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Cost Effectiveness of Human Papillomavirus-16/18 Genotyping in Cervical Cancer Screening
BACKGROUND: There is limited understanding of the health economic implications of cervical screening with human papillomavirus (HPV)-16/18 genotyping. OBJECTIVE: The aim of this study was to evaluate the cost effectiveness of cervical cancer primary screening with a HPV-16/18 genotyping test which s...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5031721/ https://www.ncbi.nlm.nih.gov/pubmed/25385310 http://dx.doi.org/10.1007/s40258-014-0135-4 |
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author | Huh, Warner K. Williams, Erin Huang, Joice Bramley, Tommy Poulios, Nick |
author_facet | Huh, Warner K. Williams, Erin Huang, Joice Bramley, Tommy Poulios, Nick |
author_sort | Huh, Warner K. |
collection | PubMed |
description | BACKGROUND: There is limited understanding of the health economic implications of cervical screening with human papillomavirus (HPV)-16/18 genotyping. OBJECTIVE: The aim of this study was to evaluate the cost effectiveness of cervical cancer primary screening with a HPV-16/18 genotyping test which simultaneously detects 12 other high-risk HPV types. METHODS: A Markov cohort model compared four strategies: (1) cytology with reflex HPV testing for atypical squamous cells of undetermined significance (ASC-US); (2) co-testing with cytology and HPV testing; (3) HPV with reflex to cytology; and (4) HPV with 16/18 genotyping and reflex cytology (ASC-US threshold). Screening began at age 30 and was performed triennially over 40 years. Screening sensitivity and specificity values for cervical intraepithelial neoplasia (CIN) 3 were obtained from the Addressing THE Need for Advanced HPV Diagnostics (ATHENA) trial. Outcomes for a 1-year follow-up scenario wherein persistent disease was detected were estimated. Screening and cancer treatment costs were calculated from a US payer’s perspective in 2013. Costs and quality-adjusted life-years (QALYs) were discounted at 3 % annually. RESULTS: Applying a US$50,000/QALY threshold, strategy (4) dominated strategies (2) and (3) by reducing costs and cancer incidence and improving QALYs, and was cost effective versus strategy (1). Accounting for persistent ≥CIN 3 at 1 year, strategy (4) was cost effective versus all other strategies. Detecting HPV-16/18 resulted in earlier diagnosis of clinically relevant ≥CIN 3 at initial screening and efficient use of follow-up resources. Outcomes were most influenced by strategy performance. CONCLUSIONS: Incorporating HPV-16/18 genotyping is cost effective and may improve detection of CIN, thereby preventing cervical cancer. |
format | Online Article Text |
id | pubmed-5031721 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-50317212016-10-09 Cost Effectiveness of Human Papillomavirus-16/18 Genotyping in Cervical Cancer Screening Huh, Warner K. Williams, Erin Huang, Joice Bramley, Tommy Poulios, Nick Appl Health Econ Health Policy Original Research Article BACKGROUND: There is limited understanding of the health economic implications of cervical screening with human papillomavirus (HPV)-16/18 genotyping. OBJECTIVE: The aim of this study was to evaluate the cost effectiveness of cervical cancer primary screening with a HPV-16/18 genotyping test which simultaneously detects 12 other high-risk HPV types. METHODS: A Markov cohort model compared four strategies: (1) cytology with reflex HPV testing for atypical squamous cells of undetermined significance (ASC-US); (2) co-testing with cytology and HPV testing; (3) HPV with reflex to cytology; and (4) HPV with 16/18 genotyping and reflex cytology (ASC-US threshold). Screening began at age 30 and was performed triennially over 40 years. Screening sensitivity and specificity values for cervical intraepithelial neoplasia (CIN) 3 were obtained from the Addressing THE Need for Advanced HPV Diagnostics (ATHENA) trial. Outcomes for a 1-year follow-up scenario wherein persistent disease was detected were estimated. Screening and cancer treatment costs were calculated from a US payer’s perspective in 2013. Costs and quality-adjusted life-years (QALYs) were discounted at 3 % annually. RESULTS: Applying a US$50,000/QALY threshold, strategy (4) dominated strategies (2) and (3) by reducing costs and cancer incidence and improving QALYs, and was cost effective versus strategy (1). Accounting for persistent ≥CIN 3 at 1 year, strategy (4) was cost effective versus all other strategies. Detecting HPV-16/18 resulted in earlier diagnosis of clinically relevant ≥CIN 3 at initial screening and efficient use of follow-up resources. Outcomes were most influenced by strategy performance. CONCLUSIONS: Incorporating HPV-16/18 genotyping is cost effective and may improve detection of CIN, thereby preventing cervical cancer. Springer International Publishing 2014-11-11 2015 /pmc/articles/PMC5031721/ /pubmed/25385310 http://dx.doi.org/10.1007/s40258-014-0135-4 Text en © Springer International Publishing Switzerland 2014 |
spellingShingle | Original Research Article Huh, Warner K. Williams, Erin Huang, Joice Bramley, Tommy Poulios, Nick Cost Effectiveness of Human Papillomavirus-16/18 Genotyping in Cervical Cancer Screening |
title | Cost Effectiveness of Human Papillomavirus-16/18 Genotyping in Cervical Cancer Screening |
title_full | Cost Effectiveness of Human Papillomavirus-16/18 Genotyping in Cervical Cancer Screening |
title_fullStr | Cost Effectiveness of Human Papillomavirus-16/18 Genotyping in Cervical Cancer Screening |
title_full_unstemmed | Cost Effectiveness of Human Papillomavirus-16/18 Genotyping in Cervical Cancer Screening |
title_short | Cost Effectiveness of Human Papillomavirus-16/18 Genotyping in Cervical Cancer Screening |
title_sort | cost effectiveness of human papillomavirus-16/18 genotyping in cervical cancer screening |
topic | Original Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5031721/ https://www.ncbi.nlm.nih.gov/pubmed/25385310 http://dx.doi.org/10.1007/s40258-014-0135-4 |
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