Cost-effectiveness of using human papillomavirus 16/18 genotype triage in cervical cancer screening Journal Article


Authors: Vijayaraghavan, A.; Efrusy, M. B.; Goodman, K. A.; Santas, C. C.; Huh, W. K.
Article Title: Cost-effectiveness of using human papillomavirus 16/18 genotype triage in cervical cancer screening
Abstract: Objective: Testing for human papillomavirus (HPV) 16 and 18 genotypes, which are known to cause approximately 65-70% of invasive cervical cancer cases, may allow clinicians to identify women at highest risk for underlying cervical intraepithelial neoplasia missed by Pap cytology. Our objective was to determine the cost-effectiveness of adding HPV-16 and 18 genotype triage to current cervical cancer screening strategies in the United States. Methods: We developed a lifetime Markov model to assess the cost-effectiveness of the following cervical cancer screening algorithms: (1) liquid-based cytology (LBC), (2) LBC + HPV triage, (3) HPV + LBC triage, (4) co-screening, (5) co-screening + HPV genotyping, and (6) HPV only + HPV genotyping. Costs were estimated from a payer perspective in 2007 U.S. dollars. Outcome measures included lifetime risk of cervical cancer, quality-adjusted life years saved (QALYs), and incremental cost-effectiveness ratios (ICERs). Results: In our model, the use of HPV genotyping strategies prevented 51-73 deaths per 100,000 women screened compared to screening using LBC followed by HPV triage and 4-26 deaths compared to co-screening with LBC and high-risk HPV. Use of HPV genotyping to triage all high-risk HPV-positive women every three years had an ICER of $34,074 per QALY compared to HPV and LBC co-screening. HPV genotyping with co-screening was the most effective strategy and had an ICER of $33,807 per QALY compared to HPV genotyping for all high-risk HPV-positive women. Conclusion: The addition of HPV-16 and -18 genotype triage to HPV and LBC co-screening was a cost-effective screening strategy in the United States. © 2010 Published by Elsevier Inc.
Keywords: adolescent; adult; child; child, preschool; young adult; cancer risk; united states; outcome assessment; sensitivity and specificity; sensitivity analysis; cytology; markov chains; incidence; genotype; cancer screening; mass screening; cost effectiveness analysis; uterine cervix cancer; uterine cervical neoplasms; quality adjusted life year; cost-benefit analysis; cost-effectiveness; emergency health service; lifespan; cervical cancer; monte carlo method; cervical intraepithelial neoplasia; papillomavirus infections; genotyping; papanicolaou test; human papillomavirus; human papillomavirus type 16; human papillomavirus 16; human papillomavirus type 18; human papillomavirus 18; triage
Journal Title: Gynecologic Oncology
Volume: 119
Issue: 2
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2010-11-01
Start Page: 237
End Page: 242
Language: English
DOI: 10.1016/j.ygyno.2010.07.004
PUBMED: 20713299
PROVIDER: scopus
PMCID: PMC4568837
DOI/URL:
Notes: --- - "Export Date: 20 April 2011" - "CODEN: GYNOA" - "Source: Scopus"
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  1. Karyn A Goodman
    257 Goodman