The Potential Cost-Effectiveness of Extended Genotyping in US Cervical Cancer Screening Paradigms [14Q]. (May 2018)

• Record Type: Journal Article
• Authors: Asjes, Caitlin; Andrews, Jeff
• Is Part Of: Obstetrics and gynecology. Volume 131(2018)Supplement 1
• Publication Date: 2018-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/01.AOG.0000533227.52261.92
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : INTRODUCTION: A multitude of factors determine a women's risk of cervical cancer and also determine the most cost-effective patient management. HPV extended genotyping (XGT) can support patient triage and management via individual risk stratification. It's important to understand the potential clinical and economic impact of adding XGT into existing screening paradigms. METHODS: An Excel-based budget impact model was calibrated for the US population. Disease and genotype-specific prevalence was derived from the BD Onclarity Clinical Trial and published literature. The model compares: Cytology-based screening with ASCUS triage by HPV DNA testing and Co-testing. Each scenario compared a pooled HPV assay and one reporting high-risk genotypes individually. The model follows patients through one screening cycle and compares disease outcomes (CIN2+) and costs. RESULTS: The initial results demonstrate the use of XGT has the potential to increase cervical cancer and CIN2+ disease detection. While under certain scenarios there may be a minor increase in colposcopies performed, this analysis shows that by utilizing XGT up to 50% more high-risk genotypes would be referred to colposcopy, with more lower-risk genotypes being deferred to a 1 year follow-up. By this mechanism the model suggests that XGT will increase the colposcopy yield and decrease costs. CONCLUSION: Incorporating XGT into the existing screening paradigms could lead to improved patient outcomes and lower costs in the US. While this model only looked at the impact of the first screen, further research is recommended into the impact of XGT on persistence tracking and individualized patient management over time.