Economic evaluation of DNA ploidy analysis vs liquid-based cytology for cervical screening.
BACKGROUND
DNA ploidy analysis involves automated quantification of chromosomal aneuploidy, a potential marker of progression toward cervical carcinoma. We evaluated the cost-effectiveness of this method for cervical screening, comparing five ploidy strategies (using different numbers of aneuploid cells as cut points) with liquid-based Papanicolaou smear and no screening.


METHODS
A state-transition Markov model simulated the natural history of HPV infection and possible progression into cervical neoplasia in a cohort of 12-year-old females. The analysis evaluated cost in 2012 US$ and effectiveness in quality-adjusted life-years (QALYs) from a health-system perspective throughout a lifetime horizon in the US setting. We calculated incremental cost-effectiveness ratios (ICERs) to determine the best strategy. The robustness of optimal choices was examined in deterministic and probabilistic sensitivity analyses.


RESULTS
In the base-case analysis, the ploidy 4 cell strategy was cost-effective, yielding an increase of 0.032 QALY and an ICER of $18 264/QALY compared to no screening. For most scenarios in the deterministic sensitivity analysis, the ploidy 4 cell strategy was the only cost-effective strategy. Cost-effectiveness acceptability curves showed that this strategy was more likely to be cost-effective than the Papanicolaou smear.


CONCLUSIONS
Compared to the liquid-based Papanicolaou smear, screening with a DNA ploidy strategy appeared less costly and comparably effective.
1] The University of Texas MD Anderson Cancer Center, Department of Health Services Research, 1515 Holcombe Blvd., Houston, TX 77030, USA [2] The University of Texas School of Public Health, Division of Management, Policy and Community Health, 1200 Pressler Street, Houston, TX 77030, USA.
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VT
Nghiem
The University of Texas MD Anderson Cancer Center, Department of Health Services Research, 1515 Holcombe Blvd., Houston, TX 77030, USA.
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Davies
Fox Chase Cancer Center, Cancer Prevention and Control Program, 333 Cottman Avenue, Philadelphia, PA 19111, USA.
J R
JR
Beck
Brookdale University Hospital & Medical Center, Department of Obstetrics & Gynecology, One Brookdale Plaza, Brooklyn, NY 11212, USA.
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Follen
British Columbia Cancer Research Centre, Integrative Oncology Department, 675 West 10th Avenue, Vancouver, BC V5Z 1L3, Canada.
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MacAulay
British Columbia Cancer Research Centre, Integrative Oncology Department, 675 West 10th Avenue, Vancouver, BC V5Z 1L3, Canada.
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M
Guillaud
The University of Texas MD Anderson Cancer Center, Department of Health Services Research, 1515 Holcombe Blvd., Houston, TX 77030, USA.
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Cantor
D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003584:Cytological Techniques / Q000191:economics / Q000379:methods*; D004247:DNA / Q000235:genetics*; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods; D005260:Female; D006801:Humans; D008390:Markov Chains; D011003:Ploidies; D014626:Vaginal Smears / Q000191:economics / Q000379:methods*
D004247:DNA