Incorporating testing for human papillomavirus (HPV) DNA into cervical cancer screening has the potential for improving health benefits at a reasonable cost in France, Italy, the Netherlands, and the United Kingdom, according to a new study in the June 15 issue of the Journal of the National Cancer Institute.
Cervical cancer screening has been shown to decrease mortality from the disease. The discovery that HPV infection is the cause of most cervical cancers has led to some countries to incorporate HPV DNA testing into national screening programs. For example, in the United States, HPV testing is used as both a triage strategy in the case of uncertain Pap test results and in combination with cytology in women older than age 30. Many European countries with established cytology-based cervical cancer screening programs will soon face the decision of whether to incorporate HPV DNA testing into their programs and which strategies will be the most cost-effective.
To assess the cost-effectiveness of incorporating HPV DNA testing into the cervical cancer screening programs of France, Italy, the Netherlands, and the United Kingdom, Jane J. Kim, M.S., and Sue J. Goldie, M.D., M.P.H., of the Harvard School of Public Health in Cambridge, Mass., and Thomas C. Wright, M.D., of Columbia University in New York, created a computer-based model of the natural history of cervical carcinogenesis and compared each country's current screening policy with two new strategies: (1) cytology (i.e., Pap tests) throughout a woman's lifetime with HPV DNA testing as a triage strategy for abnormal cytology results and (2) cytology until age 30 followed by HPV DNA testing in combination with cytology after age 30.
Both HPV DNA testing strategies were more effective than each country's current cytology-based screening program. The cost-effectiveness ratios for the triage strategy were less than $13,000 per year of life saved in all four countries. For the combination testing strategy, the cost-effectiveness ranged from $9,800 to $75,900 per year of life saved, depending on the screening interval. The authors conclude that HPV DNA testing can improve health benefits at a reasonable cost in the four countries studied.
"The development of sound clinical guidelines and public health policy requires careful consideration of the incremental benefits, harms, and costs that are associated with new technology and its adoption into existing screening strategies, compared with the status quo," the authors write. "As a result of the rapid infusion of new technologies for cervical cancer screening, there is an increased need for policy evaluation to guide such investments."