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Cost-effectiveness of primary HPV screening for cervical cancer in Germany – a decision analysis
- Source :
- European Journal of Cancer. 47:1633-1646
- Publication Year :
- 2011
- Publisher :
- Elsevier BV, 2011.
-
Abstract
- Objectives: To systematically evaluate the long-term effectiveness and cost-effectiveness of HPV-based primary cervical cancer screening in the German health care context using a decision-analysis approach. Methods: A Markov-model for HPV-infection and cervical cancer was developed for the German health care context, and applied to evaluate various screening strategies that differ by screening interval and test algorithms, including HPV-testing alone or in combination with cytology. German clinical, epidemiological, and economic data, and test accuracy data from international meta-analyses were used. Outcomes predicted included the reduction in cervical cancer cases and deaths, life expectancy and discounted incremental cost-effectiveness ratios (ICER). The analysis was performed from the perspective of the healthcare system adopting a 3% annual discount rate for costs and outcomes. Extensive sensitivity analyses were performed. Results: HPV-based screening is more effective than cytology alone. It results in a 71-97% reduction in cervical cancer cases as compared to 53-93% for cytology alone. The ICER range from 2600 Euro/LYG (cytology, 5-year-interval) to 155,500 Euro/LYG (annual HPV-testing starting at age 30 years, cytology age 20-29 years). Annual cytology alone, the current recommended screening strategy in Germany, is dominated by HPV-strategies. Increasing the age at screening initiation from 20 to 25 years does not result in a relevant loss in effectiveness but results in lower costs. Conclusions: Based on our analyses, HPV-based cervical cancer screening is more effective than cytology alone and could be cost-effective if performed at intervals of two years or longer. In the German context, an optimal screening strategy may be biennial HPV screening starting at age 30 years preceded by biennial cytology for women aged 25-29 years. Longer screening intervals may be considered in low-risk women with good screening adherence and in populations with low HPV-incidence. (C) 2011 Elsevier Ltd. All rights reserved.
- Subjects :
- Adult
Human papillomavirus
Cancer Research
medicine.medical_specialty
Cost effectiveness
Cost-Benefit Analysis
Uterine Cervical Neoplasms
Cost benefit analyses
Context (language use)
Decision analysis
Medical Oncology
Sensitivity and Specificity
Decision Support Techniques
Cytology
Outcome Assessment, Health Care
Epidemiology
Health care
Prevalence
medicine
Humans
Mass Screening
Early Detection of Cancer
Aged
Aged, 80 and over
Gynecology
Cervical cancer
Cost–benefit analysis
Obstetrics
business.industry
Wirtschaftswissenschaften
Middle Aged
medicine.disease
Markov Chains
Oncology
Screening
Life expectancy
Cost-effectiveness
Female
business
Subjects
Details
- ISSN :
- 09598049
- Volume :
- 47
- Database :
- OpenAIRE
- Journal :
- European Journal of Cancer
- Accession number :
- edsair.doi.dedup.....6adb692e3953381843a7c280a30b91f6
- Full Text :
- https://doi.org/10.1016/j.ejca.2011.03.006