1. A model to evaluate the costs and clinical effectiveness of human papilloma virus screening compared with annual papanicolaou cytology in Germany
- Author
-
Cordula Barth, Jürgen Wasem, Karl Ulrich Petry, and Anja Neumann
- Subjects
medicine.medical_specialty ,Clinical effectiveness ,Cost-Benefit Analysis ,Papanicolaou stain ,Uterine Cervical Neoplasms ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Cytology ,Germany ,Medicine ,Humans ,Mass Screening ,030212 general & internal medicine ,Genotyping ,Gynecology ,Cervical cancer ,Human papilloma virus ,Colposcopy ,Human papillomavirus 16 ,medicine.diagnostic_test ,Human papillomavirus 18 ,business.industry ,Obstetrics ,Incidence ,Papillomavirus Infections ,virus diseases ,Obstetrics and Gynecology ,Hpv screening ,medicine.disease ,female genital diseases and pregnancy complications ,Reproductive Medicine ,030220 oncology & carcinogenesis ,Female ,business ,Papanicolaou Test - Abstract
Objectives We modelled human papilloma virus (HPV) primary screening scenarios compared with Pap cytology to evaluate clinical effectiveness and projected annual costs in Germany. Study design 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. Conclusion 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.
- Published
- 2016