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; lynette.denny{at}uct.ac.za
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
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In the absence of vaccination, primary screening using human papillomavirus (HPV) DNA testing for cervical cancer prevention is potentially cost-effective.
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Costs associated with HPV testing must be kept low, particularly when background prevalence of HPV in the population is high.
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Screening primarily with cytology was preferred when cytology costs were low, despite lower sensitivity and specificity.
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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.
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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.
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Establishing country-specific estimates for factors, including background HPV prevalence, …
