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Cost-effectiveness of high-risk human papillomavirus testing for cervical cancer screening in Québec, Canada.

PMID: 20737813 (view PubMed database entry)
DOI: 10.1007/bf03404377 (read at publisher's website )
PMCID: PMC6973910 (free full text version available)

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Arthi Vijayaraghavan, Molly B Efrusy, Marie-Hélêne Mayrand, Christopher C Santas, Patricia Goggin,

<h4>Objectives</h4>Human papillomavirus (HPV) testing is not widely used for triage of equivocal Pap smears or primary screening in Québec, Canada. Our objective was to evaluate the cost-effectiveness of cervical cancer screening strategies utilizing HPV testing.<h4>Methods</h4>We used a lifetime Markov model to estimate costs, quality of life, and survival associated with the following strategies: 1) cytology; 2) cytology with HPV testing to triage equivocal Pap smears; 3) HPV testing followed by colposcopy for HPV-positive women; 4) HPV testing with cytology to triage HPV-positive women; and 5) simultaneous HPV testing and cytology. Cytology was used in all strategies prior to age 30. Outcome measures included disease incidence, quality-adjusted life-years saved (QALYs), lifetime risk of cervical cancer, and incremental cost-effectiveness ratios.<h4>Results</h4>All strategies incorporating HPV testing as a primary screening test were more effective and less expensive than annual cytology alone, while HPV testing to triage equivocal Pap smears annually was very cost-effective ($2,991 per QALY gained compared to annual cytology alone). When compared to cytology every three years, HPV-based strategies cost an additional $8,200 to $13,400 per QALY gained.<h4>Conclusion</h4>Strategies incorporating HPV testing are not only more effective than screening based on cytology alone but are also highly cost-effective. Provincial policy-makers should evaluate incorporating HPV-based strategies into current cervical cancer screening guidelines.

Can J Public Health (Canadian journal of public health = Revue canadienne de sante publique)
[2010, 101(3):220-225]

Cited: 20 times

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