title: Cost-effectiveness of high-risk human papillomavirus testing for cervical cancer screening in Québec, Canada.
abstract: 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.
authors.affiliation: McKesson Corp., San Francisco, CA, USA. vijayaraghavan_arthi@yahoo.com
authors.forename: Arthi
authors.initials: A
authors.lastname: Vijayaraghavan
authors.forename: Molly B
authors.initials: MB
authors.lastname: Efrusy
authors.forename: Marie-Hélêne
authors.initials: MH
authors.lastname: Mayrand
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Santas
authors.forename: Patricia
authors.initials: P
authors.lastname: Goggin
mesh_terms: 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