Table 3.
Sensitivity analyses: efficient screening programmes with an ICER just below a €50 000 per QALY cost-effectiveness threshold, in various situations. All results are per 100 000 simulated women, discounted using a 3% rate for costs and effects, except for the sensitivity analysis using differential discounting.
| Sensitivity analysis | Strategy (type of primary test)* | Number of screening rounds | Interval (years) | Age range (years) | QALYs gained | Net costs (× €1000) | ICER (euros per QALY gained) |
|---|---|---|---|---|---|---|---|
| Base case | D (HPV test) | 7 | 6 | 30–66 | 944 | 10 418 | 46 566 |
| Life years gained instead of QALYs gained** | C (HPV test) | 7 | 6 | 30–66 | 943 | 10 666 | 44 970 |
| No triage utility loss | C (HPV test) | 7 | 6 | 30–66 | 981 | 10 666 | 46 022 |
| Two times higher triage utility loss | D (HPV test) | 7 | 6 | 30–66 | 930 | 10 418 | 47 620 |
| Three times higher triage utility loss | I (cytology) | 9 | 5 | 27–67 | 927 | 10 635 | 49 662 |
| Lower attendance at triage tests (90 instead of 100%) | I (cytology) | 8 | 4 | 30–58 | 887 | 9109 | 39 544 |
| Lower costs HPV test (€20 instead of €33.87) | D (HPV test) | 9 | 5 | 27–67 | 995 | 10 636 | 47 106 |
| Higher costs HPV test (€45 instead of €33.87) | I (cytology) | 9 | 5 | 27–67 | 926 | 10 583 | 49 483 |
| Sensitivity of LBC 5% higher than of conventional cytology | D (HPV test)*** | 7 | 6 | 30–66 | 1002 | 10 412 | 46 299 |
| Equal risk in screening attenders and non-attenders (30% higher background cervical cancer risk) | D (HPV test) | 9 | 5 | 27–67 | 1304 | 12 598 | 46 277 |
| Differential discounting (4% for costs, 1.5% for effects), €20 000 per QALY threshold**** | E (HPV test) | 5 | 6 | 30–54 | 1506 | 6523 | 15 539 |
| Differential discounting (4% for costs, 1.5% for effects), €50 000 per QALY threshold**** | D (HPV test) | 9 | 5 | 27–67 | 1731 | 12 256 | 31 471 |
| Cytology screening (strategy I) below 33 years of age, HPV screening for age 33 years and older | E (HPV test) | 7 | 5 | 27–57 | 992 | 9297 | 40 384 |
*
See Figure S1.
**
For the analysis with life years gained, all results are calculated using life years gained instead of QALYs gained.
***
LBC is used as the triage test after a primary HPV test.
****
The analysis with differential discounting is presented for cost-effectiveness thresholds of €20 000 and €50 000 per QALY gained.