BACKGROUND: Although current human papillomavirus (HPV) genotype screening tests identify genotypes 16 and 18 and do not specifically identify other high-risk types, a new extended genotyping test identifies additional individual (31, 45, 51, and 52) and groups (33/58, 35/39/68, and 56/59/66) of high-risk genotypes. METHODS: We developed a Markov model of the HPV disease course and evaluated the clinical and economic value of HPV primary screening with Onclarity (BD Diagnostics, Franklin Lakes, NJ) capable of extended genotyping in a cohort of women 30 years or older. Women with certain genotypes were later rescreened instead of undergoing immediate colposcopy and varied which genotypes were rescreened, disease progression rate, and test cost. RESULTS: Assuming 100% compliance with screening, HPV primary screening using current tests resulted in 25,194 invasive procedures and 48 invasive cervical cancer (ICC) cases per 100,000 women. Screening with extended genotyping (100% compliance) and later rescreening women with certain genotypes averted 903 to 3163 invasive procedures and resulted in 0 to 3 more ICC cases compared with current HPV primary screening tests. Extended genotyping was cost-effective ($2298-$7236/quality-adjusted life year) when costing $75 and cost saving (median, $0.3-$1.0 million) when costing $43. When the probabilities of disease progression increased (2-4 times), extended genotyping was not cost-effective because it resulted in more ICC cases and accrued fewer quality-adjusted life years. CONCLUSIONS: Our study identified the conditions under which extended genotyping was cost-effective and even cost saving compared with current tests. A key driver of cost-effectiveness is the risk of disease progression, which emphasizes the need to better understand such risks in different populations.
BACKGROUND: Although current human papillomavirus (HPV) genotype screening tests identify genotypes 16 and 18 and do not specifically identify other high-risk types, a new extended genotyping test identifies additional individual (31, 45, 51, and 52) and groups (33/58, 35/39/68, and 56/59/66) of high-risk genotypes. METHODS: We developed a Markov model of the HPV disease course and evaluated the clinical and economic value of HPV primary screening with Onclarity (BD Diagnostics, Franklin Lakes, NJ) capable of extended genotyping in a cohort of women 30 years or older. Women with certain genotypes were later rescreened instead of undergoing immediate colposcopy and varied which genotypes were rescreened, disease progression rate, and test cost. RESULTS: Assuming 100% compliance with screening, HPV primary screening using current tests resulted in 25,194 invasive procedures and 48 invasive cervical cancer (ICC) cases per 100,000 women. Screening with extended genotyping (100% compliance) and later rescreening women with certain genotypes averted 903 to 3163 invasive procedures and resulted in 0 to 3 more ICC cases compared with current HPV primary screening tests. Extended genotyping was cost-effective ($2298-$7236/quality-adjusted life year) when costing $75 and cost saving (median, $0.3-$1.0 million) when costing $43. When the probabilities of disease progression increased (2-4 times), extended genotyping was not cost-effective because it resulted in more ICC cases and accrued fewer quality-adjusted life years. CONCLUSIONS: Our study identified the conditions under which extended genotyping was cost-effective and even cost saving compared with current tests. A key driver of cost-effectiveness is the risk of disease progression, which emphasizes the need to better understand such risks in different populations.
Authors: Warner K Huh; Kevin A Ault; David Chelmow; Diane D Davey; Robert A Goulart; Francisco A R Garcia; Walter K Kinney; L Stewart Massad; Edward J Mayeaux; Debbie Saslow; Mark Schiffman; Nicolas Wentzensen; Herschel W Lawson; Mark H Einstein Journal: Gynecol Oncol Date: 2015-01-08 Impact factor: 5.482
Authors: M Schiffman; R D Burk; S Boyle; T Raine-Bennett; H A Katki; J C Gage; N Wentzensen; J R Kornegay; C Aldrich; T Tam; H Erlich; R Apple; B Befano; P E Castle Journal: J Clin Microbiol Date: 2014-10-22 Impact factor: 5.948
Authors: Mark H Stoler; Thomas C Wright; Valentin Parvu; Laurence Vaughan; Karen Yanson; Karen Eckert; Tobi Karchmer; Salma Kodsi; Charles K Cooper Journal: Gynecol Oncol Date: 2018-04-19 Impact factor: 5.482
Authors: Susan J Curry; Alex H Krist; Douglas K Owens; Michael J Barry; Aaron B Caughey; Karina W Davidson; Chyke A Doubeni; John W Epling; Alex R Kemper; Martha Kubik; C Seth Landefeld; Carol M Mangione; Maureen G Phipps; Michael Silverstein; Melissa A Simon; Chien-Wen Tseng; John B Wong Journal: JAMA Date: 2018-08-21 Impact factor: 56.272
Authors: Margaret R E McCredie; Katrina J Sharples; Charlotte Paul; Judith Baranyai; Gabriele Medley; Ronald W Jones; David C G Skegg Journal: Lancet Oncol Date: 2008-04-11 Impact factor: 41.316
Authors: N W J Bulkmans; J Berkhof; S Bulk; M C G Bleeker; F J van Kemenade; L Rozendaal; P J F Snijders; C J L M Meijer Journal: Br J Cancer Date: 2007-03-06 Impact factor: 7.640
Authors: Cosette M Wheeler; William C Hunt; Jack Cuzick; Erika Langsfeld; Michael Robertson; Philip E Castle Journal: Int J Cancer Date: 2014-04-15 Impact factor: 7.396
Authors: Christopher A Paynter; Benjamin J Van Treeck; Inge Verdenius; Agnes W Y Lau; Twinkle Dhawan; Kayla A Lash; Elizabeth A Bergamini; Chiazotam N Ekekezie; Amna M Hilal; Kristen N James; Sadie Alongi; Sean M Harper; Aaron J Bonham; Kathy B Baumgartner; Richard N Baumgartner; Diane M Harper Journal: Prev Med Rep Date: 2015-07-31
Authors: Brandon Wen Bing Chua; Viva Yan Ma; Jonathan Alcántar-Fernández; Hwee Lin Wee Journal: Int J Public Health Date: 2022-05-12 Impact factor: 5.100