Cost-effectiveness of high-risk human papillomavirus testing for cervical cancer screening in Québec, Canada.
OBJECTIVE
Human papillomavirus (HPV) testing is not widely used for triage of equivocal Pap smears or primary screening in Québec, Canada. Our objective was to evaluate the cost-effectiveness of cervical cancer screening strategies utilizing HPV testing.


METHODS
We used a lifetime Markov model to estimate costs, quality of life, and survival associated with the following strategies: 1) cytology; 2) cytology with HPV testing to triage equivocal Pap smears; 3) HPV testing followed by colposcopy for HPV-positive women; 4) HPV testing with cytology to triage HPV-positive women; and 5) simultaneous HPV testing and cytology. Cytology was used in all strategies prior to age 30. Outcome measures included disease incidence, quality-adjusted life-years saved (QALYs), lifetime risk of cervical cancer, and incremental cost-effectiveness ratios.


RESULTS
All strategies incorporating HPV testing as a primary screening test were more effective and less expensive than annual cytology alone, while HPV testing to triage equivocal Pap smears annually was very cost-effective ($2,991 per QALY gained compared to annual cytology alone). When compared to cytology every three years, HPV-based strategies cost an additional $8,200 to $13,400 per QALY gained.


CONCLUSIONS
Strategies incorporating HPV testing are not only more effective than screening based on cytology alone but are also highly cost-effective. Provincial policy-makers should evaluate incorporating HPV-based strategies into current cervical cancer screening guidelines.
Vijayaraghavan
Arthi
A
McKesson Corp., San Francisco, CA, USA. vijayaraghavan_arthi@yahoo.com
Efrusy
Molly B
MB
Mayrand
Marie-Hélêne
MH
Santas
Christopher C
CC
Goggin
Patricia
P
D000328:Adult; D000368:Aged; D003127:Colposcopy / Q000191:economics; D003362:Cost-Benefit Analysis; D003584:Cytological Techniques / Q000191:economics; D005260:Female; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D015233:Models, Statistical; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000191:economics* / Q000453:epidemiology / Q000821:virology*; D011788:Quality of Life; D011792:Quebec / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000191:economics* / Q000453:epidemiology / Q000821:virology*; D014626:Vaginal Smears / Q000191:economics; D002578:Uterine Cervical Dysplasia / Q000191:economics / Q000453:epidemiology / Q000821:virology