Cost effectiveness of human papillomavirus-16/18 genotyping in cervical cancer screening.
BACKGROUND
There is limited understanding of the health economic implications of cervical screening with human papillomavirus (HPV)-16/18 genotyping.


OBJECTIVE
The aim of this study was to evaluate the cost effectiveness of cervical cancer primary screening with a HPV-16/18 genotyping test which simultaneously detects 12 other high-risk HPV types.


METHODS
A Markov cohort model compared four strategies: (1) cytology with reflex HPV testing for atypical squamous cells of undetermined significance (ASC-US); (2) co-testing with cytology and HPV testing; (3) HPV with reflex to cytology; and (4) HPV with 16/18 genotyping and reflex cytology (ASC-US threshold). Screening began at age 30 and was performed triennially over 40 years. Screening sensitivity and specificity values for cervical intraepithelial neoplasia (CIN) 3 were obtained from the Addressing THE Need for Advanced HPV Diagnostics (ATHENA) trial. Outcomes for a 1-year follow-up scenario wherein persistent disease was detected were estimated. Screening and cancer treatment costs were calculated from a US payer's perspective in 2013. Costs and quality-adjusted life-years (QALYs) were discounted at 3 % annually.


RESULTS
Applying a US$50,000/QALY threshold, strategy (4) dominated strategies (2) and (3) by reducing costs and cancer incidence and improving QALYs, and was cost effective versus strategy (1). Accounting for persistent ≥CIN 3 at 1 year, strategy (4) was cost effective versus all other strategies. Detecting HPV-16/18 resulted in earlier diagnosis of clinically relevant ≥CIN 3 at initial screening and efficient use of follow-up resources. Outcomes were most influenced by strategy performance.


CONCLUSIONS
Incorporating HPV-16/18 genotyping is cost effective and may improve detection of CIN, thereby preventing cervical cancer.
University of Alabama at Birmingham, 1700 6th Avenue South, WIC Room 10250, Birmingham, 35233, AL, USA, whuh@uabmc.edu.
Warner K
WK
Huh
Erin
E
Williams
Joice
J
Huang
Tommy
T
Bramley
Nick
N
Poulios
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics*; D005260:Female; D005820:Genetic Testing / Q000191:economics*; D060005:Genotyping Techniques / Q000191:economics*; D052162:Human papillomavirus 16 / Q000302:isolation & purification*; D052161:Human papillomavirus 18 / Q000302:isolation & purification*; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000235:genetics*