Open AccessProjected cost‐effectiveness of repeat high‐risk human papillomavirus testing using self‐collected vaginal samples in the Swedish cervical cancer screening program
Author(s) -
Östensson Ellinor,
Hellström AnnCathrin,
Hellman Kristina,
Gustavsson Inger,
Gyllensten Ulf,
Wilander Erik,
Zethraeus Niklas,
Andersson Sonia
Publication year - 2013
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.12143
Subject(s) - medicine , cost effectiveness , cervical cancer , gynecology , cervical cancer screening , cost effectiveness analysis , obstetrics , confidence interval , human papillomavirus , quality adjusted life year , cancer , risk analysis (engineering)
Background Human papillomavirus ( HPV ) testing is not currently used in primary cervical cancer screening in Sweden, and corresponding cost‐effectiveness is unclear. Objective From a societal perspective, to evaluate the cost‐effectiveness of high‐risk ( HR )‐ HPV testing using self‐collected vaginal samples. Design A cost‐effectiveness analysis. Setting The Swedish organized cervical cancer screening program. Methods We constructed a model to simulate the natural history of cervical cancer using Swedish data on cervical cancer risk. For the base‐case analysis we evaluated two screening strategies with different screening intervals: (i) cytology screening throughout the woman's lifetime (i.e. “conventional cytology strategy”) and (ii) conventional cytology screening until age 35 years, followed by HR ‐ HPV testing using self‐collected vaginal samples in women aged ≥35 years (i.e. “combination strategy”). Sensitivity analyses were performed, varying model parameters over a significant range of values to identify cost‐effective screening strategies. Main outcome measures Average lifetime cost, discounted and undiscounted life‐years gained, reduction in cervical cancer risk, incremental cost‐effectiveness ratios with and without the cost of added life‐years. Results Depending on screening interval, the incremental cost‐effectiveness ratios for the combination strategy ranged from €43 000 to €180 000 per life‐years gained without the cost of added life‐years, and from €74 000 to €206 000 with costs of added life‐years included. Conclusion The combination strategy with a 5‐year screening interval is potentially cost‐effective compared with no screening, and with current screening practice when using a threshold value of €80 000 per life‐years gained.