Study Finds Improving Cervical Cancer Screening Practice May Generate Health Gains With Nominal Increases in Cost
Cytology-based screening has led to substantial declines in cervical cancer incidence and mortality since it was introduced in the 1940s. A population-based, cost-effective analysis investigating the benefits, costs, and cost-effectiveness of current cervical cancer screening practice, however, has found inefficiencies in health benefits and costs due to noncompliance with recommended screening guidelines. Achieving universal screening every 3 years with cytologic testing and diagnostic follow-up yielded the greatest health gains compared with current practice, justifying the additional costs incurred, according to the study findings. The study by Kim et al was published in Annals of Internal Medicine.
Study Methodology
Utilizing data from the New Mexico HPV Pap Registry (NMHPVPR), the researchers used a disease simulation model of the natural history of human papillomavirus and cervical cancer to conduct an analysis integrating screening, diagnosis, and treatment to estimate the associated long-term health and economic outcomes of current cervical cancer screening practice in the United States. They also compared its cost-effectiveness against recently revised U.S. screening guidelines.
To understand the major contributors to inefficiency and identify high-value improvements, the researchers estimated the change in health benefits, costs, and net monetary benefits of improving different aspects of the screening process compared with current practice.
Study Findings
Compared with no screening, the researchers found that current screening practice reduced lifetime cervical cancer incidence by 48.5% and mortality by 58.4%. Further, screening had an incremental cost-effectiveness ratio of $19,530 per quality-adjusted life-years gained.
In comparison, guidelines-based cytologic screening every 3 years resulted in greater cancer benefit (80.9% incidence reduction; 86.7% mortality reduction) and a lower incremental cost-effectiveness ratio, thereby dominating current screening practice; cytologic screening every 3 years compared with no screening yielded an incremental cost-effectiveness ratio of $15,260 per quality-adjusted life-years gained.
Switching from cytologic testing every 3 years to cotesting every 5 years at age 30 increased cancer benefit (91.1% incidence reduction; 93.5% mortality reduction) but at an increased lifetime cost with an incremental cost-effectiveness ratio of $59,440 per quality-adjusted life-years.
Annual cytologic screening, historically recommended for routine screening, yielded slightly higher cancer benefit (91.4% incidence reduction; 93.8% mortality reduction), but the added cost far exceeded the gain in health benefit, with a resulting incremental cost-effectiveness ratio of more than $1 million per quality-adjusted life-years gained.
“These model-projected outcomes can inform strategic investments in interventions designed to improve the screening process, as well as examine the effect of new human papillomavirus-related technologies,” concluded the researchers.
Funding for this study was provided by the National Cancer Institute.
To view author disclosures, visit acponline.org/authors/icmje/ConflictsOfInterestForms.do?msNum=M15-0420.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
