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. 2021 Jun 10:23:101448.
doi: 10.1016/j.pmedr.2021.101448. eCollection 2021 Sep.

A health economic model to estimate the costs and benefits of an mRNA vs DNA high-risk HPV assay in a hypothetical HPV primary screening algorithm in Ontario, Canada

Georgie Weston  1 , Caroline Dombrowski  1 , Marc Steben  2 , Catherine Popadiuk  3 , James Bentley  4 , Elisabeth J Adams  1
Affiliations

A health economic model to estimate the costs and benefits of an mRNA vs DNA high-risk HPV assay in a hypothetical HPV primary screening algorithm in Ontario, Canada

Georgie Weston et al. Prev Med Rep. .

Abstract

This study models the impact of using two different types of high-risk (HR) human papillomavirus (HPV) tests: mRNA (Aptima) and DNA (Hybrid Capture 2) as part of a hypothetical primary HPV screening program in Ontario, Canada. Outcomes were the costs of the screening program, and number of colposcopies, HPV tests and cytology tests. Results were estimated for one cohort going through the screening algorithm. A decision tree model was adapted from a published UK study, with inputs drawn from published Canadian data for the probabilities through the model, costs, demographic, and screening data from Ontario. Sensitivity and scenario analyses explored uncertainty in the model inputs and assumptions. Results indicated that screening using an mRNA test could yield cost savings of CAD $4,007,266 (95% credibility interval [CI]: -7,866,251 - 8,035) compared to using a DNA test, with 10,639 (95% CI: 10,170 - 11,094) fewer women undergoing unnecessary colposcopies, and reductions in unnecessary HR-HPV and cytology tests. The HR-HPV test comprised the largest percentage of the costs saved, and the probability of being HPV positive in the first year had the biggest impact on results. These results indicate that the choice of HR-HPV test is important when implementing a primary HPV screening program to avoid unnecessary resource use and cost, which will benefit both women and healthcare providers.

Keywords: Cancer screening; Economic model; HPV infection.

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Conflict of interest statement

GW, CD, and EA work for Aquarius Population Health, which has conducted work on HPV for several organizations, and diagnostic testing projects funded by other commercial companies, charities, grants and governmental agencies. MS has received grants from Abbott, BD, BioFire, Hologic, Roche, GSK and Merck. CP has received travel funds for a conference from Hologic. JB has received research support from Merck Oncology and Clovis Oncology and is an advisor for NSV Tech.

Figures

Fig. 1
Fig. 1
Structure of the decision tree to simulate primary HR-HPV cervical screening taken from Weston et al (Weston et al., 2020); this structure was applied to Ontario for both the mRNA and DNA testing arms.
Fig. 2
Fig. 2
A breakdown of the total costs in the mRNA and DNA pathways for one cohort of women aged 30–65.
Fig. 3
Fig. 3
Probabilistic sensitivity analysis results for A. costs, B. colposcopies, C. cytology, and D. HPV tests for a cohort of women aged 30–65.
See this image and copyright information in PMC

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