Projected cost‐effectiveness of repeat high‐risk human papillomavirus testing using self‐collected vaginal samples in the Swedish cervical cancer screening program. (22nd April 2013)

• Record Type: Journal Article
• Authors: Östensson, Ellinor; Hellström, Ann‐Cathrin; Hellman, Kristina; Gustavsson, Inger; Gyllensten, Ulf; Wilander, Erik; Zethraeus, Niklas; Andersson, Sonia
• Is Part Of: Acta obstetricia et gynecologica Scandinavica. Volume 92:Number 7(2013)
• Page Start: 830
• Page End: 840
• Publication Date: 2013-04-22
• Subjects: Cervical cancer -- cost‐effectiveness -- human papillomavirus (HPV) -- screening -- self‐sampling; Gynecology -- Periodicals; Pregnancy -- Periodicals; Obstetrics -- Periodicals; 618.05
• DOI: 10.1111/aogs.12143
• Languages: English
• ISSNs: 0001-6349

Abstract

Abstract: Background: Human papillomavirus (HPV) testing is not currently used in primary cervical cancer screening in Sweden, and corresponding cost‐effectiveness is unclear. Objective: From a societal perspective, to evaluate the cost‐effectiveness of high‐risk (HR)‐HPV testing using self‐collected vaginal samples. Design: A cost‐effectiveness analysis. Setting: The Swedish organized cervical cancer screening program. Methods: We constructed a model to simulate the natural history of cervical cancer using Swedish data on cervical cancer risk. For the base‐case analysis we evaluated two screening strategies with different screening intervals: (i) cytology screening throughout the woman's lifetime (i.e. "conventional cytology strategy") and (ii) conventional cytology screening until age 35 years, followed by HR‐HPV testing using self‐collected vaginal samples in women aged ≥35 years (i.e. "combination strategy"). Sensitivity analyses were performed, varying model parameters over a significant range of values to identify cost‐effective screening strategies. Main outcome measures: Average lifetime cost, discounted and undiscounted life‐years gained, reduction in cervical cancer risk, incremental cost‐effectiveness ratios with and without the cost of added life‐years. Results: Depending on screening interval, the incremental cost‐effectiveness ratios for the combination strategy ranged from €43 000 to €180 000 per life‐years gained without the cost of added life‐years, and from €74 000 to €206 000 with costs of added life‐years included. Conclusion: The combination strategy with a 5‐year screening interval is potentially cost‐effective compared with no screening, and with current screening practice when using a threshold value of €80 000 per life‐years gained.