Vidit N Munshi1, Rebecca B Perkins2, Stephen Sy3, Jane J Kim3. 1. Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Markets, Public Policy & Law, Questrom School of Business, Boston University, Boston, MA. Electronic address: viditm@bu.edu. 2. Boston University School of Medicine, Boston, MA. 3. Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA.
Abstract
BACKGROUND: The guidelines for managing abnormal cervical cancer screening tests changed from a results-based approach in 2012 to a risk-based approach in 2019. OBJECTIVE: We estimated the cost-effectiveness of the 2019 management guidelines and the changes in resource utilization moving from 2012 to 2019 guidelines. STUDY DESIGN: We utilized a previously published model of cervical cancer natural history and screening to estimate and compare the lifetime costs and the number of screens, colposcopies, precancer treatments, cancer cases, and cancer deaths associated with the 2012 vs 2019 management guidelines. We assessed these guidelines under the scenarios of observed screening practice and perfect screening adherence to 3-year cytology starting at age 21, with a switch to either 3-year or 5-year cytology plus human papillomavirus cotesting at age 30. In addition, we estimated the lifetime costs and life years to determine the cost-effectiveness of shifting to the 2019 management guidelines. RESULTS: Under the assumptions of both observed screening practice and perfect screening adherence with a strategy of 3-year cytology at ages 21 to 29 and switching to 3-year cotesting at age 30, the management of the screening tests according to the 2019 guidelines was less costly and more effective than the 2012 guidelines. For 3-year cytology screening at ages 21 to 29 and switching to 5-year cotesting at age 30, the 2019 guidelines were more cost-effective at a willingness-to-pay threshold of $100,000 per life year gained. Across all scenarios, the 2019 management guidelines were associated with fewer colposcopies and cancer deaths. CONCLUSION: Our model-based analysis suggests that the 2019 guidelines are more effective overall and also more cost-effective than the 2012 guidelines, supporting the principle of "equal management of equal risks."
BACKGROUND: The guidelines for managing abnormal cervical cancer screening tests changed from a results-based approach in 2012 to a risk-based approach in 2019. OBJECTIVE: We estimated the cost-effectiveness of the 2019 management guidelines and the changes in resource utilization moving from 2012 to 2019 guidelines. STUDY DESIGN: We utilized a previously published model of cervical cancer natural history and screening to estimate and compare the lifetime costs and the number of screens, colposcopies, precancer treatments, cancer cases, and cancer deaths associated with the 2012 vs 2019 management guidelines. We assessed these guidelines under the scenarios of observed screening practice and perfect screening adherence to 3-year cytology starting at age 21, with a switch to either 3-year or 5-year cytology plus human papillomavirus cotesting at age 30. In addition, we estimated the lifetime costs and life years to determine the cost-effectiveness of shifting to the 2019 management guidelines. RESULTS: Under the assumptions of both observed screening practice and perfect screening adherence with a strategy of 3-year cytology at ages 21 to 29 and switching to 3-year cotesting at age 30, the management of the screening tests according to the 2019 guidelines was less costly and more effective than the 2012 guidelines. For 3-year cytology screening at ages 21 to 29 and switching to 5-year cotesting at age 30, the 2019 guidelines were more cost-effective at a willingness-to-pay threshold of $100,000 per life year gained. Across all scenarios, the 2019 management guidelines were associated with fewer colposcopies and cancer deaths. CONCLUSION: Our model-based analysis suggests that the 2019 guidelines are more effective overall and also more cost-effective than the 2012 guidelines, supporting the principle of "equal management of equal risks."
Keywords:
American Society for Colposcopy and Cervical Pathology; abnormal screen; cervical cancer; co-testing; cost-effectiveness; guidelines; risk-based; screening; simulation modeling
Authors: Hormuzd A Katki; Mark Schiffman; Philip E Castle; Barbara Fetterman; Nancy E Poitras; Thomas Lorey; Li C Cheung; Tina Raine-Bennett; Julia C Gage; Walter K Kinney Journal: J Low Genit Tract Dis Date: 2013-04 Impact factor: 1.925
Authors: L Stewart Massad; Mark H Einstein; Warner K Huh; Hormuzd A Katki; Walter K Kinney; Mark Schiffman; Diane Solomon; Nicolas Wentzensen; Herschel W Lawson Journal: J Low Genit Tract Dis Date: 2013-04 Impact factor: 1.925
Authors: Walter Kinney; William C Hunt; Helen Dinkelspiel; Michael Robertson; Jack Cuzick; Cosette M Wheeler Journal: Gynecol Oncol Date: 2014-01-04 Impact factor: 5.482
Authors: Gillian D Sanders; Peter J Neumann; Anirban Basu; Dan W Brock; David Feeny; Murray Krahn; Karen M Kuntz; David O Meltzer; Douglas K Owens; Lisa A Prosser; Joshua A Salomon; Mark J Sculpher; Thomas A Trikalinos; Louise B Russell; Joanna E Siegel; Theodore G Ganiats Journal: JAMA Date: 2016-09-13 Impact factor: 56.272
Authors: Elizabeth T H Fontham; Andrew M D Wolf; Timothy R Church; Ruth Etzioni; Christopher R Flowers; Abbe Herzig; Carmen E Guerra; Kevin C Oeffinger; Ya-Chen Tina Shih; Louise C Walter; Jane J Kim; Kimberly S Andrews; Carol E DeSantis; Stacey A Fedewa; Deana Manassaram-Baptiste; Debbie Saslow; Richard C Wender; Robert A Smith Journal: CA Cancer J Clin Date: 2020-07-30 Impact factor: 508.702
Authors: Didem Egemen; Li C Cheung; Xiaojian Chen; Maria Demarco; Rebecca B Perkins; Walter Kinney; Nancy Poitras; Brian Befano; Alexander Locke; Richard S Guido; Amy L Wiser; Julia C Gage; Hormuzd A Katki; Nicolas Wentzensen; Philip E Castle; Mark Schiffman; Thomas S Lorey Journal: J Low Genit Tract Dis Date: 2020-04 Impact factor: 3.842