Cost effectiveness analysis of cervical cancer screening in women until age 70

Authors

  • James C. Quon School of Public Health, University of Alberta, Edmonton, AB, Canada

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20184111

Keywords:

Cancer screening, Cervical cancer, Economic analysis, Gynecology, Primary care, Prevention

Abstract

Background: 2017 US Preventive Services Task Force guidelines for screening cervical cancer and pre-malignant lesions advise that screenings cease for women over age 65, with qualifications. Recent literature has identified significant discrepancies in rates of cervical cancer in older women – if hysterectomies in this patient population is accounted for, cervical cancer incidence does not decline with age as previously established. This adjusted incidence of cervical cancer necessitates a re-examination of current practice.

Methods: This study seeks to demonstrate the utility of extending the cervical cancer screening age recommendations to age 70. Cost effectiveness will be estimated, from a payer perspective, of extending screening to age 70 for the United States women’s population in those who have not undergone hysterectomy or otherwise been treated for past cervical cancer or premalignancy. A Markov model was constructed to project outcomes in a hypothetical cohort of 10 000 women aged 65 to 70, with a time horizon of lifetime. A Probability Sensitivity Analysis determined the robustness of the result, and the Incremental Cost-effectiveness Ratio (ICER) is charted.

Results: The economic evaluation of screening compared to none in this population was determined to be cost effective, with an ICER demonstrating a cost benefit, and Quality Adjusted Life Year (QALY) benefit, to extended screening.

Conclusions: The sensitivity analysis confirms the robustness of this result. Implementing extended screening guidelines could potentially be a significant gain for both patients and society.

References

Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, et al. American cancer society, american society for colposcopy and cervical pathology, and american society for clinical pathology screening guidelines for the prevention and early detection of cervical cancer. CA: Cancer J Clinic. 2011;62(3):147-72.

USPTF. U.S. Preventive Services Task Force Recommends Screening Most Adult Women for Cervical Cancer. 2017. Available at https://www.uspreventiveservicestaskforce.org/Home/GetFile/6/250/cervical-cancer-bulletin/pdf.

Rositch AF, Nowak RG, Gravitt PE. Increased age and race-specific incidence of cervical cancer after correction for hysterectomy prevalence in the united states from 2000 to 2009. Cancer.2014;120(13): 2032-8.

Apgar BS, Zoschnick L, Wright TC Jr. The 2001 bethesda system terminology. Am Family Physician. 2003;68(10):1992-8.

Schlecht NF, Platt RW, Duarte-Franco E, Costa MC, Sobrinho JP, Prado JC, et al. Human papillomavirus infection and time to progression and regression of cervical intraepithelial neoplasia. J National Cancer Inst. 2003;95(17):1336-43.

Cantor SB, Atkinson EN, Cardenas-Turanzas M, Benedet JL, Follen M, MacAulay C. Natural history of cervical intraepithelial neoplasia. Acta Cytologica. 2005;49(4):405-5

Benard V. Vital signs: Cervical cancer incidence, mortality, and screening - united states 2007 - 2012. CDC Morbidity and Mortality Weekly Rep. 2014;63(44):1004.

Bidus MA, Maxwell GL, Kulasingam S, Rose GS, Elkas JC, Chernofsky M, et al. Cost-effectiveness analysis of liquid-based cytology and human papillomavirus testing in cervical cancer screening. Obstet Gynecol. 2006;107(5):997-1005.

Caprara L, Monari F, De Bianchi PS, Amadori A, Bondi A. ASCUS in screening. [ASCUS in screening] Pathol. 2001;93(6):645-50.

Esselen KM, Feldman S. Cost-effectiveness of cervical cancer prevention. Clinical Obstet Gynecol. 2013;56(1),55-64.

Kind P, Hardman G, Macran S. UK population norms for EQ-5D No. 172. 1993. University of York: Centre for Health Economics.

Kulasingam SL, Hughes JP, Kiviat NB, et al. Evaluation of human papillomavirus testing in primary screening for cervical abnormalities: Comparison of sensitivity, specificity, and frequency of referral. JAMA. 2002;288(14):1749-57.

Myers ER, McCrory DC, Nanda K, Bastian L, Matchar DB. Mathematical model for the natural history of human papillomavirus infection and cervical carcinogenesis. Am J Epidemiol. 2000;51(12),1158-71.

Plummer M, Schiffman M, Castle PE, Maucort-Boulch D, Wheeler CM, ALTS Group. A 2-year prospective study of human papillomavirus persistence among women with a cytological diagnosis of atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion. J Infect Disease. 2007;195(11):1582-9.

Taylor DC, Pawar V, Kruzikas D, Gilmore KE, Pandya A, Iskandar R, et al. Methods of model calibration: Observations from a mathematical model of cervical cancer. Pharmacoeco. 2010;28(11):995-1000.

Vijayaraghavan A, Efrusy MB, Goodman KA, Santas CC, Huh WK. Cost-effectiveness of using human papillomavirus 16/18 genotype triage in cervical cancer screening. Gynecol Oncol. 2010;119(2):237-42.

Vink MA, Bogaards JA, van Kemenade FJ, de Melker HE, Meijer CJ, Berkhof J. Clinical progression of high-grade cervical intraepithelial neoplasia: Estimating the time to preclinical cervical cancer from doubly censored national registry data. Am J Epidemiol. 2013;178(7), 1161-9.

Walker JL, Wang SS, Schiffman M, Solomon D. Predicting absolute risk of CIN3 during post-colposcopic follow-up: Results from the ASCUS-LSIL triage study (ALTS). Am J Obstet Gynecol. 2006;195(2):341-8.

Zhao Z, Pan X, Lv S, Xie Y, Zhang S, Qiao Y, et al. Quality of life in women with cervical precursor lesions and cancer: A prospective, 6-month, hospital-based study in china. Chinese J Cancer. 2013;33(7):339-45.

Edelman M, Fox AS, Alderman EM, Neal W, Shapiro A, Silver EJ, et al. Cervical Papanicolaou smear abnormalities in inner city Bronx adolescents: prevalence, progression, and immune modifiers. Cancer. 1999;87(4):184-9.

Melnikow J, Nuovo J, Willan AR, Chan BK, Howell LP. Natural history of cervical squamous intraepithelial lesions: a meta-analysis. Obstet Gynecol. 1998:92(4 Pt 2):727-35.

Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, et al, eds. SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.

Centers for Medicare and Medicaid Service. Physician Fee Schedule Look-Up Tool. 2015. Accessed February 25, 2015. Available at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PFSlookup/.

Subramanian S, Trogdon J, Ekwueme DU, Gardner JG, Whitmire JT, Rao C. Cost of cervical cancer treatment: implications for providing coverage to low-income women under the Medicaid expansion for cancer care. Womens Health Issues. 2010;20(6):400-5.

Zhang X, Zhang L, Tian C, Yang L, Wang Z. Genetic variants and risk of cervical cancer: epidemiological evidence, meta-analysis and research review. BJOG: Int J Obstet Gynaecol. 2014;121(6):664-73.

Downloads

Published

2018-09-26

Issue

Section

Original Research Articles