Long-term costs of introducing HPV-DNA post-treatment surveillance to national cervical cancer screening in Ireland

Abstract

Introduction Co-testing (cytology plus human papillomavirus DNA testing) as part of cervical cancer surveillance in Ireland increases one-time testing costs. Of interest to policy makers was the long-term impact of these costs accompanied by decreases in intensity of recalls for women with no detected abnormalities. Methods A cost-analysis of cytology-only and co-testing was implemented using decision analytic modeling, aggregating testing utilization and costs for each of the two strategies over 12 years. Results Aggregated incremental costs of the co-testing strategy were positive for the first 3 years but became negative thereafter, generating a cost savings of roughly €20 million in favor of the cytology-only strategy over a 12-year period. Results were robust over a range of sensitivity analyses with respect to discount and attrition rates. Discussion This analysis provided valuable information to policy makers contributing to the introduction of co-testing for post-treatment surveillance in Ireland.

The 5-year risk of recurrence of grade 2/3 cervical intraepithelial neoplasia after treatment in a population screening programme by human papillomavirus status: A cohort study in central Italy

“…In the past, Pap tests were used in follow-up, but this tool has now been replaced by HPV testing. Two recent studies found that strategies with co-testing 24 or HPV testing alone 25 were cost-effective compared to the previous standard follow-up strategy (Pap test alone 24 or Pap test and colposcopy 25 ). HPV testing has a high negative predictive value, 2,5 and there is thus a high probability that subjects with a negative HPV test result really do not have the disease.…”