The Clinical and Economic Benefits of Co-Testing Versus Primary HPV Testing for Cervical Cancer Screening: A Modeling...

Area of Science:

• Oncology
• Public Health
• Health Economics

Background:

• Current US guidelines recommend Pap plus human papillomavirus (HPV) testing for women aged 30-65.
• HPV testing alone was FDA-approved for primary cervical cancer screening in women 25 and older in 2014.

Purpose of the Study:

• To compare the clinical and economic outcomes of HPV primary testing versus co-testing for cervical cancer screening.
• To evaluate cost-effectiveness using a Markov model.

Main Methods:

• A health state transition (Markov) model simulated one million women aged 30-70 undergoing triennial cervical cancer screening.
• Compared HPV primary testing with HPV 16/18 genotyping and reflex cytology against co-testing (Pap plus HPV mRNA testing with HPV 16/18 genotyping).
• Outcomes included costs, invasive cervical cancer (ICC) cases and deaths, colposcopies, and quality-adjusted life years (QALYs).

Main Results:

• HPV primary testing predicted 2,141 more ICC cases and 2,041 more ICC deaths compared to co-testing in a simulated cohort of one million women.
• Co-testing resulted in 22,334 more lifetime QALYs.
• Co-testing yielded $39.0 million in savings compared to HPV primary testing.

Conclusions:

• Co-testing demonstrates superior clinical and economic outcomes compared to HPV primary testing for cervical cancer screening.
• Findings are relevant for US healthcare payers and policymakers focused on cost-effective screening technologies.
• Co-testing offers greater effectiveness at a lower cost, improving overall health outcomes.