An evaluation of liquid-based cytology and human papillomavirus testing within the UK cervical cancer screening programme.
The aim of this study is to evaluate different options for introducing liquid-based cytology (LBC) and human papillomavirus (HPV) testing into the UK cervical cancer screening programme. These include options that incorporate HPV testing either as a triage for mild and borderline smear abnormalities or as a primary screening test. Outcomes include the predicted impact on resource use, total cost, life years and cost-effectiveness. Extensive sensitivity analysis has been carried out to explore the importance of the uncertainty associated with disease natural history and the impact of screening. Under baseline assumptions, the cost-effectiveness of different options for introducing LBC appears favourable, and these results are consistent under a range of assumptions for its impact on the diagnostic effectiveness of cytology. However, if we assume a higher marginal cost of LBC in comparison to conventional methods, primary smear testing options are predicted to be more cost-effective without LBC. Combined LBC primary smear and HPV testing with a 5-year interval is similar in both cost and effectiveness to the other 3-yearly options of primary smear testing or primary HPV testing alone. However, both primary HPV testing and combined options would give rise to a far greater risk of inappropriate colposcopy throughout a woman's lifetime. British Journal of Cancer (2004) 91, 84-91. doi:10.1038/sj.bjc.6601884 www.bjcancer.com Published online 25 May 2004
Sherlaw-Johnson
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C
Clinical Operational Research Unit, University College London, Department of Mathematics, University College London, Gower Street, London WC1E 6BT, UK. c.sherlaw-johnson@ucl.ac.uk
Philips
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D000328:Adult; D003127:Colposcopy; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000592:standards*; D008875:Middle Aged; D008962:Models, Theoretical; D027383:Papillomaviridae / Q000472:pathogenicity*; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000191:economics; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D013048:Specimen Handling; D014218:Triage; D006113:United Kingdom; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000821:virology*; D014626:Vaginal Smears