BACKGROUND AND PURPOSE:

• There are multiple different strategies available for cervical cancer screening
• Sawaya et al. (JAMA Intern Med., 2019) estimated the cost-effectiveness as well as the quality of life outcomes of 12 cervical cancer screening strategies

METHODS:

• Cross-sectional study and cost-effectiveness analysis
• Participants
  • 4 focus groups
  • English or Spanish-speaking women aged 21-65 years
  • Sociodemographically diverse
  • Preferences elicited via interview and questionnaire
  • Natural history and test accuracy determined using model-predicted outcomes based on literature
• Overall 12 strategies were evaluated including currently recommended ACOG / USPSTF guidance
• Measures
  • Utilities (preferences) for 23 cervical cancer screening associated health states
• Data analysis
  • Analyses were conducted from both the societal and health care sector perspectives
  • Costs included screening, diagnosis and treatment, including cancer
• Primary outcomes
  • Quality-adjusted life-years (QALYs) and total costs for each strategy

RESULTS:

• 451 women helped to determine utilities
  • Mean [SD] age: 38.2 [10.7] years; 258 nonwhite [57.2%]
• Screening was cost-saving ($1267-$2577 per woman) vs no screening ($2891 per woman)
• Lowest cost strategy
  • Cytologic testing every 3 years with hrHPV triage of ASC-US
• Higher cost strategy
  • Cytologic testing every 3 years with repeat cytologic testing for ASC-US
• Fewer QALYs at higher costs
  • Cotesting and primary hrHPV testing
• Most costly strategy
  • Annual cytologic testing
  • Fewer QALYs than cytologic testing every 3 years
• Not cost-effective to
  • Perform cytologic testing plus hrHPV testing (cotesting) under any condition
  • To start primary hrHPV testing prior to age 30 years
  • To perform hrHPV testing every 3 years
  • To perform cytologic testing annually  

CONCLUSION:

• Superior strategy when considering benefits, harms, and costs were
  • Cytologic testing every 3 years for women aged 21 to 29 years with either
    • Continued cytologic testing every 3 years
    • Switching to a low-cost hrHPV test every 5 years

Learn More – Primary Sources:

Estimated Quality of Life and Economic Outcomes Associated With 12 Cervical Cancer Screening Strategies A Cost-effectiveness Analysis