title: Projected cost-effectiveness of repeat high-risk human papillomavirus testing using self-collected vaginal samples in the Swedish cervical cancer screening program.
abstract: BACKGROUND
  Human papillomavirus (HPV) testing is not currently used in primary cervical cancer screening in Sweden, and corresponding cost-effectiveness is unclear.
  
  
  OBJECTIVE
  From a societal perspective, to evaluate the cost-effectiveness of high-risk (HR)-HPV testing using self-collected vaginal samples.
  
  
  METHODS
  A cost-effectiveness analysis.
  
  
  METHODS
  The Swedish organized cervical cancer screening program.
  
  
  METHODS
  We constructed a model to simulate the natural history of cervical cancer using Swedish data on cervical cancer risk. For the base-case analysis we evaluated two screening strategies with different screening intervals: (i) cytology screening throughout the woman's lifetime (i.e. "conventional cytology strategy") and (ii) conventional cytology screening until age 35 years, followed by HR-HPV testing using self-collected vaginal samples in women aged ≥35 years (i.e. "combination strategy"). Sensitivity analyses were performed, varying model parameters over a significant range of values to identify cost-effective screening strategies.
  
  
  METHODS
  Average lifetime cost, discounted and undiscounted life-years gained, reduction in cervical cancer risk, incremental cost-effectiveness ratios with and without the cost of added life-years.
  
  
  RESULTS
  Depending on screening interval, the incremental cost-effectiveness ratios for the combination strategy ranged from €43,000 to €180,000 per life-years gained without the cost of added life-years, and from €74,000 to €206,000 with costs of added life-years included.
  
  
  CONCLUSIONS
  The combination strategy with a 5-year screening interval is potentially cost-effective compared with no screening, and with current screening practice when using a threshold value of €80,000 per life-years gained.
authors.affiliation: Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska University Hospital-Solna, Karolinska Institute, Stockholm, Sweden. ellinor.ostensson@ki.se
authors.forename: Ellinor
authors.initials: E
authors.lastname: Östensson
authors.forename: Ann-Cathrin
authors.initials: AC
authors.lastname: Hellström
authors.forename: Kristina
authors.initials: K
authors.lastname: Hellman
authors.forename: Inger
authors.initials: I
authors.lastname: Gustavsson
authors.forename: Ulf
authors.initials: U
authors.lastname: Gyllensten
authors.forename: Erik
authors.initials: E
authors.lastname: Wilander
authors.forename: Niklas
authors.initials: N
authors.lastname: Zethraeus
authors.forename: Sonia
authors.initials: S
authors.lastname: Andersson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D004279:DNA, Viral; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods; D005260:Female; D017048:Health Care Costs; D061809:Human Papillomavirus DNA Tests / Q000191:economics*; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D008954:Models, Biological; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis* / Q000191:economics; D012306:Risk; D013548:Sweden; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000517:prevention & control* / Q000821:virology; D014626:Vaginal Smears / Q000191:economics* / Q000379:methods; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control* / Q000821:virology
chemical_list: D004279:DNA, Viral