A model developed using data from health care databases and published literature has found that Pap plus human papillomavirus (HPV) mRNA testing that includes genotying for HPV 16 and 18 may be a more effective clinical and economic method of cervical cancer screening than DNA-based primary HPV testing with HPV 16/18 genotyping and reflex cytology (HPV primary).
The development of effective screening guidelines and advancements in medical technology has helped cervical cancer go from the number one cause of cancer-related death in women to 14th. However, despite these gains, an estimated 12,900 patients will be diagnosed with the condition in 2016 and 4100 expected to die of the disease. Currently, Pap plus HPV testing is recommended for women 30 to 65 years of age while only one test is recommended for patients aged 21 to 30. However, controversies have emerged regarding the appropriate use of the tests, with questions about how cost-effective the strategies really are.
Researchers led by Jeffrey D Miller, MS, Truven Health Analytics (Cambridge, MA), compared the clinical and economic benefits of co-testing with HPV primary using a hypothetical cohort of 1 million 30-year-old women modeled up to age 70 years. They assessed both strategies by looking at the number of deaths from cervical cancer, expected quality-adjusted life years (QALYs), and estimated costs associated with each method. They published their results in the Journal of Women’s Health.
Results from the model revealed per patient costs of $2326 for co-testing and $2365 for HPV primary. Overall, the total savings equaled ~$39 million with co-testing compared with HPV primary. Likewise co-testing demonstrated a greater number of QALYs gained (22,334).
Only one more patient died in the HPV primary group (21 per 10,000) than in the co-testing group (20 per 10,000), but additional analysis revealed that HPV primary testing instead of co-testing could lead to as many as 2141 more cases of cervical cancer and 2041 deaths more deaths related to the disease.
Thus, researchers concluded that co-testing for cervical cancer could potentially improve clinical and economic outcomes compared to HPV primary testing, which could be important information for health care payers, patient advocates, and physicians to consider as they look to identify more cost-effective cervical cancer screening strategies.
