title: A model to evaluate the costs and clinical effectiveness of human papilloma virus screening compared with annual papanicolaou cytology in Germany.
abstract: OBJECTIVE
  We modelled human papilloma virus (HPV) primary screening scenarios compared with Pap cytology to evaluate clinical effectiveness and projected annual costs in Germany.
  
  
  METHODS
  A Markov cohort model was built to compare the budget impact of annual Pap cytology with different 5-yearly HPV screening scenarios: (1) a positive HPV test followed by Pap cytology; (2) a positive HPV test followed by p16/Ki-67 dual-stained cytology; (3) a positive HPV test followed by colposcopy if HPV-16/18-positive or p16/Ki-67 dual-stained cytology if positive for other subtypes; (4) co-testing with HPV and Pap. Screening scenarios were based on a 10-year horizon.
  
  
  RESULTS
  All HPV screening scenarios in the model were associated with fewer deaths from missed diagnosis of cervical cancer compared with Pap screening; 10-year totals n=172-344 (1.5-3 per 100,000) versus n=477 (4.1 per 100,000), respectively. Total annual costs were lower with HPV screening than Pap cytology. The projected average annual cost for HPV screening ranged from €117 million to €136 million compared with €177 million for Pap screening, representing annual savings of €41-60 million. The greatest clinical impact was achieved with primary HPV screening (with genotyping) followed by colposcopy for HPV 16/18-positive women or p16/Ki-67 dual-stained cytology for women positive for other HPV subtypes.
  
  
  CONCLUSIONS
  Screening strategies including primary HPV testing for high-risk subtypes (HPV-16/18) in conjunction with p16/Ki-67 dual-stained cytology can improve the detection of cervical cancer at a lower total annual cost than conventional Pap cytology screening.
authors.affiliation: Department of Gynaecology and Obstetrics, Klinikum Wolfsburg, Sauerbruchstrasse 7, 38440 Wolfsburg, Germany. Electronic address: k.u.petry@klinikum.wolfsburg.de.
authors.forename: Karl Ulrich
authors.initials: KU
authors.lastname: Petry
authors.affiliation: Institute for Health Care Management and Research, Thea-Leymann-Strasse 9, 45127 Essen, Germany.
authors.forename: Cordula
authors.initials: C
authors.lastname: Barth
authors.affiliation: Institute for Health Care Management and Research, Thea-Leymann-Strasse 9, 45127 Essen, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Wasem
authors.affiliation: Institute for Health Care Management and Research, Thea-Leymann-Strasse 9, 45127 Essen, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Neumann
mesh_terms: D015331:Cohort Studies; D003127:Colposcopy / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D005260:Female; D005858:Germany / Q000453:epidemiology; D052162:Human papillomavirus 16 / Q000302:isolation & purification; D052161:Human papillomavirus 18 / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000191:economics* / Q000592:standards / Q000706:statistics & numerical data; D065006:Papanicolaou Test / Q000191:economics* / Q000592:standards / Q000706:statistics & numerical data; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*
keywords: Human papilloma virus; Screening cervical cancer