title: Accuracy and cost-effectiveness of cervical cancer screening by high-risk human papillomavirus DNA testing of self-collected vaginal samples.
abstract: OBJECTIVE
  Estimate the accuracy and cost-effectiveness of cervical cancer screening strategies based on high-risk human papillomavirus (HPV) DNA testing of self-collected vaginal samples.
  
  
  METHODS
  A subset of 1,665 women (age range, 18-50 y) participating in a cervical cancer screening study were screened by liquid-based cytology and by high-risk HPV DNA testing of both self-collected vaginal swab samples and clinician-collected cervical samples. Women with positive/abnormal screening test results and a subset of women with negative screening test results were triaged to colposcopy. On the basis of individual and combined test results, 5 screening strategies were defined. Estimates of sensitivity and specificity for cervical intraepithelial neoplasia grade 2 or worse were calculated, and a Markov model was used to estimate the incremental cost-effectiveness ratios for each strategy.
  
  
  RESULTS
  Compared with cytology-based screening, high-risk HPV DNA testing of self-collected vaginal samples was more sensitive (68%, 95% CI = 58%-78% vs 85%, 95% CI = 76%-94%) but less specific (89%, 95% CI = 86%-91% vs 73%, 95% CI = 67%-79%). A strategy of high-risk HPV DNA testing of self-collected vaginal samples followed by cytology triage of HPV-positive women was comparably sensitive (75%, 95% CI = 64%-86%) and specific (88%, 95% CI = 85%-92%) to cytology-based screening. In-home self-collection for high-risk HPV DNA detection followed by in-clinic cytology triage had a slightly lower lifetime cost and a slightly higher quality-adjusted life year (QALY) expectancy than did cytology-based screening (incremental cost-effectiveness ratio of triennial screening compared with no screening was $9,871/QALY and $12,878/QALY, respectively).
  
  
  CONCLUSIONS
  Triennial screening by high-risk HPV DNA testing of in-home, self-collected vaginal samples followed by in-clinic cytology triage was cost-effective.
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA, USA. akhilab@amgen.com
authors.forename: Akhila
authors.initials: A
authors.lastname: Balasubramanian
authors.forename: Shalini L
authors.initials: SL
authors.lastname: Kulasingam
authors.forename: Atar
authors.initials: A
authors.lastname: Baer
authors.forename: James P
authors.initials: JP
authors.lastname: Hughes
authors.forename: Evan R
authors.initials: ER
authors.lastname: Myers
authors.forename: Constance
authors.initials: C
authors.lastname: Mao
authors.forename: Nancy B
authors.initials: NB
authors.lastname: Kiviat
authors.forename: Laura A
authors.initials: LA
authors.lastname: Koutsky
mesh_terms: D000293:Adolescent; D000328:Adult; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis*; D012646:Self Administration / Q000379:methods; D012680:Sensitivity and Specificity; D013048:Specimen Handling / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D014621:Vagina / Q000821:virology*; D055815:Young Adult