Cost-effectiveness of using human papillomavirus 16/18 genotype triage in cervical cancer screening

Abstract

Objective Testing for human papillomavirus (HPV) 16 and 18 genotypes, which are known to cause approximately 65–70% of invasive cervical cancer cases, may allow clinicians to identify women at highest risk for underlying cervical intraepithelial neoplasia missed by Pap cytology. Our objective was to determine the cost-effectiveness of adding HPV-16 and 18 genotype triage to current cervical cancer screening strategies in the United States. Methods We developed a lifetime Markov model to assess the cost-effectiveness of the following cervical cancer screening algorithms: (1) liquid-based cytology (LBC), (2) LBC + HPV triage, (3) HPV + LBC triage, (4) co-screening, (5) co-screening + HPV genotyping, and (6) HPV only + HPV genotyping. Costs were estimated from a payer perspective in 2007 U.S. dollars. Outcome measures included lifetime risk of cervical cancer, quality-adjusted life years saved (QALYs), and incremental cost-effectiveness ratios (ICERs). Results In our model, the use of HPV genotyping strategies prevented 51–73 deaths per 100,000 women screened compared to screening using LBC followed by HPV triage and 4–26 deaths compared to co-screening with LBC and high-risk HPV. Use of HPV genotyping to triage all high-risk HPV-positive women every three years had an ICER of $34,074 per QALY compared to HPV and LBC co-screening. HPV genotyping with co-screening was the most effective strategy and had an ICER of $33,807 per QALY compared to HPV genotyping for all high-risk HPV-positive women. Conclusion The addition of HPV-16 and -18 genotype triage to HPV and LBC co-screening was a cost-effective screening strategy in the United States.