Inefficiencies and High-Value Improvements in U.S. Cervical Cancer Screening Practice

Abstract

Background Studies suggest that cervical cancer screening practice in the United States is inefficient. The cost and health implications of non-compliance in the screening process compared to recommended guidelines are uncertain. Objective To estimate the benefits, costs, and cost-effectiveness of current cervical cancer screening practice and assess the value of screening improvements. Design Model-based cost-effectiveness analysis. Data Sources New Mexico HPV Pap Registry; medical literature. Target Population Cohort of women eligible for routine screening. Time Horizon Lifetime. Perspective Societal. Interventions Current cervical cancer screening practice; improved compliance to guidelines-based screening interval, triage testing, diagnostic referrals, and precancer treatment referrals. Outcome Measures Reductions in lifetime cervical cancer risk, quality-adjusted life-years (QALYs), lifetime costs, incremental cost-effectiveness ratios (ICERs), incremental net monetary benefits (INMBs Results of Base-Case Analysis Current screening practice was associated with lower health benefit and was not cost-effective relative to guidelines-based strategies. Improvements in the screening process were associated with higher QALYs and small changes in costs. Perfect c4mpliance to a 3-yearly screening interval and to colposcopy/biopsy referrals were associated with the highest INMBs ($759 and $741, respectively, at a willingness-to-pay threshold of $100,000 per QALY gained); together, the INMB increased to $1,645. Results of Sensitivity Analysis Current screening practice was inefficient in 100% of simulations. The rank ordering of screening improvements according to INMBs was stable over a range of screening inputs and willingness-to-pay thresholds. Limitations The impact of HPV vaccination was not considered. Conclusions The added health benefit of improving compliance to guidelines, especially the 3-yearly interval for cytology screening and diagnostic follow-up, may justify additional investments in interventions to improve U.S. cervical cancer screening practice. Funding Source U.S. National Cancer Institute.

Optimal Cervical Cancer Screening in Women Vaccinated Against Human Papillomavirus

“…Individual girls enter the model at an early age (ie, 9 years) prior to HPV acquisition and transition between mutually exclusive health states that represent clinically relevant stages of cervical disease (Supplementary Figure 1, available online) (13,14). Transitions to and from the HPV health states are governed by persistence of type-specific infection (ie, time since HPV acquisition) and can vary by factors such as age, history of prior HPV infection, and patterns of vaccination and screening.…”

“…In order to reflect the uncertainty in the natural history inputs, we utilized the 50 topfitting parameter sets for all analyses and calculated the expected value, as well as a range of values, for all outcomes. Descriptions of the model development process, including parameter estimation, model calibration, and model validation, have been previously published (13,14); details of model inputs and calibration results for this particular analysis are provided in the Supplementary Material (Supplementary Table 1 and Supplementary Figure 2, available online).…”

Advancing the evaluation of cervical cancer screening: development and application of a longitudinal adherence metric

“…Improving adherence among women that consistently never-or under-screen is expected to improve the effectiveness and efficiency of organised screening (24,25).…”

Using novel biomarkers to triage young adult women with minor cervical lesions: a cost‐effectiveness analysis

“…The model has been adapted to evaluate CC prevention policies in several settings, such as the US [83,85,[149][150][151], Norway [63,152,153] and other European countries [154], as well as developing countries [155][156][157]. The most recent version of the model [145] (used in Assuming that the underlying mechanism of cervical carcinogenesis does not vary across settings, the baseline parameter inputs for the natural history parameters were estimated from large epidemiologic studies and described in detail elsewhere [145].…”