Abstract
Objectives
Human papillomavirus (HPV) testing is not widely used for triage of equivocal Pap smears or primary screening in Québec, Canada. Our objective was to evaluate the cost-effectiveness of cervical cancer screening strategies utilizing HPV testing.
Methods
We used a lifetime Markov model to estimate costs, quality of life, and survival associated with the following strategies: 1) cytology; 2) cytology with HPV testing to triage equivocal Pap smears; 3) HPV testing followed by colposcopy for HPV-positive women; 4) HPV testing with cytology to triage HPV-positive women; and 5) simultaneous HPV testing and cytology. Cytology was used in all strategies prior to age 30. Outcome measures included disease incidence, quality-adjusted life-years saved (QALYs), lifetime risk of cervical cancer, and incremental cost-effectiveness ratios.
Results
All strategies incorporating HPV testing as a primary screening test were more effective and less expensive than annual cytology alone, while HPV testing to triage equivocal Pap smears annually was very cost-effective ($2,991 per QALY gained compared to annual cytology alone). When compared to cytology every three years, HPV-based strategies cost an additional $8,200 to $13,400 per QALY gained.
Conclusion
Strategies incorporating HPV testing are not only more effective than screening based on cytology alone but are also highly cost-effective. Provincial policy-makers should evaluate incorporating HPV-based strategies into current cervical cancer screening guidelines.
Key words: Human papillomavirus, cervical cancer, cost-effectiveness, health economics, screening
Résumé
Objectifs
Au Québec (Canada), le dépistage du virus du papillome humain (VPH) n’est pas beaucoup utilisé pour le triage des frottis vaginaux suspects ni pour le dépistage primaire. Nous avons voulu évaluer le rapport coût-efficacité des stratégies de dépistage du cancer du col utérin faisant appel au dépistage du VPH.
Méthode
À l’aide d’un modèle de Markov sur la vie entière, nous avons estimé les coûts, la qualité de vie et la survie associés aux stratégies suivantes: 1) cytologie; 2) cytologie avec dépistage du VPH pour trier les frottis suspects; 3) dépistage du VPH suivi d’une colposcopie chez les femmes séropositives pour le VPH; 4) dépistage du VPH avec cytologie pour trier les femmes séropositives pour le VPH; et 5) dépistage du VPH et cytologie simultanément. La cytologie a été utilisée dans toutes les stratégies visant les femmes de moins de 30 ans. Les résultats ont été mesurés selon la fréquence de la maladie, les années de vie pondérées par la qualité (AVPQ) gagnées, le risque à vie de cancer du col utérin et les rapports coût-efficacité marginaux.
Résultats
Toutes les stratégies intégrant le dépistage du VPH comme test de dépistage primaire étaient plus efficaces et moins chères que la cytologie annuelle à elle seule, mais le dépistage du VPH pour trier les frottis suspects une fois l’an était particulièrement rentable (2991 $ par AVPQ gagnée comparativement à la cytologie annuelle à elle seule). Comparativement à la cytologie tous les trois ans, les stratégies axées sur le VPH coûtent 8200 $ à 13 400 $ de plus par AVPQ gagnée.
Conclusion
Les stratégies intégrant le dépistage du VPH sont non seulement plus efficaces que le dépistage uniquement basé sur la cytologie, mais elles sont aussi très rentables. Les stratèges provinciaux devraient donc songer à les intégrer dans les lignes directrices actuelles sur le dépistage du cancer du col utérin.
Mots clés: virus du papillome humain, cancer du col utérin, rapport coût-efficacité, économie de la santé, dépistage
Footnotes
Sources of support: This work was supported by a grant from Roche Molecular Systems, Inc., Pleasanton, CA, USA (Roche). Representatives from Roche were allowed to review model results as well as a draft of the manuscript, but all final decisions regarding model calculations and manuscript content were made by the authors.
Conflict of Interest: All authors have received honoraria or consultancy fees from Roche Molecular Systems, Inc.
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