European cost-effectiveness analysis of cervical screening strategies for women not vaccinated for HPV: in many scenarios primary HPV screening is preferable to primary cytology screening in women aged over 30 years
- 1Department of Obstetrics and Gynaecology, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
- 2Harvard School of Public Health, Boston, Massachusetts, USA
- Correspondence to
Professor Lynette Denny
, Department of Obstetrics and Gynaecology, University of Cape Town, H45, Old Main Building, Groote Schuur Hospital, Observatory 7925, South Africa;
Commentary on: de Kok IM, van Rosmalen J, Dillner J, et al. Primary screening for human papillomavirus compared with cytology screening for cervical cancer in European settings: cost effectiveness analysis based on a Dutch microsimulation model. BMJ 2012;344:e670.
Implications for practice and research
In the absence of vaccination, primary screening using human papillomavirus (HPV) DNA testing for cervical cancer prevention is potentially cost-effective.
Costs associated with HPV testing must be kept low, particularly when background prevalence of HPV in the population is high.
Screening primarily with cytology was preferred when cytology costs were low, despite lower sensitivity and specificity.
For the same number of quality-adjusted life year's (QALY) gained, fewer lifetime HPV tests were required as a primary screening test (five vs eight for cytology); however, cytology remained the cheaper option.
There is ‘no one size fits all’ situation and each country should assess several factors when deciding on cervical cancer screening, including laboratory infrastructure and accessibility to effective treatment.
Establishing country-specific estimates for factors, including background HPV prevalence, …