Economic evaluation of HPV DNA test as primary screening method for cervical cancer: A health policy discussion in Greece
HPV test appears to be more effective in cervical cancer (CC) screening. However, the decision of its adoption as a primary screening method by substituting the established cytology lies in the evaluation of multiple criteria. Aim of this study is to evaluate the economic and clinical impact of HPV...
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| description | HPV test appears to be more effective in cervical cancer (CC) screening. However, the decision of its adoption as a primary screening method by substituting the established cytology lies in the evaluation of multiple criteria. Aim of this study is to evaluate the economic and clinical impact of HPV test as primary screening method for CC.
A decision tree and a Markov model were developed to simulate the screening algorithm and the natural history of CC. Fourteen different screening strategies were evaluated, for women 25-65 years old. Clinical inputs were drawn from the HERMES study and cost inputs from the official price lists. In the absence of CC treatment cost data, the respective Spanish costs were used after being converted to 2017 Greek values. One-way and probabilistic sensitivity analyses were conducted.
All screening strategies, that offer as primary screening method triennial HPV genotyping (simultaneous or reflex) alone or as co-testing with cytology appear to be more effective than all other strategies, with regards to both annual CC mortality, due to missed disease (-10.1), and CC incidence(-7.5) versus annual cytology (current practice). Of those, the strategy with HPV test with simultaneous 16/18 genotyping is the strategy that provides savings of 1.050 million euros annually. However, when the above strategy is offered quinquennially despite the fact that outcomes are decreased it remains more effective than current practice (-7.7 deaths and -1.3 incidence) and more savings per death averted (1.323 million) or incidence reduced (7.837 million) are realized.
HPV 16/18 genotyping as a primary screening method for CC appears to be one of the most effective strategies and dominates current practice in respect to both cost and outcomes. Even when compared with all other strategies, the outcomes that it generates justify the cost that it requires, representing a good value for money alternative. |
| doi_str_mv | 10.1371/journal.pone.0226335 |
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A decision tree and a Markov model were developed to simulate the screening algorithm and the natural history of CC. Fourteen different screening strategies were evaluated, for women 25-65 years old. Clinical inputs were drawn from the HERMES study and cost inputs from the official price lists. In the absence of CC treatment cost data, the respective Spanish costs were used after being converted to 2017 Greek values. One-way and probabilistic sensitivity analyses were conducted.
All screening strategies, that offer as primary screening method triennial HPV genotyping (simultaneous or reflex) alone or as co-testing with cytology appear to be more effective than all other strategies, with regards to both annual CC mortality, due to missed disease (-10.1), and CC incidence(-7.5) versus annual cytology (current practice). Of those, the strategy with HPV test with simultaneous 16/18 genotyping is the strategy that provides savings of 1.050 million euros annually. However, when the above strategy is offered quinquennially despite the fact that outcomes are decreased it remains more effective than current practice (-7.7 deaths and -1.3 incidence) and more savings per death averted (1.323 million) or incidence reduced (7.837 million) are realized.
HPV 16/18 genotyping as a primary screening method for CC appears to be one of the most effective strategies and dominates current practice in respect to both cost and outcomes. Even when compared with all other strategies, the outcomes that it generates justify the cost that it requires, representing a good value for money alternative.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0226335</identifier><identifier>PMID: 31830114</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Aged ; Algorithms ; Analysis ; Biology and Life Sciences ; Cancer ; Cancer screening ; Cellular biology ; Cervical cancer ; Cervical Intraepithelial Neoplasia - diagnosis ; Cervical Intraepithelial Neoplasia - economics ; Cervical Intraepithelial Neoplasia - epidemiology ; Cervical Intraepithelial Neoplasia - virology ; Computer simulation ; Cost-Benefit Analysis ; Cytology ; Decision trees ; Deoxyribonucleic acid ; DNA ; Early Detection of Cancer - economics ; Economic aspects ; Female ; Genetic testing ; Genotyping ; Greece - epidemiology ; Health Care Costs ; Health care policy ; Health Policy ; Human papillomavirus ; Human Papillomavirus DNA Tests - economics ; Human Papillomavirus DNA Tests - methods ; Humans ; Immunization ; Impact analysis ; Incidence ; Markov chains ; Markov processes ; Medical screening ; Medicine and Health Sciences ; Methods ; Middle Aged ; Multiple criterion ; Papillomaviridae - classification ; Papillomaviridae - genetics ; Papillomavirus infections ; Papillomavirus Infections - complications ; Papillomavirus Infections - virology ; Public health ; Research and Analysis Methods ; Screening ; Sensitivity analysis ; Strategy ; Training ; Uterine Cervical Neoplasms - diagnosis ; Uterine Cervical Neoplasms - economics ; Uterine Cervical Neoplasms - epidemiology ; Uterine Cervical Neoplasms - virology ; Women ; Womens health</subject><ispartof>PloS one, 2019-12, Vol.14 (12), p.e0226335-e0226335</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Skroumpelos et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Skroumpelos et al 2019 Skroumpelos et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-60818a12cc5fd4fcf3c65666e3eb2587ca297655a5a91b6d534114f89e81d2213</citedby><cites>FETCH-LOGICAL-c692t-60818a12cc5fd4fcf3c65666e3eb2587ca297655a5a91b6d534114f89e81d2213</cites><orcidid>0000-0002-5357-4708 ; 0000-0002-0662-9905</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6907825/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6907825/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31830114$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Lhachimi, Stefan K.</contributor><creatorcontrib>Skroumpelos, Anastasios</creatorcontrib><creatorcontrib>Agorastos, Theodoros</creatorcontrib><creatorcontrib>Constantinidis, Theodoros</creatorcontrib><creatorcontrib>Chatzistamatiou, Kimon</creatorcontrib><creatorcontrib>Kyriopoulos, John</creatorcontrib><title>Economic evaluation of HPV DNA test as primary screening method for cervical cancer: A health policy discussion in Greece</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>HPV test appears to be more effective in cervical cancer (CC) screening. However, the decision of its adoption as a primary screening method by substituting the established cytology lies in the evaluation of multiple criteria. Aim of this study is to evaluate the economic and clinical impact of HPV test as primary screening method for CC.
A decision tree and a Markov model were developed to simulate the screening algorithm and the natural history of CC. Fourteen different screening strategies were evaluated, for women 25-65 years old. Clinical inputs were drawn from the HERMES study and cost inputs from the official price lists. In the absence of CC treatment cost data, the respective Spanish costs were used after being converted to 2017 Greek values. One-way and probabilistic sensitivity analyses were conducted.
All screening strategies, that offer as primary screening method triennial HPV genotyping (simultaneous or reflex) alone or as co-testing with cytology appear to be more effective than all other strategies, with regards to both annual CC mortality, due to missed disease (-10.1), and CC incidence(-7.5) versus annual cytology (current practice). Of those, the strategy with HPV test with simultaneous 16/18 genotyping is the strategy that provides savings of 1.050 million euros annually. However, when the above strategy is offered quinquennially despite the fact that outcomes are decreased it remains more effective than current practice (-7.7 deaths and -1.3 incidence) and more savings per death averted (1.323 million) or incidence reduced (7.837 million) are realized.
HPV 16/18 genotyping as a primary screening method for CC appears to be one of the most effective strategies and dominates current practice in respect to both cost and outcomes. Even when compared with all other strategies, the outcomes that it generates justify the cost that it requires, representing a good value for money alternative.</description><subject>Adult</subject><subject>Aged</subject><subject>Algorithms</subject><subject>Analysis</subject><subject>Biology and Life Sciences</subject><subject>Cancer</subject><subject>Cancer screening</subject><subject>Cellular biology</subject><subject>Cervical cancer</subject><subject>Cervical Intraepithelial Neoplasia - diagnosis</subject><subject>Cervical Intraepithelial Neoplasia - economics</subject><subject>Cervical Intraepithelial Neoplasia - epidemiology</subject><subject>Cervical Intraepithelial Neoplasia - virology</subject><subject>Computer simulation</subject><subject>Cost-Benefit Analysis</subject><subject>Cytology</subject><subject>Decision trees</subject><subject>Deoxyribonucleic acid</subject><subject>DNA</subject><subject>Early Detection of Cancer - economics</subject><subject>Economic aspects</subject><subject>Female</subject><subject>Genetic testing</subject><subject>Genotyping</subject><subject>Greece - epidemiology</subject><subject>Health Care Costs</subject><subject>Health care policy</subject><subject>Health Policy</subject><subject>Human papillomavirus</subject><subject>Human Papillomavirus DNA Tests - economics</subject><subject>Human Papillomavirus DNA Tests - methods</subject><subject>Humans</subject><subject>Immunization</subject><subject>Impact analysis</subject><subject>Incidence</subject><subject>Markov chains</subject><subject>Markov processes</subject><subject>Medical screening</subject><subject>Medicine and Health Sciences</subject><subject>Methods</subject><subject>Middle Aged</subject><subject>Multiple criterion</subject><subject>Papillomaviridae - classification</subject><subject>Papillomaviridae - genetics</subject><subject>Papillomavirus infections</subject><subject>Papillomavirus Infections - complications</subject><subject>Papillomavirus Infections - virology</subject><subject>Public health</subject><subject>Research and Analysis Methods</subject><subject>Screening</subject><subject>Sensitivity analysis</subject><subject>Strategy</subject><subject>Training</subject><subject>Uterine Cervical Neoplasms - diagnosis</subject><subject>Uterine Cervical Neoplasms - economics</subject><subject>Uterine Cervical Neoplasms - epidemiology</subject><subject>Uterine Cervical Neoplasms - virology</subject><subject>Women</subject><subject>Womens health</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk12PEyEUhidG467Vf2CUxMToResAA2X2wqRZ190mG9f4sbeE8tHSUKgw09h_L2NnNx2zF4YLCDznhfNyTlG8hOUE4in8sA5t9MJNtsHrSYkQxZg8Kk5hjdGYohI_PlqfFM9SWpclwYzSp8UJhgyXEFanxf5CBh82VgK9E64VjQ0eBAOuvt6CT19moNGpASKBbbQbEfcgyai1t34JNrpZBQVMiEDquLNSOCCFz-szMAMrLVyzAtvgrNwDZZNsU-q0rQeXWULq58UTI1zSL_p5VPz8fPHj_Gp8fXM5P59djyWtUTOmJYNMQCQlMaoy0mBJCaVUY71AhE2lQPWUEiKIqOGCKoKrnJhhtWZQIQTxqHh90N26kHjvWuIII4JLhhDOxPxAqCDWvM-UB2H5340Ql1zExkqneW2gglBQraiomCIMIqgwYmWtaiOZyFof-9vaxUYrqX0ThRuIDk-8XfFl2HFal1OWnzQq3vUCMfxqs_t8k83TzgmvQ9u9G0NEKKZVRt_8gz6cXU8tRU7AehPyvbIT5bNsbkUoqaeZmjxA5aF0Lo5cYsbm_UHA-0FAZhr9u1mK_M98_v3b_7M3t0P27RF7KKMUXNsVZhqC1QGUMaQUtbk3GZa865A7N3jXIbzvkBz26viD7oPuWgL_ARrdCpg</recordid><startdate>20191212</startdate><enddate>20191212</enddate><creator>Skroumpelos, Anastasios</creator><creator>Agorastos, Theodoros</creator><creator>Constantinidis, Theodoros</creator><creator>Chatzistamatiou, Kimon</creator><creator>Kyriopoulos, John</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-5357-4708</orcidid><orcidid>https://orcid.org/0000-0002-0662-9905</orcidid></search><sort><creationdate>20191212</creationdate><title>Economic evaluation of HPV DNA test as primary screening method for cervical cancer: A health policy discussion in Greece</title><author>Skroumpelos, Anastasios ; Agorastos, Theodoros ; Constantinidis, Theodoros ; Chatzistamatiou, Kimon ; Kyriopoulos, John</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-60818a12cc5fd4fcf3c65666e3eb2587ca297655a5a91b6d534114f89e81d2213</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Algorithms</topic><topic>Analysis</topic><topic>Biology and Life Sciences</topic><topic>Cancer</topic><topic>Cancer screening</topic><topic>Cellular biology</topic><topic>Cervical cancer</topic><topic>Cervical Intraepithelial Neoplasia - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Skroumpelos, Anastasios</au><au>Agorastos, Theodoros</au><au>Constantinidis, Theodoros</au><au>Chatzistamatiou, Kimon</au><au>Kyriopoulos, John</au><au>Lhachimi, Stefan K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Economic evaluation of HPV DNA test as primary screening method for cervical cancer: A health policy discussion in Greece</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2019-12-12</date><risdate>2019</risdate><volume>14</volume><issue>12</issue><spage>e0226335</spage><epage>e0226335</epage><pages>e0226335-e0226335</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>HPV test appears to be more effective in cervical cancer (CC) screening. However, the decision of its adoption as a primary screening method by substituting the established cytology lies in the evaluation of multiple criteria. Aim of this study is to evaluate the economic and clinical impact of HPV test as primary screening method for CC.
A decision tree and a Markov model were developed to simulate the screening algorithm and the natural history of CC. Fourteen different screening strategies were evaluated, for women 25-65 years old. Clinical inputs were drawn from the HERMES study and cost inputs from the official price lists. In the absence of CC treatment cost data, the respective Spanish costs were used after being converted to 2017 Greek values. One-way and probabilistic sensitivity analyses were conducted.
All screening strategies, that offer as primary screening method triennial HPV genotyping (simultaneous or reflex) alone or as co-testing with cytology appear to be more effective than all other strategies, with regards to both annual CC mortality, due to missed disease (-10.1), and CC incidence(-7.5) versus annual cytology (current practice). Of those, the strategy with HPV test with simultaneous 16/18 genotyping is the strategy that provides savings of 1.050 million euros annually. However, when the above strategy is offered quinquennially despite the fact that outcomes are decreased it remains more effective than current practice (-7.7 deaths and -1.3 incidence) and more savings per death averted (1.323 million) or incidence reduced (7.837 million) are realized.
HPV 16/18 genotyping as a primary screening method for CC appears to be one of the most effective strategies and dominates current practice in respect to both cost and outcomes. Even when compared with all other strategies, the outcomes that it generates justify the cost that it requires, representing a good value for money alternative.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31830114</pmid><doi>10.1371/journal.pone.0226335</doi><tpages>e0226335</tpages><orcidid>https://orcid.org/0000-0002-5357-4708</orcidid><orcidid>https://orcid.org/0000-0002-0662-9905</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2019-12, Vol.14 (12), p.e0226335-e0226335 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2325308223 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adult Aged Algorithms Analysis Biology and Life Sciences Cancer Cancer screening Cellular biology Cervical cancer Cervical Intraepithelial Neoplasia - diagnosis Cervical Intraepithelial Neoplasia - economics Cervical Intraepithelial Neoplasia - epidemiology Cervical Intraepithelial Neoplasia - virology Computer simulation Cost-Benefit Analysis Cytology Decision trees Deoxyribonucleic acid DNA Early Detection of Cancer - economics Economic aspects Female Genetic testing Genotyping Greece - epidemiology Health Care Costs Health care policy Health Policy Human papillomavirus Human Papillomavirus DNA Tests - economics Human Papillomavirus DNA Tests - methods Humans Immunization Impact analysis Incidence Markov chains Markov processes Medical screening Medicine and Health Sciences Methods Middle Aged Multiple criterion Papillomaviridae - classification Papillomaviridae - genetics Papillomavirus infections Papillomavirus Infections - complications Papillomavirus Infections - virology Public health Research and Analysis Methods Screening Sensitivity analysis Strategy Training Uterine Cervical Neoplasms - diagnosis Uterine Cervical Neoplasms - economics Uterine Cervical Neoplasms - epidemiology Uterine Cervical Neoplasms - virology Women Womens health |
| title | Economic evaluation of HPV DNA test as primary screening method for cervical cancer: A health policy discussion in Greece |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-24T03%3A45%3A03IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Economic%20evaluation%20of%20HPV%20DNA%20test%20as%20primary%20screening%20method%20for%20cervical%20cancer:%20A%20health%20policy%20discussion%20in%20Greece&rft.jtitle=PloS%20one&rft.au=Skroumpelos,%20Anastasios&rft.date=2019-12-12&rft.volume=14&rft.issue=12&rft.spage=e0226335&rft.epage=e0226335&rft.pages=e0226335-e0226335&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0226335&rft_dat=%3Cgale_plos_%3EA608456597%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2325308223&rft_id=info:pmid/31830114&rft_galeid=A608456597&rft_doaj_id=oai_doaj_org_article_9f1d11a6ed6a48d58121d32809d9fc8a&rfr_iscdi=true |