Revisiting the Cost-Effectiveness of HPV Co-Testing Versus Primary HPV Testing for Cervical Cancer Screening

Jeffrey D Miller, A. Vilalta, Kathleen A Troeger
{"title":"Revisiting the Cost-Effectiveness of HPV Co-Testing Versus Primary HPV Testing for Cervical Cancer Screening","authors":"Jeffrey D Miller, A. Vilalta, Kathleen A Troeger","doi":"10.26502/fjwhd.2644-28840069","DOIUrl":null,"url":null,"abstract":"Objectives: Consensus U.S. cervical cancer screening guidelines recommend women aged 30–65 years should be screened: (1) every 5 years with high-risk HPV testing alone; or (2) every 5 years with Pap and highrisk HPV co-testing; or (3) every 3 years with Pap alone. However, nearly 1-in-5 cancers (18.6%) are missed by HPV testing alone and 12.2% of cancers are missed by Pap testing alone. Hence, co-testing is the preferred screening method, but the cost implications are not fully known. For deeper understanding, we performed updated clinical-economic comparisons of cervical cancer screening with co-testing versus primary HPV from a U.S. perspective. Methods: A health state transition (Markov) model with one-year cycling was previously developed using epidemiologic, clinical, and economic data from healthcare databases and published literature. After updating the model, it was used to perform simulations of women receiving either 3-year or 5-year interval cervical cancer screening with either co-testing or HPV primary, starting from age 30 years and running up through age 64 years. Outcomes included total and incremental differences in costs, number of referral colposcopies (true and false positive), invasive cervical cancer (ICC) cases, ICC deaths, and quality-adjusted life years (QALYs) for cost-effectiveness calculations. J Women’s Health Dev 2021; 4 (4): 151-162 DOI: 10.26502/fjwhd.2644-28840069 Journal of Women’s Health and Development Volume 4 No 4 – December 2021 152 Results: In the 3-year and 5-year screening interval scenarios, per-patient cumulative costs of screening and management over 35 years with co-testing versus HPV primary led to cost savings of $15 and $217, respectively. These cost saving resulted from fewer referral colposcopies, fewer ICC cases, and fewer ICC deaths. Co-testing also conferred more QALYs. Costeffectiveness calculations showed co-testing as the economically dominant screening strategy by simultaneously confers greater effectiveness (i.e., more QALYs) at lower cost compared with HPV primary. National average annual cost savings of $154 to $655 million could be realized if every woman in the U.S. was routinely screened with co-testing instead of HPV primary. Conclusions: Model results demonstrate that cervical cancer screening with co-testing provides valuable clinical and economic outcomes when compared to primary HPV testing alone. These findings are relevant to healthcare payers and women’s health policy advocates seeking cost-effective cervical cancer screening options.","PeriodicalId":74017,"journal":{"name":"Journal of women's health and development","volume":"1 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of women's health and development","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.26502/fjwhd.2644-28840069","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Objectives: Consensus U.S. cervical cancer screening guidelines recommend women aged 30–65 years should be screened: (1) every 5 years with high-risk HPV testing alone; or (2) every 5 years with Pap and highrisk HPV co-testing; or (3) every 3 years with Pap alone. However, nearly 1-in-5 cancers (18.6%) are missed by HPV testing alone and 12.2% of cancers are missed by Pap testing alone. Hence, co-testing is the preferred screening method, but the cost implications are not fully known. For deeper understanding, we performed updated clinical-economic comparisons of cervical cancer screening with co-testing versus primary HPV from a U.S. perspective. Methods: A health state transition (Markov) model with one-year cycling was previously developed using epidemiologic, clinical, and economic data from healthcare databases and published literature. After updating the model, it was used to perform simulations of women receiving either 3-year or 5-year interval cervical cancer screening with either co-testing or HPV primary, starting from age 30 years and running up through age 64 years. Outcomes included total and incremental differences in costs, number of referral colposcopies (true and false positive), invasive cervical cancer (ICC) cases, ICC deaths, and quality-adjusted life years (QALYs) for cost-effectiveness calculations. J Women’s Health Dev 2021; 4 (4): 151-162 DOI: 10.26502/fjwhd.2644-28840069 Journal of Women’s Health and Development Volume 4 No 4 – December 2021 152 Results: In the 3-year and 5-year screening interval scenarios, per-patient cumulative costs of screening and management over 35 years with co-testing versus HPV primary led to cost savings of $15 and $217, respectively. These cost saving resulted from fewer referral colposcopies, fewer ICC cases, and fewer ICC deaths. Co-testing also conferred more QALYs. Costeffectiveness calculations showed co-testing as the economically dominant screening strategy by simultaneously confers greater effectiveness (i.e., more QALYs) at lower cost compared with HPV primary. National average annual cost savings of $154 to $655 million could be realized if every woman in the U.S. was routinely screened with co-testing instead of HPV primary. Conclusions: Model results demonstrate that cervical cancer screening with co-testing provides valuable clinical and economic outcomes when compared to primary HPV testing alone. These findings are relevant to healthcare payers and women’s health policy advocates seeking cost-effective cervical cancer screening options.
重新审视宫颈癌筛查中HPV联合检测与原发性HPV检测的成本效益
目的:美国宫颈癌筛查指南建议30-65岁的女性应进行筛查:(1)每5年单独进行高危HPV检测;(2)每5年进行一次Pap和高危HPV联合检测;(3)每3年单独使用Pap。然而,近五分之一(18.6%)的癌症仅通过HPV检测被遗漏,12.2%的癌症仅通过巴氏涂片检测被遗漏。因此,联合检测是首选的筛查方法,但其成本影响尚不完全清楚。为了更深入的了解,我们从美国的角度对宫颈癌筛查联合检测与原发性HPV进行了最新的临床经济比较。方法:利用来自卫生保健数据库和已发表文献的流行病学、临床和经济数据,建立了一个一年周期的健康状态转变(马尔可夫)模型。在更新模型后,该模型被用于对从30岁到64岁接受3年或5年宫颈癌联合检测或HPV原发筛查的女性进行模拟。结果包括总成本和增量差异、转诊阴道镜检查(真阳性和假阳性)数量、浸润性宫颈癌(ICC)病例、ICC死亡和用于成本-效果计算的质量调整生命年(QALYs)。J妇女健康发展2021;4 (4): 151-162 DOI: 10.26502/fjwhd。结果:在3年和5年筛查间隔的情况下,与HPV原发筛查相比,35年的筛查和管理的每位患者累积成本分别节省了15美元和217美元。这些费用的节省是由于转诊阴道镜检查减少、ICC病例减少和ICC死亡减少。联合测试还带来了更多的qaly。成本效益计算表明,与HPV原发相比,联合检测以更低的成本同时获得更大的有效性(即更多的qaly),是经济上占主导地位的筛查策略。如果美国的每位女性都进行常规联合检测而不是HPV初级筛查,那么全国平均每年可节省1.54亿至6.55亿美元的成本。结论:模型结果表明,与单独进行原发性HPV检测相比,宫颈癌筛查联合检测提供了有价值的临床和经济结果。这些发现与医疗保健支付者和妇女健康政策倡导者寻求具有成本效益的宫颈癌筛查方案有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信