Comparative cost analysis of cervical cancer screening programme based on molecular detection of HPV in Spain

R Ibáñez,D Andía,I Oyagüez,M García-Rojo,J C Quílez,M Mareque,R Granados

doi:10.1186/s12905-021-01310-8

Abstract

BackgroundHPV cervical cancer screening (CCS) must use validated HPV tests based on the molecular detection of either viral mRNA (Aptima HPV Assay—AHPV) or DNA. AHPV has demonstrated the same cross-sectional and longitudinal sensitivity for the detection of HSIL/CIN2+ lesions but with greater specificity than HPV-DNA tests. The study aimed to estimate the total costs of a CCS with a primary HPV test based on the detection of mRNA compared to DNA in women aged 35–65 years for the National Health System.MethodsA decision-tree-based model to estimate the cost of the CCS until the first colposcopy was designed based on Spanish CCS guidelines. The total cost (€, 2019) for CCS with AHPV or DNA tests (HC2 and Cobas) was calculated, including HPV test, liquid-based cytology (LBC) and colposcopy, for a population of 7,263,529 women aged 35–65 years (assuming 70% coverage). Clinical inputs derived from a literature review were validated by a multidisciplinary expert panel. Data from head-to-head studies between different HPV tests were selected.ResultsThe use of AHPV showed reduction of 290,541 (− 35%) and 355,913 (− 40%) LBC compared to HC2 or Cobas, respectively. Furthermore, AHPV avoided 151,699 (− 47%) colposcopies versus HC2 and 151,165 (− 47%) versus Cobas. The total cost of CCS was € 282,747,877 with AHPV, € 322,587,588 with HC2 and € 324,614,490 with Cobas. Therefore, AHPV savings € − 39,839,711 versus HC2 and € − 41,866,613 versus Cobas.ConclusionsAssuming that 70% of women from 35 to 65 years attend the CCS programme, the cost of screening up to the first colposcopy using AHPV would provide cost savings of up to € 41.9 million versus DNA tests in Spain.

Highlights

HPV cervical cancer screening (CCS) must use validated HPV tests based on the molecular detection of either viral mRNA (Aptima HPV Assay—Aptima human papillomavirus (AHPV)) or DNA
The initial analysis defined as the base case, was performed in women aged 35–65 years, where the primary screening was performed with HPV testing
This study showed rates of 7.5%, 11.50% and 12.40% for AHPV, Hybrid Capture 2 (HC2) and Cobas 4800, respectively (Table 1)

Summary

Introduction

HPV cervical cancer screening (CCS) must use validated HPV tests based on the molecular detection of either viral mRNA (Aptima HPV Assay—AHPV) or DNA. The study aimed to estimate the total costs of a CCS with a primary HPV test based on the detection of mRNA compared to DNA in women aged 35–65 years for the National Health System. According Globocan estimation in 2018, the standardized mortality is 6.9 per 105 women over the world, In Spain, one of the countries with the lowest incidence of this cancer in the world, the incidence of cervical cancer is around 5.2 × 105 women, and the cervical cancer related mortality is 1.7 cases per 100,000 women per year [1] In absolute numbers, these figures represent 1900 cervical cancer diagnoses and 825 deaths per year [1]. It is very common among the sexually active population, reaching the highest prevalence at the beginning of sexual intercourse, with a marked decrease after 30 years of age [4, 5]

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