title: Cost-effectiveness of cervical cancer screening with primary human papillomavirus testing in Norway.
abstract: BACKGROUND
  New screening technologies and vaccination against human papillomavirus (HPV), the necessary cause of cervical cancer, may impact optimal approaches to prevent cervical cancer. We evaluated the cost-effectiveness of alternative screening strategies to inform cervical cancer prevention guidelines in Norway.
  
  
  METHODS
  We leveraged the primary epidemiologic and economic data from Norway to contextualise a simulation model of HPV-induced cervical cancer. The current cytology-only screening was compared with strategies involving cytology at younger ages and primary HPV-based screening at older ages (31/34+ years), an option being actively deliberated by the Norwegian government. We varied the switch-age, screening interval, and triage strategies for women with HPV-positive results. Uncertainty was evaluated in sensitivity analysis.
  
  
  RESULTS
  Current cytology-only screening was less effective and more costly than strategies that involve switching to primary HPV testing in older ages. For unvaccinated women, switching at age 34 years to primary HPV testing every 4 years was optimal given the Norwegian cost-effectiveness threshold ($83,000 per year of life saved). For vaccinated women, a 6-year screening interval was cost-effective. When we considered a wider range of strategies, we found that an earlier switch to HPV testing (at age 31 years) may be preferred.
  
  
  CONCLUSIONS
  Strategies involving a switch to HPV testing for primary screening in older women is expected to be cost-effective compared with current recommendations in Norway.
authors.affiliation: Department of Health Management and Health Economics, University of Oslo, Norway.
authors.forename: E A
authors.initials: EA
authors.lastname: Burger
authors.forename: J D
authors.initials: JD
authors.lastname: Ortendahl
authors.forename: S
authors.initials: S
authors.lastname: Sy
authors.forename: I S
authors.initials: IS
authors.lastname: Kristiansen
authors.forename: J J
authors.initials: JJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D004279:DNA, Viral / Q000235:genetics; D055088:Early Detection of Cancer / Q000191:economics*; D005260:Female; D006801:Humans; D008962:Models, Theoretical; D009664:Norway; D027383:Papillomaviridae / Q000235:genetics; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000191:economics* / Q000517:prevention & control*; D016133:Polymerase Chain Reaction; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000517:prevention & control*; D014626:Vaginal Smears
chemical_list: D004279:DNA, Viral