. Author manuscript; available in PMC: 2022 May 1.

Published in final edited form as: Sex Transm Dis. 2021 May 1;48(5):370–380. doi: 10.1097/OLQ.0000000000001327

Table 3.

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 when increasing the probability of progression 2 times

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	578,101	144,476	23,868	2,003	110	1,249,382	17.6	33.6	-^†
HPV primary with partial genotyping	(405,336 - 735,958)	(98,165 - 13,104)	(19,254 - 28,022)	(1,822 - 2,185)	(82 - 143)	(913,440 - 1,538,147)	(13.6 - 21.1)	(27.0 - 39.9)	-^†
$43.33 Onclarity test
Patient management strategy 1	578,474	144,685	22,889	1,987	112	1,244,871	17.6	33.3	Less costly, but less effective
Patient management strategy 1	(407,614 - 739,989)	(98,307 - 191,417)	(18,304 - 27,057)	(1,780 - 2,156)	(83 - 143)	(915,578 - 1,532,741)	(13.6 - 21.1)	(26.5 - 39.8)	Less costly, but less effective
Patient management strategy 2	574,269	143,440	21,355	1,859	114	1,241,198	17.5	32.6	Less costly, but less effective
Patient management strategy 2	(405,894 - 727,248)	(99,343 - 191,244)	(17,093 - 25,464)	(1,675 - 2,052)	(86 - 149)	(916,383 - 1,517,023)	(13.6 - 20.9)	(26.2 - 39.4)	Less costly, but less effective
Patient management strategy 3	574,520	143,734	20,617	1,801	118	1,242,745	17.5	32.6	Less costly, but less effective
Patient management strategy 3	(409,897 - 737,930)	(99,761 - 190,989)	(16,394 - 24,519)	(1,601 - 1,980)	(91 - 152)	(924,928 - 1,536,586)	(13.7 - 21.1)	(25.9 - 39.1)	Less costly, but less effective

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

Incremental cost-effectiveness ratio (ICER) of HPV primary screening with extended genotyping compared to partial genotyping.

^†

ICERs of partial genotyping compared to extended genotyping with patient management strategies 1, 2, and 3 are $61/QALY, $119/QALY, and $158/QALY, respectively.