Long-term costs of introducing HPV-DNA post-treatment surveillance to national cervical cancer screening in Ireland

Abstract

Introduction: Co-testing (cytology plus human papillomavirus DNA testing) as part of cervical cancer surveillance in Ireland increases one-time testing costs. Of interest to policy makers was the long-term impact of these costs accompanied by decreases in intensity of recalls for women with no detected abnormalities. Methods: A cost analysis of cytology-only and co-testing strategy was implemented using decision analytic modeling, aggregating testing utilization and costs for each of the two strategies over 12 years. Results: Aggregated incremental costs of the co-testing strategy were positive for the first 3 years but became negative thereafter, generating a cost savings of roughly €20 million in favor of the cytology-only strategy over a 12-year period. Results were robust over a range of sensitivity analyses with respect to discount and attrition rates. Discussion: This analysis provided valuable information to policy makers contributing to the introduction of co-testing for post-treatment surveillance (PTS) in Ireland.

Keywords:

• cervical cancer
• colposcopy
• costs analysis
• decision analysis
• human papillomavirus
• post-treatment surveillance
• screening

Acknowledgements

We thank the anonymous reviewers whose comments/suggestions helped improve and clarify the content of this manuscript.

Financial & competing interests disclosure

Financial support for this study was provided entirely by NIH grants RC4CA155809 (Basu) and R01CA155329 (Basu) and a HRB grant RL2013/16 (CON).The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• The probability of disease recurrence in treatment of women with high-grade cervical intraepithelial neoplasia (CIN) requires post-treatment surveillance (PTS) as part of an effective national cervical cancer screening program.

• The limitations of a cytology-alone-based PTS strategy necessitates a more intensive follow-up of treated women than a strategy that uses both human papillomavirus (HPV) and cytology.

• Our analysis shows significant potential savings may arise for the budget holder associated with the less intensive post treatment surveillance of women. The results of this analysis strengthened the case for the incorporation of HPV testing as part of the continued evolution of CervicalCheck – The National Cervical Screening Programme.

• The national cancer screening service (NCSS) presented the clinical, scientific and cost analyses to the Department of Health (Ireland) and ultimately HPV testing in the post-colposcopy treatment setting alongside the less intensive use of cytology modeled in this analysis was incorporated into the national screening program in 2012.

Notes