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Abstract
Objectives In England, human papillomavirus (HPV) testing is to replace cytological screening by 2019–2020. We conducted a model-based economic evaluation to project the long-term clinical impact and cost-effectiveness of routine cytology versus HPV testing.
Methods An individual-based model of HPV acquisition, natural history, and cervical cancer screening was used to compare cytological screening and HPV testing with cytology triage for women aged 25–64 years (with either 3- or 5-year screening intervals for women aged under 50 years). The model was fitted to data from England's National Health Service Cervical Screening Programme. Both clinical and economic outcomes were projected to inform cost-effectiveness analyses.
Results HPV testing is likely to decrease annual cytology testing (by 2.76 million), cervical cancer incidence (by 290 cases), and health system costs (by £13 million). It may increase the number of colposcopies, although this could be reduced without leading to more cancers compared with primary cytology by increasing the interval between screens to 5 years. The impact in terms of quality-adjusted life-years (QALYs) depends on the quality of life weight given to colposcopies versus cancer.
Conclusions England's move from cytology to HPV screening may potentially be life-saving and cost-effective. Cost-effectiveness can be improved further by extending the interval between screens or using alternative triage methods such as partial or full genotyping.
- cervical cancer
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Footnotes
Contributors IB and MJ designed the study, carried out the analysis, interpreted the data, and drafted the manuscript with input from YC and KS. All authors contributed to manuscript review and approved the final version.
Funding This work was funded by Public Health England and the NHS Cervical Screening Programme (NHSCSP).
Competing interests KS works for the Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service of Public Health England, which has provided GlaxoSmithKline plc with postmarketing surveillance reports on HPV infections which the companies are required to submit to the UK licensing authority in compliance with their Risk Management Strategy. A cost recovery charge is made for these reports.
Provenance and peer review Commissioned; internally peer reviewed.
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