent non-attendance at the cervical cancer screening program when they are aware of women's varying requirements for attending screening.
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Affiliation(s)
- Gudrun Broberg
- The Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden Närhälsan Primary Care, Western Health Care Region, Sweden
| | - Björn Strander
- The Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden The Regional Cancer Centre, Western Health Care Region, Gothenburg, Sweden
| | - Joy Ellis
- The Regional Cancer Centre, Western Health Care Region, Gothenburg, Sweden Närhälsan Primary Care, Western Health Care Region, Sweden
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Benard VB, Saraiya M, Greek A, Hawkins NA, Roland KB, Manninen D, Ekwueme DU, Miller JW, Unger ER. Overview of the CDC Cervical Cancer (Cx3) Study: an educational intervention of HPV testing for cervical cancer screening. J Womens Health (Larchmt) 2014; 23:197-203. [PMID: 24380501 PMCID: PMC4386595 DOI: 10.1089/jwh.2013.4655] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The recommended screening interval when using the Papanicolaou (Pap) and human papillomavirus (HPV) test (co-testing) is 5 years. However because providers are reluctant to extend the screening interval, we launched a study to identify barriers to appropriate use of the co-test and to implement an educational intervention to promote evidence-based screening practices. This article provides an overview of the study including the multi-component intervention and participant demographics. METHODS The study was conducted in 15 clinics associated with 6 Federally Qualified Health Centers (FQHCs) in Illinois. Each clinic received HPV tests to administer with routine Pap tests among enrolled patients (n=2,246) and was assigned to a study arm: intervention arm (n=7) received a multi-component educational intervention (small media, academic detailing, and website) for providers and printed educational materials for patients, and control arm (n=8) received printed copies of general guidelines. Clinic coordinators (n=15), providers (n=98), and patients (n=984) completed baseline surveys to assess screening practices. RESULTS Providers reported an average age of 41.3 years and were predominately female, non-Hispanic, and white. Patients reported an average age of 45.0 years and nearly two-thirds were Hispanic or black. Of the 2,246 patients, 89% had a normal co-test. Lessons learned from the study included the importance of buy-in at a high level in the organization, a champion provider, and a clinical coordinator devoted to the study. CONCLUSION Materials from this study can be adapted to educate providers and patients on appropriate use of the co-test and encourage extended screening intervals as a safe and effective practice.
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Affiliation(s)
- Vicki B. Benard
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mona Saraiya
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - April Greek
- Battelle, Health & Analytics, Seattle, Washington
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Östensson E, Hellström AC, Hellman K, Gustavsson I, Gyllensten U, Wilander E, Zethraeus N, Andersson S. Projected cost-effectiveness of repeat high-risk human papillomavirus testing using self-collected vaginal samples in the Swedish cervical cancer screening program. Acta Obstet Gynecol Scand 2013; 92:830-40. [DOI: 10.1111/aogs.12143] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 03/19/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Ellinor Östensson
- Department of Women's and Children's Health; Division of Obstetrics and Gynecology; Karolinska University Hospital-Solna; Karolinska Institute; Stockholm; Sweden
| | - Ann-Cathrin Hellström
- Gynecological Oncology; Radiumhemmet; Department of Oncology; Karolinska Hospital and Institute in Solna; Stockholm; Sweden
| | - Kristina Hellman
- Gynecological Oncology; Radiumhemmet; Department of Oncology; Karolinska Hospital and Institute in Solna; Stockholm; Sweden
| | - Inger Gustavsson
- Department of Immunology, Genetics and Pathology; Rudbeck Laboratory; Uppsala University; Uppsala; Sweden
| | - Ulf Gyllensten
- Department of Immunology, Genetics and Pathology; Rudbeck Laboratory; Uppsala University; Uppsala; Sweden
| | - Erik Wilander
- Department of Pathology and Cytology; Department of Women's and Children's Health; Uppsala University Hospital; Uppsala; Sweden
| | - Niklas Zethraeus
- Medical Management Center (MMC); Department of Learning, Informatics, Management and Ethics (LIME); Karolinska Institute; Stockholm; Sweden
| | - Sonia Andersson
- Department of Women's and Children's Health; Division of Obstetrics and Gynecology; Karolinska University Hospital-Solna; Karolinska Institute; Stockholm; Sweden
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van Rosmalen J, de Kok IMCM, van Ballegooijen M. Cost-effectiveness of cervical cancer screening: cytology versus human papillomavirus DNA testing. BJOG 2012; 119:699-709. [PMID: 22251259 PMCID: PMC3489039 DOI: 10.1111/j.1471-0528.2011.03228.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2011] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To determine the most cost-effective screening programme for cervical cancer. DESIGN Cost-effectiveness analysis from a societal perspective. SETTING The Netherlands. POPULATION Dutch women who have not been invited for human papillomavirus (HPV) vaccination. METHODS We calibrated the microsimulation screening analysis (MISCAN) model to Dutch epidemiological data. We used this model to consider nine screening strategies that use: (i) cytological testing with cytology triage for borderline/mildly abnormal smears; (ii) HPV testing with cytology triage for HPV-positive smears; or (iii) cytological testing with HPV triage for borderline/mildly abnormal smears. For each strategy, we varied the number of screening rounds, the time interval, the age of the first screening, and the type of cytological testing (conventional or liquid-based cytology). MAIN OUTCOME MEASURES Quality-adjusted life years (QALYs) gained and costs from a societal perspective. RESULTS Under the base-case assumptions, primary HPV testing with cytology triage is the most cost-effective strategy. Using cost-effectiveness thresholds of € 20,000 and € 50,000 per QALY gained yields optimal screening programmes with three and seven screening rounds, respectively. The results are sensitive to several uncertain model inputs, most importantly the costs of the HPV test. For women aged 32 years or younger, primary cytology screening is more cost-effective than primary HPV testing. CONCLUSIONS Increasing the interval between screening rounds and changing the primary test from cytology to HPV testing can improve the effectiveness and decrease the costs of cervical cancer screening in the Netherlands.
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Affiliation(s)
- J van Rosmalen
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
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Cost-effectiveness analysis of human papillomavirus DNA testing and Pap smear for cervical cancer screening in a publicly financed health-care system. Br J Cancer 2010; 103:1773-82. [PMID: 21102588 PMCID: PMC3008604 DOI: 10.1038/sj.bjc.6605974] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To evaluate the long-term cost-effectiveness of different strategies for human papillomavirus (HPV) DNA testing combined with Pap smear for cervical cancer screening in Taiwan. Methods: This study adopts a perspective of Department of Health in cost-effectiveness analysis to compare a no-screening strategy with nine different screening strategies. These strategies comprise three screening tools (Pap smear alone, HPV DNA testing followed by Pap smear triage, and HPV DNA testing combined with Pap smear), and three screening intervals (annually, every 3 years, and every 5 years). Outcomes are life expectancy, quality-adjusted life years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs). Probabilistic sensitivity analyses (PSAs) were conducted to assess parameter uncertainty. Results: When three times gross domestic product per capita is used as the decision threshold, all nine screening strategies were cost-effective compared with the no-screening strategy. Compared with the current screening strategy (an annual Pap smear), HPV DNA testing followed by Pap smear triage every 5 years and every 3 years were cost-effective. Results of PSA also indicated that a HPV DNA testing followed by Pap smear triage every 5 or every 3 years achieved the highest expected net benefits. Conclusions: Possible economic advantages are associated with extending the cervical cancer screening interval from one Pap smear annually to HPV DNA testing followed by Pap smear triage every 5 years with an ICER $1 247 000 per QALY gained, especially in a country with a publicly financed health-care system.
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Lazcano-Ponce E, Lörincz AT, Salmerón J, Fernández I, Cruz A, Hernández P, Mejia I, Hernández-Ávila M. A pilot study of HPV DNA and cytology testing in 50,159 women in the routine Mexican Social Security Program. Cancer Causes Control 2010; 21:1693-700. [DOI: 10.1007/s10552-010-9598-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Accepted: 05/29/2010] [Indexed: 11/30/2022]
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Berkhof J, Coupé VM, Bogaards JA, van Kemenade FJ, Helmerhorst TJ, Snijders PJ, Meijer CJ. The health and economic effects of HPV DNA screening in The Netherlands. Int J Cancer 2010; 127:2147-58. [DOI: 10.1002/ijc.25211] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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