Cost-effectiveness of cervical cancer screening with primary HPV testing for unvaccinated women in Sweden

Abstract

Background Sweden revised their cervical cancer screening program in 2017 to include cytology-based screening for women aged 23-29 years and primary human papillomavirus (HPV) testing for women aged 30-64 years; however, alternative strategies may be preferred. To inform cervical cancer prevention policies for unvaccinated women, we evaluated the cost-effectiveness of alternative screening strategies, including the current Swedish guidelines. Methods We adapted a mathematical simulation model of HPV and cervical cancer to the Swedish context using primary epidemiologic data. We compared the cost-effectiveness of alternative screening strategies that varied by the age to start screening, the age to switch from cytology to HPV testing, HPV strategies not preceded by cytology, screening frequency, and management of HPV-positive/cytology-negative women. Results We found that the current Swedish guidelines were more costly and less effective than alternative primary HPV-based strategies. All cost-efficient strategies involved primary HPV testing not preceded by cytology for younger women. Given a cost-effectiveness threshold of €85,619 per quality-adjusted life year gained, the optimal strategy involved 5-yearly primary HPV-based screening for women aged 23-50 years and 10-yearly HPV-based screening for women older than age 50 years. Conclusions Primary screening based on HPV alone may be considered for unvaccinated women for those countries with similar HPV burdens.

Results from a cervical cancer screening program in Samsun, Turkey

“…Since various risk factors (such as multiparity, oral contraceptive use, smoking, and immunosuppression) are known to increase the risk of HSIL in women infected with HPV, we think that the difference is due to this situation [30]. It is remarkable that in 484 (35.0%) of 1379 women who participated in the screening program and were HPV 16/18 positive, the cytology result was normal, suggesting that HPV scanning is more effective than cytology, similar to the literature [17,31,32]. WHO global call stressed that every country should not reach the goals of 90-70-90 by 2030 in order to embark on the path of eliminating cervical cancer in the next century [6].…”

“…In many countries such as the United States, Australia, Netherlands, Italy, Norway, and Sweden, HPV testing is applied for screening purposes [17][18][19]. HPV-positivity may indicate different results as per the regions.…”

High prevalence of and factors associated with human papillomavirus infection among women attending a tertiary hospital in Gauteng Province, South Africa

“…Advances in cervical cancer screening technologies have introduced HPV testing due to the higher sensitivity for precancer and cancer detection than cytology [14]. In primary HPV screening programs, two types of hr-HPV assays are used; HPV tests that are very sensitive for HPV deoxyribonucleic acid (DNA) detection and HPVspecific tests that target HPV E6/E7 oncogenes with high specificity but lower sensitivity [15].…”

Human exposome assessment platform

“…22 For applications based on microsimulation, we recently modeled for the cost-effectiveness of cervical cancer screening. 23 These results have been presented to the National Board of Health and Welfare, and we plan to use this model to evaluate the upcoming Swedish cervical screening guidelines.…”