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Cost-effectiveness of primarily human papillomavirus–based cervical cancer screening in settings with currently established Pap screening: A systematic review commissioned by the German Federal Ministry of Health

Published online by Cambridge University Press:  09 April 2008

Nikolai Mühlberger ,
Gaby Sroczynski ,
Eva Esteban ,
Thomas Mittendorf ,
Rebecca A. Miksad  and
Uwe Siebert
Nikolai Mühlberger
Affiliation:
UMIT—University for Health Sciences, Medical Informatics and Technology
Gaby Sroczynski
Affiliation:
UMIT—University for Health Sciences, Medical Informatics and Technology
Eva Esteban
Affiliation:
UMIT—University for Health Sciences, Medical Informatics and Technology
Thomas Mittendorf
Affiliation:
Leibniz University Hannover
Rebecca A. Miksad
Affiliation:
Beth Israel Deaconess Medical Center and Massachusetts General Hospital
Uwe Siebert
Affiliation:
UMIT—University of Health, Sciences, Medical Informatics and Technology and Harvard Medical School
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Abstract

Objectives: The aim of this study was to summarize the current evidence for the cost-effectiveness of primarily human papillomavirus (HPV) -based cervical cancer screening in settings with already established Papanicolaou test (Pap) programs. Emphasis was placed on the German situation with annual Pap screening.

Methods: Medical, economic, and health technology assessment (HTA) databases were systematically searched for cost-effectiveness studies comparing HPV to Pap screening. Study data were extracted, standardized, and summarized in cost-effectiveness plots contrasting HPV strategies to Pap screening with 1-, 2-, 3-, and 5-years interval. For each Pap setting, the likelihood of cost-effective HPV screening was assessed depending on willingness-to-pay.

Results: We reviewed twelve decision-analytic cost-effectiveness models. Study results showed wide variation due to methodical heterogeneity. Data synthesis revealed that the cost-effectiveness of HPV screening depends on the interval of the established Pap screening strategy. In comparison with Pap screening every 2 years, only 25 percent of the HPV-based screening strategies were cost-effective. However, in comparison with Pap screening every 1, 3, or 5 years, 83 percent, 55 percent, and 92 percent of HPV screening strategies were cost-effective, respectively. Results for settings with annual Pap screening are based on models assuming 100 percent screening coverage.

Conclusions: The introduction of HPV-based screening programs is cost-effective if the screening interval of the established Pap program exceeds 2 years. In settings with biennial Pap screening, introduction of HPV-based screening is unlikely to be cost-effective. Results also suggest cost-effectiveness of HPV-based screening in settings with annual Pap screening; however, this finding should be confirmed under realistic screening adherence assumptions.

Keywords

Cervical cancerHuman papillomavirusScreeningCost-effectivenessHealth technology assessment
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 24 , Issue 2 , April 2008 , pp. 184 - 192
Copyright
Copyright © Cambridge University Press 2008

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