Abstract
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 with the old programme. Colposcopy referrals of women without cervical intra-epithelial neoplasia grade 2 or worse, increased by 172%, but 13% more QALYs were still achieved. Total costs were reduced by 21%, mainly due to fewer screening tests. Per QALY gained, the hrHPV programme cost 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 was 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. Tweetable abstract: First results after implementation confirm that HPV screening is more cost-effective than cytology screening.
| Original language | English |
|---|---|
| Pages (from-to) | 573-582 |
| Number of pages | 10 |
| Journal | BJOG: An International Journal of Obstetrics and Gynaecology |
| Volume | 128 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Feb 2021 |
Bibliographical note
Funding Information:This study was funded by the EU‐Framework Programme (Horizon 2020; project reference 634753; PI: prof HJ de Koning, MD PhD, Erasmus MC) of the European Commission and by the Dutch National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu).
Funding Information:
This study was funded by the EU‐Framework Programme (Horizon 2020; project reference 634753; PI: prof HJ de Koning, MD PhD, Erasmus MC) of the European Commission and by the Dutch National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu). The grants did not include external peer review or priority assessment. The funders were not involved in the study design, performance of the analyses or writing of the paper.
Funding Information:
All authors report grants from the National Institute for Public Health and the Environment. EELJ, HJK, MB and IMCMK report grants from the European Commission during the conduct of the study. HJK reports speaker’s fees from University of Zürich/MSD outside the submitted work. Completed disclosure of interest forms are available to view online as supporting information.
Publisher Copyright:
© 2020 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists
Research programs
- EMC OR-01
