Clinical impact and cost-effectiveness of primary cytology versus human papillomavirus testing for cervical cancer screening in England

Irenjeet Bains; Yoon Hong Choi; Katherine Soldan; Mark Jit

doi:10.1136/ijgc-2018-000161

Clinical impact and cost-effectiveness of primary cytology versus human papillomavirus testing for cervical cancer screening in England

Irenjeet Bains
, Yoon Hong Choi
, Katherine Soldan
, Mark Jit^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

19 Citations (Scopus)

Abstract

Objectives In England, human papillomavirus (HPV) testing is to replace cytological screening by 2019-2020. We conducted a model-based economic evaluation to project the long-term clinical impact and cost-effectiveness of routine cytology versus HPV testing. Methods An individual-based model of HPV acquisition, natural history, and cervical cancer screening was used to compare cytological screening and HPV testing with cytology triage for women aged 25-64 years (with either 3- or 5-year screening intervals for women aged under 50 years). The model was fitted to data from England's National Health Service Cervical Screening Programme. Both clinical and economic outcomes were projected to inform cost-effectiveness analyses. Results HPV testing is likely to decrease annual cytology testing (by 2.76 million), cervical cancer incidence (by 290 cases), and health system costs (by £13 million). It may increase the number of colposcopies, although this could be reduced without leading to more cancers compared with primary cytology by increasing the interval between screens to 5 years. The impact in terms of quality-adjusted life-years (QALYs) depends on the quality of life weight given to colposcopies versus cancer. Conclusions England's move from cytology to HPV screening may potentially be life-saving and cost-effective. Cost-effectiveness can be improved further by extending the interval between screens or using alternative triage methods such as partial or full genotyping.

Original language	English
Pages (from-to)	669-675
Number of pages	7
Journal	International Journal of Gynecological Cancer
Volume	29
Issue number	4
DOIs	https://doi.org/10.1136/ijgc-2018-000161
Publication status	Published - 1 May 2019

Bibliographical note

Funding Information:
Contributors IB and MJ designed the study, carried out the analysis, interpreted the data, and drafted the manuscript with input from YC and KS. All authors contributed to manuscript review and approved the final version. Funding This work was funded by Public Health England and the NHS Cervical Screening Programme (NHSCSP). Competing interests KS works for the Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service of Public Health England, which has provided GlaxoSmithKline plc with postmarketing surveillance reports on HPV infections which the companies are required to submit to the UK licensing authority in compliance with their Risk Management Strategy. A cost recovery charge is made for these reports.

Publisher Copyright:
© 2019 IGCS and ESGO. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

cervical cancer

Access to Document

10.1136/ijgc-2018-000161

Cite this

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title = "Clinical impact and cost-effectiveness of primary cytology versus human papillomavirus testing for cervical cancer screening in England",

abstract = "Objectives In England, human papillomavirus (HPV) testing is to replace cytological screening by 2019-2020. We conducted a model-based economic evaluation to project the long-term clinical impact and cost-effectiveness of routine cytology versus HPV testing. Methods An individual-based model of HPV acquisition, natural history, and cervical cancer screening was used to compare cytological screening and HPV testing with cytology triage for women aged 25-64 years (with either 3- or 5-year screening intervals for women aged under 50 years). The model was fitted to data from England's National Health Service Cervical Screening Programme. Both clinical and economic outcomes were projected to inform cost-effectiveness analyses. Results HPV testing is likely to decrease annual cytology testing (by 2.76 million), cervical cancer incidence (by 290 cases), and health system costs (by £13 million). It may increase the number of colposcopies, although this could be reduced without leading to more cancers compared with primary cytology by increasing the interval between screens to 5 years. The impact in terms of quality-adjusted life-years (QALYs) depends on the quality of life weight given to colposcopies versus cancer. Conclusions England's move from cytology to HPV screening may potentially be life-saving and cost-effective. Cost-effectiveness can be improved further by extending the interval between screens or using alternative triage methods such as partial or full genotyping.",

keywords = "cervical cancer",

author = "Irenjeet Bains and Choi, \{Yoon Hong\} and Katherine Soldan and Mark Jit",

note = "Funding Information: Contributors IB and MJ designed the study, carried out the analysis, interpreted the data, and drafted the manuscript with input from YC and KS. All authors contributed to manuscript review and approved the final version. Funding This work was funded by Public Health England and the NHS Cervical Screening Programme (NHSCSP). Competing interests KS works for the Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service of Public Health England, which has provided GlaxoSmithKline plc with postmarketing surveillance reports on HPV infections which the companies are required to submit to the UK licensing authority in compliance with their Risk Management Strategy. A cost recovery charge is made for these reports. Publisher Copyright: {\textcopyright} 2019 IGCS and ESGO. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ.",

year = "2019",

month = may,

day = "1",

doi = "10.1136/ijgc-2018-000161",

language = "English",

volume = "29",

pages = "669--675",

journal = "International Journal of Gynecological Cancer",

issn = "1048-891X",

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T1 - Clinical impact and cost-effectiveness of primary cytology versus human papillomavirus testing for cervical cancer screening in England

AU - Bains, Irenjeet

AU - Choi, Yoon Hong

AU - Soldan, Katherine

AU - Jit, Mark

N1 - Funding Information: Contributors IB and MJ designed the study, carried out the analysis, interpreted the data, and drafted the manuscript with input from YC and KS. All authors contributed to manuscript review and approved the final version. Funding This work was funded by Public Health England and the NHS Cervical Screening Programme (NHSCSP). Competing interests KS works for the Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service of Public Health England, which has provided GlaxoSmithKline plc with postmarketing surveillance reports on HPV infections which the companies are required to submit to the UK licensing authority in compliance with their Risk Management Strategy. A cost recovery charge is made for these reports. Publisher Copyright: © 2019 IGCS and ESGO. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ.

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Objectives In England, human papillomavirus (HPV) testing is to replace cytological screening by 2019-2020. We conducted a model-based economic evaluation to project the long-term clinical impact and cost-effectiveness of routine cytology versus HPV testing. Methods An individual-based model of HPV acquisition, natural history, and cervical cancer screening was used to compare cytological screening and HPV testing with cytology triage for women aged 25-64 years (with either 3- or 5-year screening intervals for women aged under 50 years). The model was fitted to data from England's National Health Service Cervical Screening Programme. Both clinical and economic outcomes were projected to inform cost-effectiveness analyses. Results HPV testing is likely to decrease annual cytology testing (by 2.76 million), cervical cancer incidence (by 290 cases), and health system costs (by £13 million). It may increase the number of colposcopies, although this could be reduced without leading to more cancers compared with primary cytology by increasing the interval between screens to 5 years. The impact in terms of quality-adjusted life-years (QALYs) depends on the quality of life weight given to colposcopies versus cancer. Conclusions England's move from cytology to HPV screening may potentially be life-saving and cost-effective. Cost-effectiveness can be improved further by extending the interval between screens or using alternative triage methods such as partial or full genotyping.

AB - Objectives In England, human papillomavirus (HPV) testing is to replace cytological screening by 2019-2020. We conducted a model-based economic evaluation to project the long-term clinical impact and cost-effectiveness of routine cytology versus HPV testing. Methods An individual-based model of HPV acquisition, natural history, and cervical cancer screening was used to compare cytological screening and HPV testing with cytology triage for women aged 25-64 years (with either 3- or 5-year screening intervals for women aged under 50 years). The model was fitted to data from England's National Health Service Cervical Screening Programme. Both clinical and economic outcomes were projected to inform cost-effectiveness analyses. Results HPV testing is likely to decrease annual cytology testing (by 2.76 million), cervical cancer incidence (by 290 cases), and health system costs (by £13 million). It may increase the number of colposcopies, although this could be reduced without leading to more cancers compared with primary cytology by increasing the interval between screens to 5 years. The impact in terms of quality-adjusted life-years (QALYs) depends on the quality of life weight given to colposcopies versus cancer. Conclusions England's move from cytology to HPV screening may potentially be life-saving and cost-effective. Cost-effectiveness can be improved further by extending the interval between screens or using alternative triage methods such as partial or full genotyping.

KW - cervical cancer

UR - https://www.scopus.com/pages/publications/85068163566

U2 - 10.1136/ijgc-2018-000161

DO - 10.1136/ijgc-2018-000161

M3 - Article

C2 - 31018938

AN - SCOPUS:85068163566

SN - 1048-891X

VL - 29

SP - 669

EP - 675

JO - International Journal of Gynecological Cancer

JF - International Journal of Gynecological Cancer

IS - 4

ER -

Clinical impact and cost-effectiveness of primary cytology versus human papillomavirus testing for cervical cancer screening in England

Abstract

Bibliographical note

UN SDGs

Keywords

Access to Document

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