Cost-effectiveness of adding human papilloma virus testing to a managed care cervical cancer screening program

The purpose of this study was to demonstrate a methodology for auditing the impact of HCII testing on the direct cost of cervical cancer cytological screening, where the test is collected in all women screened and processed routinely in women age 30 years and older.

After a policy change to screen all patients 30 years or older with both Pap smears and high-risk human papillomavirus (HR-HPV), as well as cocollection of HR-HPV in women younger than 30 years, all cytological, HPV, and histological data pertaining to cervical screening was collected retrospectively during a 2-month period. We documented the direct costs of performing these tests and estimated the necessary compliance rate for balanced cost-effectiveness.

During the 2-month period, 8,300 women were screened with both Pap smear and HPV cocollection. Of the 'nonnormal' cytological findings, 5% of patients showed either atypical squamous cells (3.5%) or squamous intraepithelial abnormalities (1.5%). An additional 427 (5%) patients had the finding of positive HR-HPV with normal cytology. Six of these patients opted for immediate colposcopy, 2 of which were found to have cervical intraepithelial neoplasia 2. In women age 30 years and older, 900 patients per 1,000 screened would be eligible for a 2-year screening interval based on negative cytology and negative HR-HPV. Based on the direct costs associated with this cohort, no more than 164 women could request screening at an interval shorter than 3 years for the total costs of such a program to equal that of one without HR-HPV cocollection.

By adding HCII collection to the Pap smear for our entire screening cohort, we intended to reduce the number of tests performed, which was impacted by its age distribution. Our findings indicate that at least 736 of the 900 double-negative patients (82%) would have to be screened at no less than 3 years for such a screening paradigm to be cost-effective in managing women 30 years and older.