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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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References

REFERENCES

1. Bosch, FX, Lorincz, A, Munoz, N, Meijer, CJ, Shah, KV. The causal relation between human papillomavirus and cervical cancer. J Clin Pathol. 2002;55:244–265.CrossRefGoogle ScholarPubMed
2. Boyle, P, Maisonneuve, P, Autier, P. Update on cancer control in women. Int J Gynaecol Obstet. 2000;70:263–303.Google Scholar
3. Clavel, C, Masure, M, Bory, JP, et al. Human papillomavirus testing in primary screening for the detection of high-grade cervical lesions: A study of 7932 women. Br J Cancer. 2001;84:1616–1623.Google Scholar
4. Cuzick, J, Beverley, E, Ho, L, et al. HPV testing in primary screening of older women. Br J Cancer. 1999;81:554–558.CrossRefGoogle ScholarPubMed
5. Cuzick, J, Sasieni, P, Davies, P, et al. A systematic review of the role of human papillomavirus testing within a cervical screening programme. Health Technol Assess. 1999;3:i–iv 1-196.CrossRefGoogle ScholarPubMed
6. Cuzick, J, Szarewski, A, Cubie, H, et al. Management of women who test positive for high-risk types of human papillomavirus: The HART study. Lancet. 2003;362:1871–1876.CrossRefGoogle ScholarPubMed
7. Gandjour, A, Lauterbach, KW. [Cost-effectiveness of quality improvement measures in health care]. Med Klin (Munich). 2002;97:499–502.CrossRefGoogle ScholarPubMed
8. Goldie, SJ, Kim, JJ, Wright, TC. Cost-effectiveness of human papillomavirus DNA testing for cervical cancer screening in women aged 30 years or more. Obstet Gynecol. 2004;103:619–631.Google Scholar
9. Gustafsson, L, Ponten, J, Zack, M, Adami, HO. International incidence rates of invasive cervical cancer after introduction of cytological screening. Cancer Causes Control. 1997;8:755–763.Google Scholar
10. Henderson, JW. Cost-effectiveness of cervical cancer screening strategies. Expert Rev Pharmacoeconom Outcomes Res. 2004;4:287–296.CrossRefGoogle ScholarPubMed
11. Holmes, J, Hemmett, L, Garfield, S. The cost-effectiveness of human papillomavirus screening for cervical cancer. A review of recent modelling studies. Eur J Health Econ. 2005;6:30–37.Google Scholar
12. IARC. Cervix cancer screening. Lyon: IARC Press; 2005.Google Scholar
13. Kim, JJ, Wright, TC, Goldie, SJ. Cost-effectiveness of human papillomavirus DNA testing in the United Kingdom, The Netherlands, France, and Italy. J Natl Cancer Inst. 2005;97:888–895.CrossRefGoogle ScholarPubMed
14. Mandelblatt, JS, Lawrence, WF, Womack, SM, et al. Benefits and costs of using HPV testing to screen for cervical cancer. JAMA. 2002;287:2372–2381.CrossRefGoogle ScholarPubMed
15. McCrory, DC, Matchar, DB, Bastian, L, et al. Evaluation of cervical cytology. Evid Rep Technol Assess (Summ). 1999:1–6.Google Scholar
16. Mittendorf, T, Petry, KU, Iftner, T, Greiner, W, von der Schulenburg, JM. Economic evaluation of human papillomavirus screening in Germany. Eur J Health Econ. 2003;4:209–215.Google Scholar
17. Munoz, N, Bosch, FX, de Sanjose, S, et al. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med. 2003;348:518–527.Google Scholar
18. Nanda, K, McCrory, DC, Myers, ER, et al. Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: A systematic review. Ann Intern Med. 2000;132:810–819.CrossRefGoogle ScholarPubMed
19. Nieminen, P, Kallio, M, Hakama, M. The effect of mass screening on incidence and mortality of squamous and adenocarcinoma of cervix uteri. Obstet Gynecol. 1995;85:1017–1021.CrossRefGoogle ScholarPubMed
20. Noorani, HZ, Brown, A, Skidmore, B, Stuart, GCE. Liquid-based cytology and human papillomavirus testing in cervical cancer screening. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA); 2003.Google Scholar
21. Petry, KU, Menton, S, Menton, M, et al. Inclusion of HPV testing in routine cervical cancer screening for women above 29 years in Germany: Results for 8466 patients. Br J Cancer. 2003;88:1570–1577.CrossRefGoogle ScholarPubMed
22. Ratnam, S, Franco, EL, Ferenczy, A. Human papillomavirus testing for primary screening of cervical cancer precursors. Cancer Epidemiol Biomarkers Prev. 2000;9:945–951.Google Scholar
23. Sasieni, PD, Cuzick, J, Lynch-Farmery, E. Estimating the efficacy of screening by auditing smear histories of women with and without cervical cancer. The National Co-ordinating Network for Cervical Screening Working Group. Br J Cancer. 1996;73:1001–1005.CrossRefGoogle Scholar
24. Schenck, U, von Karsa, L. Cervical cancer screening in Germany. Eur J Cancer. 2000;36:2221–2226.Google Scholar
25. Schiffman, M, Herrero, R, Hildesheim, A, et al. HPV DNA testing in cervical cancer screening: Results from women in a high-risk province of Costa Rica. JAMA. 2000;283:87–93.Google Scholar
26. Schneider, A, Hoyer, H, Lotz, B, et al. Screening for high-grade cervical intra-epithelial neoplasia and cancer by testing for high-risk HPV, routine cytology or colposcopy. Int J Cancer. 2000;89:529–534.3.0.CO;2-G>CrossRefGoogle ScholarPubMed
27. Sherlaw-Johnson, C, Gallivan, S. The planning of cervical cancer screening programmes in eastern Europe: Is viral testing a suitable alternative to smear testing? Health Care Manag Sci. 2000;3:323–329.CrossRefGoogle ScholarPubMed
28. Sherlaw-Johnson, C, Philips, Z. An evaluation of liquid-based cytology and human papillomavirus testing within the UK cervical cancer screening programme. Br J Cancer. 2004;91:84–91.Google Scholar
29. Siebert, U, Behrend, C, Mühlberger, N, et al. Development of a criteria catalogue for the description and assessment of economic evaluations in Germany. [German; original title: Entwicklung eines Kriterienkataloges zur Beschreibung und Bewertung ökonomischer Evaluationsstudien in Deutschland]. In: Leidl, R, Schulenburg, JM, Wasem, vdJ, eds. Ansätze und Methoden der ökonomischen Evaluation – eine internationale Perspektive. Health Technology Assessment, vol. 9. Baden-Baden: Nomos, 1999.Google Scholar
30. Slater, DN, Milner, PC, Radley, H. Audit of deaths from cervical cancer: Proposal for an essential component of the National Screening Programme. J Clin Pathol. 1994;47:27–28.CrossRefGoogle ScholarPubMed
31. van Ballegooijen, M, Van Den Akker-van Marle, ME, Warmerdam, PG, Meijer, CJ, Walboomers, JM, Habbema, JD. Present evidence on the value of HPV testing for cervical cancer screening: A model-based exploration of the (cost-)effectiveness. Br J Cancer. 1997;76:651–657.Google Scholar
32. Walboomers, JM, Jacobs, MV, Manos, MM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999;189:12–19.Google Scholar
33. World Health Organization. The World Health Report 2004: Changing history. Geneva: World Health Organization; 2004.Google Scholar
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