Liquid-based cervical cytology using ThinPrep technology: weighing the pros and cons in a cost-effectiveness analysis.
OBJECTIVE
Cervical cancer screening with liquid-based cytology (LBC) has been developed as an alternative to the conventional Papanicolaou (CP) smear. Cost-effectiveness is one of the issues when evaluating LBC. Based on the results of a Dutch randomised controlled trial, we conducted cost-effectiveness threshold analyses to investigate under what circumstances manually screened ThinPrep LBC is cost-effective for screening.


METHODS
The MISCAN-Cervix microsimulation model and data from the Dutch NETHCON trial (including 89,784 women) were used to estimate the costs and (quality-adjusted) life years ((QA)LYs) gained for EU screening schedules, varying cost-effectiveness threshold values. Screening strategies were primary cytological screening with LBC or CP, and triage with human papillomavirus (HPV) testing.


RESULTS
Threshold analyses showed that screening with LBC as a primary test can be cost-effective if LBC is less than <euro>3.2 more costly per test than CP, if the sensitivity of LBC is at least 3-5 % points higher than CP, if the quality of life for women in triage follow-up is only 0.39, or if the rate of inadequate CP smears is at least 16.2 %.


CONCLUSIONS
Regarding test characteristics and costs of LBC and CP, only under certain conditions will a change from CP to manually screened ThinPrep LBC be cost-effective. If none of these conditions are met, implementation of manually screened ThinPrep LBC seems warranted only if there are advantages other than cost-effectiveness. Further research is needed to establish whether other LBC systems will be more favorable with regard to cost-effectiveness.
Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, The Netherlands. e.debekker@erasmusmc.nl
Esther W
EW
de Bekker-Grob
Inge M C M
IM
de Kok
Johan
J
Bulten
Joost
J
van Rosmalen
Judith E M
JE
Vedder
Marc
M
Arbyn
Paul J J M
PJ
Klinkhamer
Albertus G
AG
Siebers
Marjolein
M
van Ballegooijen
D000328:Adult; D003362:Cost-Benefit Analysis; D003584:Cytological Techniques / Q000191:economics* / Q000379:methods*; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D009426:Netherlands; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000473:pathology / Q000821:virology; D011933:Reagent Kits, Diagnostic / Q000191:economics; D002583:Uterine Cervical Neoplasms / Q000191:economics* / Q000473:pathology* / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000191:economics* / Q000473:pathology* / Q000821:virology
D011933:Reagent Kits, Diagnostic