Document Detail

Projected cost-effectiveness of repeat high-risk human papillomavirus testing using self-collected vaginal samples in the Swedish cervical cancer screening program.
MedLine Citation:
PMID:  23530870     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Human papillomavirus (HPV) testing is not currently used in primary cervical cancer screening in Sweden, and corresponding cost-effectiveness is unclear.
OBJECTIVE: From a societal perspective, to evaluate the cost-effectiveness of high-risk (HR)-HPV testing using self-collected vaginal samples.
DESIGN: A cost-effectiveness analysis.
SETTING: The Swedish organized cervical cancer screening program.
METHODS: We constructed a model to simulate the natural history of cervical cancer using Swedish data on cervical cancer risk. For the base-case analysis we evaluated two screening strategies with different screening intervals: (i) cytology screening throughout the woman's lifetime (i.e. "conventional cytology strategy") and (ii) conventional cytology screening until age 35 years, followed by HR-HPV testing using self-collected vaginal samples in women aged ≥35 years (i.e. "combination strategy"). Sensitivity analyses were performed, varying model parameters over a significant range of values to identify cost-effective screening strategies.
MAIN OUTCOME MEASURES: Average lifetime cost, discounted and undiscounted life-years gained, reduction in cervical cancer risk, incremental cost-effectiveness ratios with and without the cost of added life-years.
RESULTS: Depending on screening interval, the incremental cost-effectiveness ratios for the combination strategy ranged from €43,000 to €180,000 per life-years gained without the cost of added life-years, and from €74,000 to €206,000 with costs of added life-years included.
CONCLUSION: The combination strategy with a 5-year screening interval is potentially cost-effective compared with no screening, and with current screening practice when using a threshold value of €80,000 per life-years gained.
Ellinor Östensson; Ann-Cathrin Hellström; Kristina Hellman; Inger Gustavsson; Ulf Gyllensten; Erik Wilander; Niklas Zethraeus; Sonia Andersson
Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't     Date:  2013-04-22
Journal Detail:
Title:  Acta obstetricia et gynecologica Scandinavica     Volume:  92     ISSN:  1600-0412     ISO Abbreviation:  Acta Obstet Gynecol Scand     Publication Date:  2013 Jul 
Date Detail:
Created Date:  2013-06-18     Completed Date:  2013-08-26     Revised Date:  2013-09-09    
Medline Journal Info:
Nlm Unique ID:  0370343     Medline TA:  Acta Obstet Gynecol Scand     Country:  England    
Other Details:
Languages:  eng     Pagination:  830-40     Citation Subset:  IM    
Copyright Information:
© 2013 Nordic Federation of Societies of Obstetrics and Gynecology.
Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska University Hospital-Solna, Karolinska Institute, Stockholm, Sweden.
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MeSH Terms
Aged, 80 and over
Cervical Intraepithelial Neoplasia / diagnosis,  economics,  prevention & control*,  virology
Computer Simulation
Cost-Benefit Analysis
DNA, Viral
Early Detection of Cancer / economics*,  methods
Health Care Costs
Human Papillomavirus DNA Tests / economics*
Markov Chains
Middle Aged
Models, Biological
Papillomavirus Infections / complications,  diagnosis*,  economics
Uterine Cervical Neoplasms / economics,  prevention & control*,  virology
Vaginal Smears / economics*,  methods
Young Adult
Reg. No./Substance:
0/DNA, Viral
Erratum In:
Acta Obstet Gynecol Scand. 2013 Aug;92(8):994

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