title: The health and economic effects of HPV DNA screening in The Netherlands.
abstract: We studied the health and economic effects of human papillomavirus (HPV) DNA testing in cervical screening using a simulation model. The key data source was a Dutch longitudinal screening trial. We compared cytological testing with repeat cytology (for borderline/mildly abnormal smears) to HPV testing with cytology triage (for HPV-positive smears), combination testing (combined HPV and cytology) and cytological testing with HPV triage (for borderline/mildly abnormal smears). We varied the screening interval from 5 to 10 years. The main outcome measures were the number of cervical cancer cases, the number of quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER). The base-case estimates were accompanied with ranges across 118 calibrated parameter settings (calibration criteria: cervical intraepithelial neoplasia 2/3, cancer and mortality rates). In comparison to 5-yearly cytology, 5-yearly HPV testing with cytology triage gave a reduction in the number of cancer cases of 23% (range, 9-27%). The reduction was 26% (range, 10-29%) for combination testing and 3% (range, -1 to 8%) for cytology with HPV triage. For strategies with primary HPV testing, the model also estimated a reduction in cancer cases when the screening interval was extended to 7.5 years. Five-yearly cytology with HPV triage and 5 to 7.5-yearly HPV testing with cytology triage were cost effective for the base-case settings and the majority of calibrated parameter settings (ICER below Dutch willingness-to-pay threshold of euro20,000/QALY). Our model indicates that HPV testing with cytology triage is likely to be cost effective. An extension of the screening interval may be considered to control costs.
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Johannes
authors.initials: J
authors.lastname: Berkhof
authors.forename: Veerle M
authors.initials: VM
authors.lastname: Coupé
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Bogaards
authors.forename: Folkert J
authors.initials: FJ
authors.lastname: van Kemenade
authors.forename: Theo J
authors.initials: TJ
authors.lastname: Helmerhorst
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Snijders
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Meijer
mesh_terms: D003362:Cost-Benefit Analysis; D004279:DNA, Viral / Q000032:analysis*; D005260:Female; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening; D009426:Netherlands; D027383:Papillomaviridae / Q000235:genetics*; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000191:economics; D011788:Quality of Life; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000191:economics*; D014626:Vaginal Smears
chemical_list: D004279:DNA, Viral