Table 2. Costs, health benefits, and cost-effectiveness of alternative triage strategies for women diagnosed with ASC-US or LSIL, and high-risk HPV-positive.

Management of women with ASC-US/LSIL and high-risk HPVa		Costs	Health outcomes			Cost-effectiveness
Screening procedure	Follow-up wait (months) b	Discounte d lifetime costs ($) per woman	Cancer incidence reduction (%)e	Discounted QALYsf	Discounted life-years	ICERg ($ per QALY)
No screening	-	180	-	21.46887	23.97505	-
HPV testing	18	1,249	85.40 %	21.50136	24.00466	32,914
Co-testingc	18	1,253	85.46 %	21.50139	24.00468	-
HPV testing	12	1,264	85.95 %	21.50164	24.00489	-
Genotypingd	18	1,268	86.31 %	21.50171	24.00488	52,552
Co-testingc (current)	12	1,268	85.92 %	21.50164	24.00490	-
Genotypingd	12	1,276	86.51 %	21.50182	24.00499	78,012
HPV testing	6	1,285	86.52 %	21.50179	24.00494	-
Genotypingd	6	1,288	86.82 %	21.50188	24.00500	-
Co-testingc	6	1,289	86.49 %	21.50178	24.00493	-
Colposcopy	-	1,293	87.01 %	21.50198	24.00508	104,402

ASC-US: Atypical squamous cells of undetermined significance, HPV: high-risk human papillomavirus, ICER: incremental cost-effectiveness ratio, LSIL: low-grade squamous intraepithelial lesion, Lys: life-years, QALYs: quality-adjusted life-years.

^aResults at the primary screen, assuming cytology screening every three years for women aged 25-69 years. Women detected with ASC-US/LSIL receive a reflex HPV DNA test, and return to a routine screening schedule if negative for high-risk HPV.

^bNumber of months between primary screen and triage screening procedure.

^cRepeat HPV DNA testing and cytology in combination.

^dGenotyping indicates stratified management for women with HPV-16 or -18 versus other pooled high-risk HPV types, involving direct colposcopy for HPV-16/-18 positives and HPV DNA testing for other high-risk HPV positives.

^eCompared to no screening.

^fQuality of life reflect utility decrements related to both age and cancer state.[36,37]

^gThe incremental cost-effectiveness ratio (ICER) represents the incremental costs per QALY gained of a strategy compared with the next most costly strategy. Rows highlighted in bold reflect strategies on the efficiency frontier (i.e., strategies providing health benefits in terms of QALYs at lower costs, or lower ICER, than alternative strategies). Health benefits and costs are discounted by 4% per year. All costs are expressed in 2014 US dollars (US$ = NOK6.30).