title: Long-term costs of introducing HPV-DNA post-treatment surveillance to national cervical cancer screening in Ireland.
abstract: BACKGROUND
  Co-testing (cytology plus human papillomavirus DNA testing) as part of cervical cancer surveillance in Ireland increases one-time testing costs. Of interest to policy makers was the long-term impact of these costs accompanied by decreases in intensity of recalls for women with no detected abnormalities.
  
  
  METHODS
  A cost analysis of cytology-only and co-testing strategy was implemented using decision analytic modeling, aggregating testing utilization and costs for each of the two strategies over 12 years.
  
  
  RESULTS
  Aggregated incremental costs of the co-testing strategy were positive for the first 3 years but became negative thereafter, generating a cost savings of roughly €20 million in favor of the cytology-only strategy over a 12-year period. Results were robust over a range of sensitivity analyses with respect to discount and attrition rates.
  
  
  CONCLUSIONS
  This analysis provided valuable information to policy makers contributing to the introduction of co-testing for post-treatment surveillance (PTS) in Ireland.
authors.affiliation: a 1 Pharmaceutical Outcomes Research and Policy Program (PORPP), University of Washington, Seattle, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Agapova
authors.affiliation: b 2 National Cancer Screening Service, Dublin, Ireland.
authors.forename: Andrea
authors.initials: A
authors.lastname: Duignan
authors.affiliation: b 2 National Cancer Screening Service, Dublin, Ireland.
authors.forename: Alan
authors.initials: A
authors.lastname: Smith
authors.affiliation: c 3 School of Business and Economics, National University of Ireland, Galway, Ireland.
authors.forename: Ciaran
authors.initials: C
authors.lastname: O'Neill
authors.affiliation: a 1 Pharmaceutical Outcomes Research and Policy Program (PORPP), University of Washington, Seattle, USA.|d 4 Department of Health Services and Department of Economics, University of Washington, Seattle, USA.
authors.forename: Anirban
authors.initials: A
authors.lastname: Basu
mesh_terms: D000328:Adult; D017046:Cost Savings; D004279:DNA, Viral / Q000302:isolation & purification*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007494:Ireland; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000821:virology; D012680:Sensitivity and Specificity; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000628:therapy / Q000821:virology
chemical_list: D004279:DNA, Viral
keywords: cervical cancer; colposcopy; costs analysis; decision analysis; human papillomavirus; post-treatment surveillance; screening