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Primary screening for human papillomavirus compared with cytology screening for cervical cancer in European settings: cost effectiveness analysis based on a Dutch microsimulation model.

de Kok IM, van Rosmalen J, Dillner J, Arbyn M, Sasieni P, Iftner T, van Ballegooijen M - BMJ (2012)

Bottom Line: Cost effectiveness analysis based on a Dutch simulation model.Base case analyses investigated the cost effectiveness of more than 1500 different screening policies using the microsimulation model.Optimal screening strategy in terms of incremental cost effectiveness ratios (costs per quality adjusted life years gained) compared with different cost effectiveness thresholds, for two levels of sensitivity and costs of the HPV test.

View Article: PubMed Central - PubMed

Affiliation: Erasmus MC, University Medical Center, Department of Public Health, PO Box 2040, 3000 CA Rotterdam, Netherlands. i.dekok@erasmusmc.nl

ABSTRACT

Objectives: To investigate, using a Dutch model, whether and under what variables framed for other European countries screening for human papillomavirus (HPV) is preferred over cytology screening for cervical cancer, and to calculate the preferred number of examinations over a woman's lifetime.

Design: Cost effectiveness analysis based on a Dutch simulation model. Base case analyses investigated the cost effectiveness of more than 1500 different screening policies using the microsimulation model. Subsequently, the policies were compared for five different scenarios that represent different possible scenarios (risk of cervical cancer, previous screening, quality associated test characteristics, costs of testing, and prevalence of HPV).

Setting: Various European countries.

Population: Unvaccinated women born between 1939 and 1992.

Main outcome measures: Optimal screening strategy in terms of incremental cost effectiveness ratios (costs per quality adjusted life years gained) compared with different cost effectiveness thresholds, for two levels of sensitivity and costs of the HPV test.

Results: Primary HPV screening was the preferred primary test over the age of 30 in many considered scenarios. Primary cytology screening was preferred only in scenarios with low costs of cytology and in scenarios with a high prevalence of HPV in combination with high costs of HPV testing.

Conclusions: Most European countries should consider switching from primary cytology to HPV screening for cervical cancer. HPV screening must, however, only be implemented in situations where screening is well controlled.

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Related in: MedlinePlus

Representation of simulated efficient frontiers of scenario of an average background risk and high prevalence of HPV when assuming only primary cytology screening or only primary HPV screening for different assumptions about HPV testing (90% or 95% sensitivity and €52 or €64 total costs). Each mark represents an efficient programme with different screening ages. Costs (€000s) and effects (000s) of quality adjusted life years (QALYs) gained, 3% discount rate for costs and effects
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fig1: Representation of simulated efficient frontiers of scenario of an average background risk and high prevalence of HPV when assuming only primary cytology screening or only primary HPV screening for different assumptions about HPV testing (90% or 95% sensitivity and €52 or €64 total costs). Each mark represents an efficient programme with different screening ages. Costs (€000s) and effects (000s) of quality adjusted life years (QALYs) gained, 3% discount rate for costs and effects

Mentions: The results show that primary HPV screening was preferred over primary cytology screening in most of the scenarios (table 5). In the two scenarios with a high prevalence of HPV, primary cytology screening was preferred only if higher costs for HPV screening were also assumed. In the scenario with low costs for cytology, primary cytology was preferred, notwithstanding the lower sensitivity and specificity that accompanied the lower costs. This result was independent of the background risk in the range considered (results not shown). The figure shows the efficient frontier of the scenario of an average background risk and high prevalence of HPV for primary cytology screening and for primary HPV screening. It shows how primary cytology screening is dominated by primary HPV screening when the costs of HPV screening are low, and how primary HPV screening is dominated by primary cytology screening when the costs of HPV screening are high. In comparison, the efficient frontiers for the scenario of high risk with no past screening and a low sensitivity, specificity, and cost of cytology (see figure at http://hdl.handle.net/1765/31582) show how primary HPV screening is dominated by primary cytology screening. This figure also presents the number of examinations during a woman’s lifetime. It shows that for the same number of QALYs gained five HPV tests could be carried out during a woman’s lifetime, compared with eight cytological tests. In this scenario, however, eight times primary cytology is cheaper.


Primary screening for human papillomavirus compared with cytology screening for cervical cancer in European settings: cost effectiveness analysis based on a Dutch microsimulation model.

de Kok IM, van Rosmalen J, Dillner J, Arbyn M, Sasieni P, Iftner T, van Ballegooijen M - BMJ (2012)

Representation of simulated efficient frontiers of scenario of an average background risk and high prevalence of HPV when assuming only primary cytology screening or only primary HPV screening for different assumptions about HPV testing (90% or 95% sensitivity and €52 or €64 total costs). Each mark represents an efficient programme with different screening ages. Costs (€000s) and effects (000s) of quality adjusted life years (QALYs) gained, 3% discount rate for costs and effects
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3293782&req=5

fig1: Representation of simulated efficient frontiers of scenario of an average background risk and high prevalence of HPV when assuming only primary cytology screening or only primary HPV screening for different assumptions about HPV testing (90% or 95% sensitivity and €52 or €64 total costs). Each mark represents an efficient programme with different screening ages. Costs (€000s) and effects (000s) of quality adjusted life years (QALYs) gained, 3% discount rate for costs and effects
Mentions: The results show that primary HPV screening was preferred over primary cytology screening in most of the scenarios (table 5). In the two scenarios with a high prevalence of HPV, primary cytology screening was preferred only if higher costs for HPV screening were also assumed. In the scenario with low costs for cytology, primary cytology was preferred, notwithstanding the lower sensitivity and specificity that accompanied the lower costs. This result was independent of the background risk in the range considered (results not shown). The figure shows the efficient frontier of the scenario of an average background risk and high prevalence of HPV for primary cytology screening and for primary HPV screening. It shows how primary cytology screening is dominated by primary HPV screening when the costs of HPV screening are low, and how primary HPV screening is dominated by primary cytology screening when the costs of HPV screening are high. In comparison, the efficient frontiers for the scenario of high risk with no past screening and a low sensitivity, specificity, and cost of cytology (see figure at http://hdl.handle.net/1765/31582) show how primary HPV screening is dominated by primary cytology screening. This figure also presents the number of examinations during a woman’s lifetime. It shows that for the same number of QALYs gained five HPV tests could be carried out during a woman’s lifetime, compared with eight cytological tests. In this scenario, however, eight times primary cytology is cheaper.

Bottom Line: Cost effectiveness analysis based on a Dutch simulation model.Base case analyses investigated the cost effectiveness of more than 1500 different screening policies using the microsimulation model.Optimal screening strategy in terms of incremental cost effectiveness ratios (costs per quality adjusted life years gained) compared with different cost effectiveness thresholds, for two levels of sensitivity and costs of the HPV test.

View Article: PubMed Central - PubMed

Affiliation: Erasmus MC, University Medical Center, Department of Public Health, PO Box 2040, 3000 CA Rotterdam, Netherlands. i.dekok@erasmusmc.nl

ABSTRACT

Objectives: To investigate, using a Dutch model, whether and under what variables framed for other European countries screening for human papillomavirus (HPV) is preferred over cytology screening for cervical cancer, and to calculate the preferred number of examinations over a woman's lifetime.

Design: Cost effectiveness analysis based on a Dutch simulation model. Base case analyses investigated the cost effectiveness of more than 1500 different screening policies using the microsimulation model. Subsequently, the policies were compared for five different scenarios that represent different possible scenarios (risk of cervical cancer, previous screening, quality associated test characteristics, costs of testing, and prevalence of HPV).

Setting: Various European countries.

Population: Unvaccinated women born between 1939 and 1992.

Main outcome measures: Optimal screening strategy in terms of incremental cost effectiveness ratios (costs per quality adjusted life years gained) compared with different cost effectiveness thresholds, for two levels of sensitivity and costs of the HPV test.

Results: Primary HPV screening was the preferred primary test over the age of 30 in many considered scenarios. Primary cytology screening was preferred only in scenarios with low costs of cytology and in scenarios with a high prevalence of HPV in combination with high costs of HPV testing.

Conclusions: Most European countries should consider switching from primary cytology to HPV screening for cervical cancer. HPV screening must, however, only be implemented in situations where screening is well controlled.

Show MeSH
Related in: MedlinePlus