The impact of new technologies in cervical cancer screening: results of the recruitment phase of a large randomised controlled trial from a public health perspective.
The decision to introduce liquid-based cytology (LBC) and HPV as screening tests involves criteria based on resource consumption. We used cross-sectional data at recruitment from the NTCC trial [ISRCTN81678807] on 28,000 women aged 35-60, randomised to receive a conventional Pap test or LBC plus HPV. We computed the resources employed to detect a CIN2+ with different screening strategies. In order to result in the same overall cost per CIN2+ detected as screening by conventional cytology, the unit cost of LBC used alone should be less than that of a conventional Pap while its unit cost may be up to 20% higher if HPV-triage for Atypical Squamous Cells of Undetermined Significance is applied together. With the same criterion the unit cost of HPV used alone may be about 20% higher than that of a Pap-test using a 1 pg/ml cut-off and over 40% higher using a 10 pg/ml cut-off. If HPV testing is applied with cytology-triage, a single HPV test may cost 20-30% more than a conventional Pap to result in the same overall cost per CIN2+ detected.
Giorgi-Rossi
Paolo
P
Agency for Public Health, Lazio Region, Rome, Italy. giorgirossi@asplazio.it
Segnan
Nereo
N
Zappa
Marco
M
Naldoni
Carlo
C
Zorzi
Manuel
M
Confortini
Massimo
M
Merito
Monica
M
Cuzick
Jack
J
Ronco
Guglielmo
G
D000328:Adult; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D003588:Cytopathogenic Effect, Viral; D004180:Direct Service Costs; D005260:Female; D006801:Humans; D007558:Italy; D008403:Mass Screening / Q000191:economics* / Q000379:methods*; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification*; D018579:Patient Selection; D011634:Public Health; D012107:Research Design; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000191:economics* / Q000517:prevention & control; D014626:Vaginal Smears / Q000191:economics*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000191:economics