Comparative cost analysis of cervical cancer screening programme based on molecular detection of HPV in Spain

Abstract

Background HPV cervical cancer screening (CCS) must use validated HPV tests based on the molecular detection of either viral mRNA (Aptima HPV Assay—AHPV) or DNA. AHPV has demonstrated the same cross-sectional and longitudinal sensitivity for the detection of HSIL/CIN2+ lesions but with greater specificity than HPV-DNA tests. The study aimed to estimate the total costs of a CCS with a primary HPV test based on the detection of mRNA compared to DNA in women aged 35–65 years for the National Health System. Methods A decision-tree-based model to estimate the cost of the CCS until the first colposcopy was designed based on Spanish CCS guidelines. The total cost (€, 2019) for CCS with AHPV or DNA tests (HC2 and Cobas) was calculated, including HPV test, liquid-based cytology (LBC) and colposcopy, for a population of 7,263,529 women aged 35–65 years (assuming 70% coverage). Clinical inputs derived from a literature review were validated by a multidisciplinary expert panel. Data from head-to-head studies between different HPV tests were selected. Results The use of AHPV showed reduction of 290,541 (− 35%) and 355,913 (− 40%) LBC compared to HC2 or Cobas, respectively. Furthermore, AHPV avoided 151,699 (− 47%) colposcopies versus HC2 and 151,165 (− 47%) versus Cobas. The total cost of CCS was € 282,747,877 with AHPV, € 322,587,588 with HC2 and € 324,614,490 with Cobas. Therefore, AHPV savings € − 39,839,711 versus HC2 and € − 41,866,613 versus Cobas. Conclusions Assuming that 70% of women from 35 to 65 years attend the CCS programme, the cost of screening up to the first colposcopy using AHPV would provide cost savings of up to € 41.9 million versus DNA tests in Spain.

Performance of Aptima-HPV in the cervical cancer screening program of Portugal: a cost-analysis

“…This analysis is in line with the methodology of a previous study that compared the cost-effectiveness of high-risk HPV testing using a DNA-based assay and a mRNA-based assay under the US cervical cancer screening guidelines [8]. The same methodology was also used in recent studies in Europe, namely in the United Kingdom [25] and in Spain [26], where it was concluded that testing for HPV infection with mRNA-based assays generate less costs and consumes less health resources (i.e.,…”

Inter‐ and intraobserver agreement in whole‐slide digital ThinPrep samples of low‐grade squamous lesions of the cervix uteri with known high‐risk HPV status: A multicentric international study

“…All slides were annotated with regions of interest with a total of 576 annotations (mean, 6.12 [range, [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] annotations per case).…”

“…2 In Europe, many countries have implemented HR HPV primary screening programs either regionally or nationally. [3][4][5][6][7][8] In the era of HR HPV primary screening, the number of cervical cytology slides has dramatically decreased, but there is a relative increase in atypical cytological findings at least in the first screening round. 6,7 Low-grade changes of the squamous epithelia include both atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL).…”

“… 2 In Europe, many countries have implemented HR HPV primary screening programs either regionally or nationally. 3 , 4 , 5 , 6 , 7 , 8 In the era of HR HPV primary screening, the number of cervical cytology slides has dramatically decreased, but there is a relative increase in atypical cytological findings at least in the first screening round. 6 , 7 …”