Table A11.
Example application of HPV-FRAME guidelines to Lew/Simms et al., 2017 [110].
| Inputs | Reported? (Y/N) | Reported by age? (Y/N) | Comments |
|---|---|---|---|
| Routine screening behaviour | Y | Y | Screening age-group: the strategies evaluated involve: -2y conventional cytology-based screening for women 18-69 years (comparator); 3y cytology screening for women aged 25-49 years combined with 5-yearly cytology screening for women aged 50-64 years; 5-yearly primary HPV screening for women aged 25-64 years |
| - The modelled age-specific screening attendance rate for comparator strategy (i.e. current program) was based on the analysis of Victoria Cytology Cervical Register data; rates modelled for other screening strategies were derived from the currently observed Australian data and informed by other countries’ experience | |||
| - 2.1% for conventional Pap smear and 1.8% for manually-read or image-read cytology. |
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| Abnormal smear management | Y | N | - Cytology results was separated into 5-grades: negative, ASC-US (pLSIL), LSIL, ASC-H (pHSIL), HSIL+ |
| - Different management was modelled for negative, low-grade and high-grade cytology results | |||
| - For CIN2+ detection at ASC-US threshold: Conventional cytology: 74.1% (sensitivity), 95.7% (specificity) Manually-read LBC: 74.1% (sensitivity), 94.7% (specificity) Image-read LBC: 81.2% (sensitivity), 94.5% (specificity). For CIN3+ detection at ASC-US threshold: Conventional cytology: 75.6% (sensitivity), 95.3% (specificity) Manually-read LBC: 83.9% (sensitivity), 94.3% (specificity) Image-read LBC: 80.0% (sensitivity), 96.6% (specificity) |
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| Diagnostic follow-up of | Y | N | -Indication of diagnostic follow-up stated |
| abnormal cytology | - Colposcopy outcomes including unsatisfactory, satisfactory and normal, and satisfactory and abnormal. Biopsy outcomes including negative/HPV infected, CIN2, CIN2/3 and cervical cancer. | ||
| - The modelled colposcopy positive rate are 40.2% for women without CIN, 76.5% for women with CIN1, and 88.4% for women with CIN 2 or worse | |||
| - Follow-up of treated disease: Annual follow-up with HPV and cytology co-testing until the woman obtained negative outcome on both test in two consecutive 12 months follow-up visit (test-of-cure) |
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| Inputs |
Reported? |
Reported by age (Y/N) |
Lew/Simms et al, 2017 |
| Management by CIN grade | Y | N | - Indication of CIN management stated |
| - Distinct CIN management approaches: women with negative histology outcome or CIN1 were referred to follow-up; women with CIN2/3 were referred to precancer treatment. | |||
| - Treatment efficacy of treated CIN: 100% (assumed a 10% failure rate in the first treatment but all women with unsuccessful treatment were assumed to be identified and had successful second treatment) | |||
| Sources of information for screening structure and parameterisation | Y | N | Australian National Health and Medical Research Council (NHMRC) 2005 guideline and the new clinical management guidelines that developed in 2015–16 to support the new National Cervical Cancer Screening Program were modelled. |
| Survey/ surveillance: - The Victorian Cytology Cytology Register data was analysed to inform the screening coverage, and the proportion of early-screening, ‘on-time’ screening and late-screening. |
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| - Colposcopy data collected at Royal Women Hospital was used to inform the compliance rate to colposcopy follow-up and colposcopy accuracy. - Screening outcomes reported in the annual National Cervical Cancer Screening Program monitoring report (i.e. age-specific proportion of cytology test with low-grade and/or high-grade outcomes, age-specific proportion of women with abnormal high-grade histology per 1,000 women screened etc) were used to calibrate/validate model’s screening outcome. - Age-specific cervical cancer incidence and mortality rate reported by the Australian Institute of Health and Welfare was used for model calibration. - Cost was assumption was informed by Australian Medical Benefit Scheme; assumption were made where applicable |
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| - HPV vaccination coverage was modelled based on the National HPV Vaccination Program Register data. | |||
| - Expert opinion of the Renewal Steering Committee was seek for management that was not specified in the guideline for cervical screening. | |||
| Cost of manually-read LBC, image-read LBC and HPV test (when it was used as primary screening test) were based on assumption |
ASC-H: atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion; CIN: cervical intraepithelial neoplasia; HSIL: high-grade squamous intraepithelial lesion; LBC: liquid based cytology; LSIL: low-grade squamous intraepithelial lesion; pHSIL: possible high-grade squamous intraepithelial lesion; pLSIL: possible low-grade squamous intraepithelial lesion.