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Which Cervical Cancer Screening Is Most Cost-Effective?

Cervical cancer.

A variety of cervical cancer screenings are available in the United States. However, the benefits, harms, and costs of all testing options are not known. In order to find out the cost-effectiveness of each type of cervical cancer test, researchers conducted a study analyzing 12 testing strategies.

For this study, published in JAMA Internal Medicine, 451 women aged 21 to 65 years were enrolled. Each woman was asked her preference regarding 23 cervical cancer screening-associated health states. The results were then applied to a decision model of type-specific high-risk human papillomavirus (hrHPV)-induced cervical carcinogenesis. The accuracy of each test was approximated from systemic reviews.

The strategies evaluated included cytologic testing—more commonly known as a pap smear—every three years for women aged 21 to 65 years with either repeat cytologic testing in 1 year or immediate hrHPV triage for atypical squamous cells of undetermined significance (ASC-US), cytologic testing every 3 years for women age 21 to 29 years followed by cytologic testing plus hrHPV testing, or primary hrHPV testing alone for women aged 30 to 65 years. The following factors were varied: screening frequency, abnormal test result management, and the age to switch from cytologic testing to hrHPV testing (25 or 30 years). Preferences for the 23 cervical cancer screening-associated health states, quality-adjusted life-years (QALYs), and total costs for each strategy were measured.

The results revealed that cytologic testing every three years for women aged 21 to 29 with either continued triennial cytologic testing or switching to a low-cost high-risk HPV test every 5 years from age 30 to 65 struck a balance of benefits, harms, and costs from both a community and health care division perspective.

The study authors succinctly conclude the study's results, "Cytologic testing every 3 years and low-cost high-risk human papillomavirus testing every 5 years both may be considered reasonable cervical cancer screening options for women aged 30 to 65 years."

For More Information

Sawaya GF, Sanstead E, Alarid-Escudero F, et al (2019). Estimated quality of life and economic outcomes associated with 12 cervical cancer screening strategies. JAMA Intern Med. [Epub ahead of print] DOI:10.1001/jamainternmed.2019.0299

Image Courtesy of the National Cancer Institute 

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