Benefits and costs of using HPV testing to screen for cervical cancer.
BACKGROUND
Despite quality assurance standards, Papanicolaou (Pap) test characteristics remain less than optimal.


OBJECTIVE
To compare the societal costs and benefits of human papillomavirus (HPV) testing, Pap testing, and their combination to screen for cervical cancer.


METHODS
A simulation model of neoplasia natural history was used to estimate the societal costs and quality-adjusted life expectancy associated with 18 different general population screening strategies: Pap plus HPV testing, Pap testing alone, and HPV testing alone every 2 or 3 years among hypothetical longitudinal cohorts of US women beginning at age 20 years and continuing to 65 years, 75 years, or death.


METHODS
Discounted costs per quality-adjusted life-year (QALY) saved of each screening strategy.


RESULTS
Maximal savings in lives were achieved by screening every 2 years until death with combined HPV and Pap testing at an incremental cost of $76 183 per QALY compared with Pap testing alone every 2 years. Stopping biennial screening with HPV and Pap testing at age 75 years captures 97.8% of the benefits of lifetime screening at a cost of $70 347 per QALY. Combined biennial HPV and Pap testing to age 65 years captures 86.6% of the benefits achievable by continuing to screen until age 75 years. Human papillomavirus screening alone was equally effective as Pap testing alone at any given screening interval or age of screening cessation but was more costly and therefore was dominated. In sensitivity analyses, HPV testing would be more effective and less costly than Pap testing at a cost threshold of $5 for an HPV test.


CONCLUSIONS
Screening with HPV plus Pap tests every 2 years appears to save additional years of life at reasonable costs compared with Pap testing alone. Applying age limits to screening is a viable option to maintain benefits while reducing costs.
Mandelblatt
Jeanne S
JS
Lombardi Cancer Center, 2233 Wisconsin Ave NW, Suite 317, Washington, DC 20007. mandelbj@georgetown.edu
Lawrence
William F
WF
Womack
Sharita Mizell
SM
Jacobson
Denise
D
Yi
Bin
B
Hwang
Yi-ting
YT
Gold
Karen
K
Barter
James
J
Shah
Keerti
K
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D008962:Models, Theoretical; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis*; D016133:Polymerase Chain Reaction / Q000191:economics; D019057:Quality-Adjusted Life Years; D014412:Tumor Virus Infections / Q000175:diagnosis*; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control* / Q000821:virology*; D014626:Vaginal Smears / Q000191:economics*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control / Q000821:virology
D004279:DNA, Viral