An economic analysis of human papillomavirus triage for the management of women with atypical and abnormal Pap smear results in Germany

Abstract

We developed decision-analytic models to determine the cost effectiveness of incorporating human papillomavirus (HPV) testing into the management of atypical and abnormal Pap smear results in Germany. The models compare three management strategies: (1) repeat Pap smear, (2) triage with HPV DNA testing, or (3) immediate treatment. The primary outcome measure is incremental cost per case of cervical intraepithelial neoplasia (CIN) 2+ detected and treated. The models take the perspective of the German health system. For patients with initial PapIIw, III, and IIId results, incremental cost effectiveness ratios for HPV triage versus repeat Pap smears are 2,232 euro, 815 euro, and 487 euro per additional case of CIN2+ detected and treated. In addition, the number of cases of CIN2+ detected and treated in a hypothetical population of 1,000 women increases from 17 to 35, 61 to 130, and 157 to 332 for each population, respectively. For patients with initial PapIII and IIId results, immediate treatment of 1,000 patients detects only four and 11 additional cases of CIN2+ versus HPV triage at incremental cost effectiveness ratios of 39,684 euro and 10,716 euro per case, respectively. For each of the populations evaluated, HPV triage is the most cost-effective management strategy versus either repeat Pap smear or immediate treatment.

A pilot study of HPV DNA and cytology testing in 50,159 women in the routine Mexican Social Security Program

“…HR-HPV testing has proven to be a highly sensitive screening tool for cervical cancer precursor lesions and has been successfully used in diverse clinical settings; clinical trials and epidemiological studies have demonstrated the suitability of testing for HR-HPV in population-based programs in women older than 35 years of age [31,32]. There is also evidence showing that HR-HPV testing increases the positive predictive value for identifying CIN2/3?…”

Cost-effectiveness of a tetravalent human papillomavirus vaccine in Germany

“…The model was structurally adapted to reflect the current screening pathways in Germany in the case of abnormal results, although substantial differences exist among general physicians in terms of management (Sheriff et al 2007). …”

“…Discussion Although previous studies have assessed the cost-effectiveness of HPV vaccination in other European countries (Bergeron et al 2008;Dasbach et al 2008), this is the first analysis conducted on HPV vaccination Germany. Until now, cost-effectiveness studies specific to Germany have focussed on the cost-effectiveness of several screening strategies (Mittendorf et al 2003;Siebert et al 2004;Sheriff et al 2007). Based on a vaccination coverage rate of 80%, the use of a quadrivalent vaccine alongside the current national cervical cancer screening programme was found to be a cost-effective public health initiative compared to screening alone, with an incremental cost per QALY gained and LYG gained that was well within the accepted threshold for cost-effectiveness in Germany (Siebert et al 2004).…”

“…It may happen that some girls received only two doses instead of three, although it is difficult to make an assumption on this. Lastly, previous German economic studies suggested that HPV testing would improve screening performance (Sheriff et al 2007). However, we decided not to include HPV testing in our analysis as HPV testing is not standard practice in Germany.…”

Cost-Effectiveness of 21 Alternative Cervical Cancer Screening Strategies

“…Several economic evaluations comparing alternative CC screening algorithms have been published in the extant literature [5][6][7][8][9][10][11][12][13][14]. While these studies identify whether alternatives are more/less costly and more/less effective, they do not provide any indication of the resource impacts to disparate sectors of the health system from which decision makers can use to strategize…”