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

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.

Figure 1

Scatter plot of expected cost and quality-adjusted life expectancy for all seven strategies.

Figure 2

Cost-effectiveness plane for a comparison between the Papanicolaou smear and ploidy 4 cell strategies. Abbreviation: WTP=willingness-to-pay.

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.