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Grand Rounds

Cervical Cancer Screening Strategies and Cost-Effectiveness: Which is the Best?

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BACKGROUND AND PURPOSE:

  • There are multiple different strategies available for cervical cancer screening
  • Sawaya et al. (JAMA Intern Med., 2019) estimated the cost-effectiveness as well as the quality of life outcomes of 12 cervical cancer screening strategies

METHODS:

  • Cross-sectional study and cost-effectiveness analysis
  • Participants
    • 4 focus groups
    • English or Spanish-speaking women aged 21-65 years
    • Sociodemographically diverse
    • Preferences elicited via interview and questionnaire
    • Natural history and test accuracy determined using model-predicted outcomes based on literature
  • Overall 12 strategies were evaluated including currently recommended ACOG / USPSTF guidance
  • Measures
    • Utilities (preferences) for 23 cervical cancer screening associated health states
  • Data analysis
    • Analyses were conducted from both the societal and health care sector perspectives
    • Costs included screening, diagnosis and treatment, including cancer
  • Primary outcomes
    • Quality-adjusted life-years (QALYs) and total costs for each strategy

RESULTS:

  • 451 women helped to determine utilities
    • Mean [SD] age: 38.2 [10.7] years; 258 nonwhite [57.2%]
  • Screening was cost-saving ($1267-$2577 per woman) vs no screening ($2891 per woman)
  • Lowest cost strategy
    • Cytologic testing every 3 years with hrHPV triage of ASC-US
  • Higher cost strategy
    • Cytologic testing every 3 years with repeat cytologic testing for ASC-US
  • Fewer QALYs at higher costs
    • Cotesting and primary hrHPV testing
  • Most costly strategy
    • Annual cytologic testing
    • Fewer QALYs than cytologic testing every 3 years
  • Not cost-effective to
    • Perform cytologic testing plus hrHPV testing (cotesting) under any condition
    • To start primary hrHPV testing prior to age 30 years
    • To perform hrHPV testing every 3 years
    • To perform cytologic testing annually  

CONCLUSION:

  • Superior strategy when considering benefits, harms, and costs were
    • Cytologic testing every 3 years for women aged 21 to 29 years with either
      • Continued cytologic testing every 3 years
      • Switching to a low-cost hrHPV test every 5 years

Learn More – Primary Sources:

Estimated Quality of Life and Economic Outcomes Associated With 12 Cervical Cancer Screening Strategies A Cost-effectiveness Analysis

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Related ObG Topics:

Guidance Update: Professional Organizations Align on Cervical Cancer Screening
Cervical Cancer Screening Guidelines: The Role of Pap and HPV
What is the Most Efficient Method for Cervical Cancer Screening?
Urine Samples to Detect HPV?
HPV Testing vs PAP Smear: Results of the HPV FOCAL Trial

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