Cost‐effectiveness of HPV‐based cervical screening based on first year results in the Netherlands: a modelling study

Objective We aim to compare the cost‐effectiveness of the old cytology programme with the new high‐risk human papillomavirus (hrHPV) screening programme, using performance indicators from the new Dutch hrHPV screening programme. Design Model‐based cost‐effectiveness analysis. Setting The Netherlands...

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Bibliographic Details
Published in:	BJOG : an international journal of obstetrics and gynaecology Vol. 128; no. 3; pp. 573 - 582
Main Authors:	Jansen, EEL, Naber, SK, Aitken, CA, Koning, HJ, Ballegooijen, M, Kok, IMCM
Format:	Journal Article
Language:	English
Published:	England Wiley Subscription Services, Inc 01-02-2021 John Wiley and Sons Inc
Subjects:	Adult Cancer screening Cellular biology Cervical cancer Cervix Cervix Uteri - virology Colposcopy Colposcopy - economics Computer Simulation Cost-Benefit Analysis Costs Cytology early detection of cancer Early Detection of Cancer - economics Early Detection of Cancer - methods Epidemiology Female Human papillomavirus human papillomavirus DNA tests Humans Incidence Medical screening Middle Aged Models, Theoretical Mortality Netherlands Netherlands - epidemiology Original Orignal Papillomaviridae - isolation & purification Program Evaluation Quality-Adjusted Life Years Referral and Consultation - economics Sensitivity analysis uterine cervical neoplasms Uterine Cervical Neoplasms - diagnosis Uterine Cervical Neoplasms - economics Uterine Cervical Neoplasms - epidemiology Netherlands Cost-benefit analysis human papillomavirus DNA tests Netherlands early detection of cancer uterine cervical neoplasms
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Summary:	Objective We aim to compare the cost‐effectiveness of the old cytology programme with the new high‐risk human papillomavirus (hrHPV) screening programme, using performance indicators from the new Dutch hrHPV screening programme. Design Model‐based cost‐effectiveness analysis. Setting The Netherlands. Population Dutch 30‐year‐old unvaccinated females followed up lifelong. Methods We updated the microsimulation screening analysis (MISCAN) model using the most recent epidemiological and screening data from the Netherlands. We simulated both screening programmes, using the screening behaviour and costs observed in each programme. Sensitivity analyses were performed on screening behaviour, utility losses and discount rates. Main outcome measures Cervical cancer incidence and mortality rates, number of screening tests and repeat tests, colposcopy referrals by lesion grade, costs from a societal perspective, quality‐adjusted life years (QALYs) gained and cost‐effectiveness. Results The new Dutch cervical cancer screening programme decreased the cervical cancer mortality by 4% and the incidence by 1% compared with the old programme. Colposcopy referrals of women without cervical intra‐epithelial neoplasia grade 2 or worse, increased by 172%, but 13% more QALYs were still achieved. Total costs were reduced by 21%, mainly due to fewer screening tests. Per QALY gained, the hrHPV programme cost 46% less (€12,225) than the cytology programme (€22,678), and hrHPV‐based screening remained more cost‐effective in all sensitivity analyses. Conclusions The hrHPV‐based screening programme was found to be more effective and cost‐effective than the cytology programme. Alternatives for the current triage strategy should be considered to lower the number of unnecessary referrals. Tweetable First results after implementation confirm that HPV screening is more cost‐effective than cytology screening. Tweetable First results after implementation confirm that HPV screening is more cost‐effective than cytology screening.
Bibliography:	Linked article https://doi.org/10.1111/1471-0528.16449 This article is commented on by TJ Palmer, p. 583 in this issue. To view this mini commentary visit . ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Linked article: This article is commented on by TJ Palmer, p. 583 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.16449.
ISSN:	1470-0328 1471-0528
DOI:	10.1111/1471-0528.16400