Table 2.
Clinical and economic (net present value 2018 $US) outcomes [median (95% uncertainty interval)] of human papillomavirus (HPV) primary screening with partial genotyping or extended genotyping (patient management strategies 1-3) over 40 simulated years in a cohort of 100,000 US women
| Scenario | Number of genotype tests | Number of cytologies | Number of colposcopies | Number of LEEPs | Number of ICC | Quality-adjusted life years (QALYs) | Cost of genotype tests (in millions) | Total cost (in millions) | ICER ($/QALY)* |
|---|---|---|---|---|---|---|---|---|---|
| HPV primary with partial genotyping | 575,598 | 144,332 | 23,583 | 1,611 | 48 | 1,240,569 | 17.6 | 30.4 | - |
| (410,407 - 738,479) | (99,611 - 190,494) | (19,223 - 27,799) | (1,473 - 1,763) | (35 - 64) | (923,530 - 1,543,255) | (13.7 - 21.1) | (24.6 - 35.9) | ||
| $43.33 Onclarity test | |||||||||
| Patient management strategy 1 | 573,020 | 144,375 | 22,699 | 1,592 | 48 | 1,242,093† | 17.5 | 30.1 | Dominant |
| (408,505 - 739,428) | (99,045 - 193,070) | (18,252 - 26,905) | (1,453 - 1,747) | (34 - 65) | (918,894 - 1,532,973) | (13.6 - 21.2) | (24.3 - 35.4) | ||
| Patient management strategy 2 | 574,712 | 143,971 | 21,323 | 1,501 | 50 | 1,243,995† | 17.5 | 29.6 | Dominant |
| (413,495 - 738,657) | (99,670 - 191,619) | (17,022 - 25,516) | (1,359 - 1,632) | (36 - 67) | (922,480 - 1,528,628) | (13.8 - 21.1) | (23.8 - 35.0) | ||
| Patient management strategy 3 | 573,808 | 143,249 | 20,572 | 1,442 | 50 | 1,242,874† | 17.5 | 29.2 | Dominant |
| (399,578 - 733,365) | (97,581 - 191,642) | (16,161 - 24,626) | (1,302 - 1,576) | (37 - 65) | (901,701 - 1,537,171) | (13.4 - 21.0) | (23.2 - 34.7) | ||
| $75 Onclarity test | |||||||||
| Patient management strategy 1 | 573,599 | 143,458 | 22,610 | 1,593 | 48 | 1,242,835† | 30.3 | 42.8 | 5,472 |
| (407,922 - 728,811) | (98,368 - 188,653) | (18,157 - 26,837) | (1,450 - 1,727) | (35 - 62) | (916,214 - 1,524,269) | (23.5 - 36.2) | (34.1 - 50.8) | ||
| Patient management strategy 2 | 572,730 | 143,181 | 21,352 | 1,502 | 49 | 1,242,246† | 30.2 | 42.5 | 7,236 |
| (404,442 - 735,325) | (98,279 - 193,460) | (16,982 - 25,524) | (1,360 - 1,635) | (37 - 66) | (908,881 - 1,529,568) | (23.4 - 36.5) | (33.7 - 50.2) | ||
| Patient management strategy 3 | 573,372 | 144,205 | 20,656 | 1,443 | 50 | 1,242,143† | 30.3 | 42.1 | 2,298 |
| (401,296 - 728,829) | (97,365 - 190,506) | (16,123 - 24,466) | (1,308 - 1,579) | (38 - 64) | (905,372 - 1,522,290) | (23.3 - 36.2) | (33.1 - 50.0) | ||
Note: Patient management strategy ordered by increasing number of high-risk HPV genotypes for which cytology results of negative for intraepithelial lesion or malignancy (NILM), atypical squamous cells of undetermined significance (ASC-US), or low-grade squamous intraepithelial lesion (LSIL) were deferred to co-testing instead of colposcopy (i.e., in Group C). Patient management strategy 1: 31, 45, 33/58, 51, 52, 35/39/68 with any abnormal cytology results will go to colposcopy; and 56/59/66 with atypical glandular cells (AGC), atypical squamous cells: cannot exclude high-grade squamous intraepithelial lesion (ASC-H), or a high-grade squamous intraepithelial lesion (HSIL) on cytology will go to colposcopy
Patient management strategy 2: 31, 45, 33/58, 52 with any abnormal cytology results will go to colposcopy; and 51, 35/39/68, 56/59/69 with AGC, ASC-H, HSIL will go to colposcopy
Patient management strategy 3: 31, 45, 33/58 with any abnormal cytology results will go to colposcopy; and 51, 52, 35/39/68, 56/59/66 with AGC, ASC-H, HSIL will go to colposcopy
ICC=invasive cervical cancer; ICER=incremental cost-effectiveness ratio; LEEP=loop electrosurgical excision procedure
Dominant indicates HPV primary screening with extended genotyping is less costly and more effective than HPV primary screening
Incremental cost-effectiveness ratio (ICER) of HPV primary screening with extended genotyping compared to partial genotyping. QALYs and total cost values in the table are rounded to millions and cannot be used to reconstruct ICERs reported in the tables and text, which used unrounded values.
Compared to HPV primary screening with partial genotyping, increases in QALYs with extended genotyping were not statistically significant, with wide ranges due to variability in the model.