Cost-effectiveness of primarily human papillomavirus-based cervical cancer screening in settings with currently established Pap screening: a systematic review commissioned by the German Federal Ministry of Health.
OBJECTIVE
The aim of this study was to summarize the current evidence for the cost-effectiveness of primarily human papillomavirus (HPV) -based cervical cancer screening in settings with already established Papanicolaou test (Pap) programs. Emphasis was placed on the German situation with annual Pap screening.


METHODS
Medical, economic, and health technology assessment (HTA) databases were systematically searched for cost-effectiveness studies comparing HPV to Pap screening. Study data were extracted, standardized, and summarized in cost-effectiveness plots contrasting HPV strategies to Pap screening with 1-, 2-, 3-, and 5-years interval. For each Pap setting, the likelihood of cost-effective HPV screening was assessed depending on willingness-to-pay.


RESULTS
We reviewed twelve decision-analytic cost-effectiveness models. Study results showed wide variation due to methodical heterogeneity. Data synthesis revealed that the cost-effectiveness of HPV screening depends on the interval of the established Pap screening strategy. In comparison with Pap screening every 2 years, only 25 percent of the HPV-based screening strategies were cost-effective. However, in comparison with Pap screening every 1, 3, or 5 years, 83 percent, 55 percent, and 92 percent of HPV screening strategies were cost-effective, respectively. Results for settings with annual Pap screening are based on models assuming 100 percent screening coverage.


CONCLUSIONS
The introduction of HPV-based screening programs is cost-effective if the screening interval of the established Pap program exceeds 2 years. In settings with biennial Pap screening, introduction of HPV-based screening is unlikely to be cost-effective. Results also suggest cost-effectiveness of HPV-based screening in settings with annual Pap screening; however, this finding should be confirmed under realistic screening adherence assumptions.
Mühlberger
Nikolai
N
University for Health Sciences, Medical Informatics and Technology, Austria. nikolai.muehlberger@umit.at
Sroczynski
Gaby
G
Esteban
Eva
E
Mittendorf
Thomas
T
Miksad
Rebecca A
RA
Siebert
Uwe
U
D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D005858:Germany; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000379:methods*; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000175:diagnosis*; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D013673:Technology Assessment, Biomedical; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000191:economics*