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. 2012 Mar 5:344:e670.
doi: 10.1136/bmj.e670.

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

Inge M C M de Kok  1 , Joost van Rosmalen, Joakim Dillner, Marc Arbyn, Peter Sasieni, Thomas Iftner, Marjolein van Ballegooijen
Affiliations

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

Inge M C M de Kok et al. BMJ. .

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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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: IMCMdK, MvB, and JvR were supported by the European Union and the Dutch National Institute for Public Health and the Environment, MA was supported by the European Union and the Belgian Foundation against Cancer, and JD was supported by the European Union; IMCMdK and MvB have received a grant from GlaxoSmithKline that might have an interest in the submitted work in the previous three years; MA has received a grant from the University of Gent that might have an interest in the submitted work in the previous three years; TI has received money for consultancy from Siemens Healthcare, grants from Roche, Hologic, and Gen-Probe, payment for lectures including service on speakers bureaus from with Hologic, Gen-Probe, Roche Diagnostics, Sanofi Pasteur MSD, Siemens Healthcare Diagnostics, GlaxoSmithKline, Qiagen, and Greiner BioOne, and patents from Greiner BioOne, that might have an interest in the submitted work in the previous three years; PS has received a grant from the Cancer Research UK programme, money for consultancy from Gen-Probe, and travel/accommodations/meeting expenses from GlaxoSmithKline that might have an interest in the submitted work in the previous three years; JD has received a grant from Merck/Sanofi Pasteur MSD that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

Figures

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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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References

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