Age-based screening cost-effective for cervical cancer

Regardless of human papillomavirus (HPV) vaccination status, the most cost-effective strategy for cervical cancer screening is for younger women to receive HPV DNA testing only for equivocal cytology results, while HPV DNA testing should be used as the primary test in older women, researchers report in the Mar. 5 issue of the Journal of the National Cancer Institute.

Jeremy D. Goldhaber-Fiebert, from Harvard University, and colleagues assessed the cost-effectiveness of screening and vaccination for HPV in both vaccinated and unvaccinated women.

The researchers found that for unvaccinated women, cytology followed by HPV test triage every 3 years starting by 21 years of age and switching to HPV testing followed by cytology triage at 30 years of age cost $78,000 per quality-adjusted life year (QALY). The same strategy was also best for girls vaccinated before 12 years of age, starting at 25 years of age and switching at 35 years of age, costing $41,000 per QALY for screening every 5 years and $188,000 per QALY for screening every 3 years.

“For both vaccinated and unvaccinated women, age-based screening by use of HPV DNA testing as a triage test for equivocal results in younger women and as a primary screening test in older women is expected to be more cost-effective than current screening recommendations,” Goldhaber-Fiebert and colleagues conclude.

Goldhaber-Fiebert JD, Stout NK, Salomon JA, et al. Cost-effectiveness of cervical cancer screening with human papillomavirus DNA testing and HPV-16,18 vaccination. J Natl Cancer Inst. 2008;100:308-320. Published online at doi:10.1093/jnci/ djn019.