OBJECTIVE: Estimate the accuracy and cost-effectiveness of cervical cancer screening strategies based on high-risk human papillomavirus (HPV) DNA testing of self-collected vaginal samples. MATERIALS AND METHODS: A subset of 1,665 women (age range, 18-50 y) participating in a cervical cancer screening study were screened by liquid-based cytology and by high-risk HPV DNA testing of both self-collected vaginal swab samples and clinician-collected cervical samples. Women with positive/abnormal screening test results and a subset of women with negative screening test results were triaged to colposcopy. On the basis of individual and combined test results, 5 screening strategies were defined. Estimates of sensitivity and specificity for cervical intraepithelial neoplasia grade 2 or worse were calculated, and a Markov model was used to estimate the incremental cost-effectiveness ratios for each strategy. RESULTS: Compared with cytology-based screening, high-risk HPV DNA testing of self-collected vaginal samples was more sensitive (68%, 95% CI = 58%-78% vs 85%, 95% CI = 76%-94%) but less specific (89%, 95% CI = 86%-91% vs 73%, 95% CI = 67%-79%). A strategy of high-risk HPV DNA testing of self-collected vaginal samples followed by cytology triage of HPV-positive women was comparably sensitive (75%, 95% CI = 64%-86%) and specific (88%, 95% CI = 85%-92%) to cytology-based screening. In-home self-collection for high-risk HPV DNA detection followed by in-clinic cytology triage had a slightly lower lifetime cost and a slightly higher quality-adjusted life year (QALY) expectancy than did cytology-based screening (incremental cost-effectiveness ratio of triennial screening compared with no screening was $9,871/QALY and $12,878/QALY, respectively). CONCLUSIONS: Triennial screening by high-risk HPV DNA testing of in-home, self-collected vaginal samples followed by in-clinic cytology triage was cost-effective.
OBJECTIVE: Estimate the accuracy and cost-effectiveness of cervical cancer screening strategies based on high-risk human papillomavirus (HPV) DNA testing of self-collected vaginal samples. MATERIALS AND METHODS: A subset of 1,665 women (age range, 18-50 y) participating in a cervical cancer screening study were screened by liquid-based cytology and by high-risk HPV DNA testing of both self-collected vaginal swab samples and clinician-collected cervical samples. Women with positive/abnormal screening test results and a subset of women with negative screening test results were triaged to colposcopy. On the basis of individual and combined test results, 5 screening strategies were defined. Estimates of sensitivity and specificity for cervical intraepithelial neoplasia grade 2 or worse were calculated, and a Markov model was used to estimate the incremental cost-effectiveness ratios for each strategy. RESULTS: Compared with cytology-based screening, high-risk HPV DNA testing of self-collected vaginal samples was more sensitive (68%, 95% CI = 58%-78% vs 85%, 95% CI = 76%-94%) but less specific (89%, 95% CI = 86%-91% vs 73%, 95% CI = 67%-79%). A strategy of high-risk HPV DNA testing of self-collected vaginal samples followed by cytology triage of HPV-positive women was comparably sensitive (75%, 95% CI = 64%-86%) and specific (88%, 95% CI = 85%-92%) to cytology-based screening. In-home self-collection for high-risk HPV DNA detection followed by in-clinic cytology triage had a slightly lower lifetime cost and a slightly higher quality-adjusted life year (QALY) expectancy than did cytology-based screening (incremental cost-effectiveness ratio of triennial screening compared with no screening was $9,871/QALY and $12,878/QALY, respectively). CONCLUSIONS: Triennial screening by high-risk HPV DNA testing of in-home, self-collected vaginal samples followed by in-clinic cytology triage was cost-effective.
Authors: K Nanda; D C McCrory; E R Myers; L A Bastian; V Hasselblad; J D Hickey; D B Matchar Journal: Ann Intern Med Date: 2000-05-16 Impact factor: 25.391
Authors: M Schiffman; R Herrero; A Hildesheim; M E Sherman; M Bratti; S Wacholder; M Alfaro; M Hutchinson; J Morales; M D Greenberg; A T Lorincz Journal: JAMA Date: 2000-01-05 Impact factor: 56.272
Authors: M A E Nobbenhuis; T J M Helmerhorst; A J C van den Brule; L Rozendaal; L H Jaspars; F J Voorhorst; R H M Verheijen; C J L M Meijer Journal: J Clin Pathol Date: 2002-06 Impact factor: 3.411
Authors: Jeanne S Mandelblatt; William F Lawrence; Sharita Mizell Womack; Denise Jacobson; Bin Yi; Yi-ting Hwang; Karen Gold; James Barter; Keerti Shah Journal: JAMA Date: 2002-05-08 Impact factor: 56.272
Authors: Felipe R Lorenzato; Albert Singer; Linda Ho; Luiz Carlos Santos; Raimundo de Lucena Batista; Telma M Lubambo; George Terry Journal: Am J Obstet Gynecol Date: 2002-05 Impact factor: 8.661
Authors: J W Sellors; A T Lorincz; J B Mahony; I Mielzynska; A Lytwyn; P Roth; M Howard; S Chong; D Daya; W Chapman; M Chernesky Journal: CMAJ Date: 2000-09-05 Impact factor: 8.262
Authors: Kayoll V Galbraith; Melissa B Gilkey; Jennifer S Smith; Alice R Richman; Lynn Barclay; Noel T Brewer Journal: J Community Health Date: 2014-10
Authors: Isabel C Scarinci; Allison G Litton; Isabel C Garcés-Palacio; Edward E Partridge; Philip E Castle Journal: Womens Health Issues Date: 2013-02-12
Authors: Romy van Baars; Remko P Bosgraaf; Bram W A ter Harmsel; Willem J G Melchers; Wim G V Quint; Ruud L M Bekkers Journal: J Clin Microbiol Date: 2012-09-26 Impact factor: 5.948
Authors: Rachel L Winer; Jasmin A Tiro; Diana L Miglioretti; Chris Thayer; Tara Beatty; John Lin; Hongyuan Gao; Kilian Kimbel; Diana S M Buist Journal: Contemp Clin Trials Date: 2017-11-04 Impact factor: 2.226
Authors: Deborah J Anderson; Joseph A Politch; Jeffrey Pudney; Cecilia I Marquez; Margaret C Snead; Christine Mauck Journal: Sex Transm Dis Date: 2012-12 Impact factor: 2.830