Cost-effectiveness of HPV-based cervical screening based on first year results in the Netherlands : A modelling study

Erik E L Jansen, Steffie K Naber, Clare A Aitken, Harry J de Koning, Marjolein van Ballegooijen, Inge M C M de Kok
BJOG: An International Journal of Obstetrics and Gynaecology 2020 July 7

OBJECTIVE: We aim to compare the cost-effectiveness of the old cytology programme with the new high-risk human papillomavirus (hrHPV) screening programme, using performance indicators from the new Dutch hrHPV screening programme.

DESIGN: Model-based cost-effectiveness analysis.

SETTING: The Netherlands.

POPULATION: Dutch 30-year-old unvaccinated females followed up lifelong.

METHODS: We updated the microsimulation screening analysis (MISCAN) model using the most recent epidemiological and screening data from the Netherlands. We simulated both screening programmes, using the screening behaviour and costs observed in each programme. Sensitivity analyses were performed on screening behaviour, utility losses and discount rates.

MAIN OUTCOME MEASURES: Cervical cancer incidence and mortality rates, number of screening tests and repeat tests, colposcopy referrals by lesion grade, costs from a societal perspective, quality-adjusted life-years (QALYs) gained and cost-effectiveness.

RESULTS: The new Dutch cervical cancer screening programme decreased the cervical cancer mortality by 4% and the incidence by 1% compared to the old programme. Colposcopy referrals of women without cervical intraepithelial neoplasia grade 2 or worse increased by 172%, but 13% more QALY's were still gained. Total costs were reduced by 21%, mainly due to fewer screening tests. Per QALY gained, the hrHPV-programme costed 46% less (€12 225) than the cytology programme (€22 678) and hrHPV-based screening remained more cost effective in all sensitivity analyses.

CONCLUSIONS: The hrHPV-based screening programme is found to be more effective and cost effective than the cytology programme. Alternatives for the current triage strategy should be considered to lower the number of unnecessary referrals.

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