Cost‐Effectiveness of Computer‐Assisted Cytology in a Primary hrHPV‐Based Cervical Cancer Screening Programme

• Published in: Cancer medicine (Malden, MA) Vol. 13; no. 19; pp. e70299 - n/a
• Main Authors: Olthof, Ellen M. G., Kaljouw, S., Kemenade, Folkert J., Uyterlinde, Anne M., Kok, Inge M. C. M.
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01-10-2024; John Wiley and Sons Inc; Wiley
• Subjects: Adult; Cancer screening; Cellular biology; Cervical cancer; cervical cancer screening; Cervix; computer‐assisted cytology; computer‐assisted screening; Cost analysis; Cost-Benefit Analysis; Cytology; Diagnosis, Computer-Assisted - economics; Diagnosis, Computer-Assisted - methods; Early Detection of Cancer - economics; Early Detection of Cancer - methods; Female; hrHPV screening; Human papillomavirus; Humans; Infections; Laboratories; Mass Screening - economics; Mass Screening - methods; Medical screening; Papillomavirus Infections - diagnosis; Papillomavirus Infections - economics; Papillomavirus Infections - virology; Pilot projects; Probability; Productivity; Quality-Adjusted Life Years; Triage - economics; Triage - methods; Uterine Cervical Dysplasia - diagnosis; Uterine Cervical Dysplasia - economics; Uterine Cervical Dysplasia - pathology; Uterine Cervical Dysplasia - virology; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - economics; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - virology; Vaccines; Vaginal Smears - economics; Vaginal Smears - methods; United States > US; computer‐assisted cytology; cervical cancer screening; hrHPV screening; computer‐assisted screening; cervical cancer
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.70299

ABSTRACT
Background
Computer‐assisted screening (CAS) shows equal performance compared to manual screening, although results are heterogeneous. Furthermore, using CAS may save costs through a potentially increased screening productivity of technicians, therefore also offering a solution for temporary and structural capacity shortage. We evaluated the circumstances under which CAS will be cost‐effective compared to manual cytology triage in a primary HPV‐based cervical screening programme.
Methods
Microsimulation model MISCAN‐Cervix was used to evaluate 198 different CAS scenarios with varying probabilities to detect cervical intraepithelial neoplasia grade 1 (CIN1) and CIN3 and cost reductions per test, compared to manual cytology triage. Cost‐effectiveness was evaluated by costs per (quality‐adjusted) life year ((QA)LY) gained.
Results
CAS will be cost‐effective in all scenarios, except for the following combinations: (1) no cost reduction and an increased probability of detecting CIN1, (2) a cost reduction of €2 per test and an increased probability of detecting CIN1 from 4% onwards or (3) a cost reduction of €4 per test and an increased probability of detecting CIN1 from 6% onwards, compared to manual cytology triage. All CAS scenarios with any reduction in the probability of detecting CIN1 (i.e., increased CIN2+ specificity), or a reduction in costs from €6 per test onwards suggested a more cost‐effective strategy compared to manual cytology triage.
Conclusion
As we based our analysis on a realistic range in costs and test performance, the implementation of CAS is likely to be cost‐effective. Our results can be used as a guideline to advise when to choose CAS instead of manual cytology triage.
Computer‐assisted screening (CAS) is an evident substitute for manual cytology screening as a triage test in a primary HPV‐based setting. This is the first study investigating under which circumstances CAS is cost‐effective in a primary HPV‐based screening programme. We showed that in case of increased CIN2+ specificity and cost reduction from €6 per test, CAS was more cost‐effective than manual cytology triage. So, implementing CAS is likely to be cost‐effective in primary HPV‐based screening, which can guide decision‐making.