Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-25T04:39:39.710Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access Rights & Permissions [Opens in a new window]

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

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
Supplementary material: File

Muhlberger supplementary material

Supplementary table

Download Muhlberger supplementary material(File)
File 104.4 KB
Supplementary material: File

Muhlberger supplementary material

Supplementary table

Download Muhlberger supplementary material(File)
File 186.4 KB