J Gynecol Oncol.  2019 Mar;30(2):e17. 10.3802/jgo.2019.30.e17.

Cost effectiveness analysis of HPV primary screening and dual stain cytology triage compared with cervical cytology

• Termrungruanglert W
• Khemapech
• Tantitamit T
• Havanond P

• KMID: 2457130
• DOI: http://doi.org/10.3802/jgo.2019.30.e17

Abstract

OBJECTIVES
To assess the clinical and cost-effectiveness of human papillomavirus (HPV) primary screening triage with p16/Ki-67 dual stain cytology compared to cytology.
METHODS
We conducted an Excel®-based budget impact model to estimate the preinvasive and invasive cervical cancer cases identified, mortality rate, direct medical costs, quality-adjusted life years (QALYs) and the incremental cost-effectiveness analysis of two strategies from the healthcare payer perspective. The study population is a cohort of women 30-65 years of age presenting for cervical screening.
RESULTS
HPV primary screening triage with p16/Ki-67 dual stain showed higher sensitivity without losing specificity compared to conventional Pap smear. The improving the screening performance leads to decrease the prevalence of precancerous lesion, annual incidence and mortality of cervical cancer. The incidence of cervical cancer case detected by new algorithm compared with conventional method were 31,607 and 38,927, respectively. In addition, the new algorithm was more effective and more costly (average QALY 24.03, annual cost $13,262,693) than conventional cytology (average QALY 23.98, annual cost $7,713,251). The incremental cost-effective ratio (ICER) per QALY gained was $1,395. The sensitivity analysis showed if the cost of cytology and HPV test increased three times, the ICER would fall to $303/QALY gained and increased to $4,970/QALY gained, respectively.
CONCLUSIONS
Our model results suggest that screening by use of HPV genotyping test as a primary screening test combined with dual stain cytology as the triage of HPV positive women in Thai population 30-65 years old is expected to be more cost-effective than conventional Pap cytology.

Keyword

Cervical Cancer; Cost-Effectiveness Analysis; Cytology; Biomarkers; Cancer Screening; Human Papillomavirus DNA Tests

MeSH Terms

Asian Continental Ancestry Group
Biomarkers
Budgets
Cohort Studies
Cost-Benefit Analysis*
Delivery of Health Care
Early Detection of Cancer
Female
Human Papillomavirus DNA Tests
Humans
Incidence
Mass Screening*
Methods
Mortality
Papanicolaou Test
Prevalence
Quality-Adjusted Life Years
Sensitivity and Specificity
Triage*
Uterine Cervical Neoplasms
Biomarkers

Figure

• 

  Fig. 1. A model of the patient flow through a cervical cancer screening. CIN, cervical intraepithelial neoplasia; FU, follow up; HPV, human papillomavirus.

• 

  Fig. 2. Screening model. (A) Cytology: screening with conventional cytology. (B) HPV/dual stain: HPV DNA test with genotyping 16&18 plus triage with p16/Ki-67 dual stain. ASCUS, atypical squamous cells of undetermined significance; CIN, cervical intraepithelial neoplasia; HPV, human papillomavirus; ICC, invasive cervical cancer. * Women with negative colposcopy return to routine screening, women with CIN or ICC were referred to treatment.

• 

  Fig. 3. The prevalence of preinvasive cervical cancer, cervical cancer, and mortality rate from cancer. CIN, cervical intraepithelial neoplasia; HPV, human papillomavirus.

Reference

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