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. 2015 Jun 9;112(12):1951-7.
doi: 10.1038/bjc.2015.95. Epub 2015 Apr 28.

Economic evaluation of DNA ploidy analysis vs liquid-based cytology for cervical screening

V T Nghiem  1 , K R Davies  2 , J R Beck  3 , M Follen  4 , C MacAulay  5 , M Guillaud  5 , S B Cantor  2
Affiliations

Economic evaluation of DNA ploidy analysis vs liquid-based cytology for cervical screening

V T Nghiem et al. Br J Cancer. .

Abstract

Background: DNA ploidy analysis involves automated quantification of chromosomal aneuploidy, a potential marker of progression toward cervical carcinoma. We evaluated the cost-effectiveness of this method for cervical screening, comparing five ploidy strategies (using different numbers of aneuploid cells as cut points) with liquid-based Papanicolaou smear and no screening.

Methods: A state-transition Markov model simulated the natural history of HPV infection and possible progression into cervical neoplasia in a cohort of 12-year-old females. The analysis evaluated cost in 2012 US$ and effectiveness in quality-adjusted life-years (QALYs) from a health-system perspective throughout a lifetime horizon in the US setting. We calculated incremental cost-effectiveness ratios (ICERs) to determine the best strategy. The robustness of optimal choices was examined in deterministic and probabilistic sensitivity analyses.

Results: In the base-case analysis, the ploidy 4 cell strategy was cost-effective, yielding an increase of 0.032 QALY and an ICER of $18 264/QALY compared to no screening. For most scenarios in the deterministic sensitivity analysis, the ploidy 4 cell strategy was the only cost-effective strategy. Cost-effectiveness acceptability curves showed that this strategy was more likely to be cost-effective than the Papanicolaou smear.

Conclusion: Compared to the liquid-based Papanicolaou smear, screening with a DNA ploidy strategy appeared less costly and comparably effective.

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Figures

Figure 1
Figure 1
Scatter plot of expected cost and quality-adjusted life expectancy for all seven strategies.
Figure 2
Figure 2
Cost-effectiveness plane for a comparison between the Papanicolaou smear and ploidy 4 cell strategies. Abbreviation: WTP=willingness-to-pay.
Figure 3
Figure 3
Cost-effectiveness acceptability curves comparing seven strategies: no screening, Papanicolaou (Pap) smear, and the five ploidy strategies. Curves indicate the probability that the given strategy is cost-effective at a given willingness-to-pay.
See this image and copyright information in PMC

References

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