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.
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 Kim and Sue Goldie of the Harvard School of Public Health in Cambridge, Mass., and Thomas Wright of Columbia University in New York, created a computer-based model of the natural history of cervical carcinogenesis.
They compared each country's current screening policy with two new strategies: cytology throughout a woman's lifetime with HPV DNA testing as a triage strategy for abnormal cytology results and 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.
MEDICA.de; Source: Journal of the National Cancer Institute