The cost-effectiveness of human papillomavirus screening for cervical cancer

Abstract

We compared findings from recent studies modelling the cost-effectiveness of screening for cervical cancer using human papillomavirus (HPV) testing and alternative strategies. Data were standardized to facilitate comparison of costs per life year or costs per QALY gained in six studies. Absolute changes in costs, life years and QALYs for each strategy were normalized to a comparison with no screening. Costs were standardized to US$ in 2000 values. Most models assume screening starts at age 18 or 20 years. Assumed prevalence of HPV ranges from 10% for those aged 18 years to 20% for those aged 20–25 years and drops substantially after age 30. All except one model assume sensitivity to LSIL of 83% or higher. Two models distinguish the increasing specificity of HPV testing in older age groups (up to 95% for LSIL in women aged 55 years or older). All the models include consultation costs as well as screening and treatment costs, but costs for follow-up diagnosis and treatment vary considerably. Two models also include patient time costs. Despite these differences all strategies involving HPV testing have cost per quality-adjusted life-year (QALY) ratios in the range of $12,400–$16,600. Costs per life year vary more widely, the highest being $19,246 (annual screening with liquid cytology and HPV). However, excluding strategies using liquid cytology, the highest costs per life year for a strategy including HPV testing are under $14,000 (simultaneous conventional cytology and HPV every two years). The cost per life year for HPV testing alone triennially is lower than for Pap smear testing alone biennially. Costs per QALY are generally lower than costs per life year (given the reported modelling assumptions and settings). Even with inclusion of patient costs, no strategies involving HPV testing cost more than $16,600 per QALY. Adoption of the ACOG guidelines to include HPV testing with cytology as a screening option for women aged 30 years or older therefore appears to be cost-effective.