Background/Aims: The availability of human papillomavirus (HPV) testing and vaccination raises questions regarding the cost-effectiveness of current cervical cancer screening recommendations. The United States Preventive Services Task Force (USPSTF) strongly recommends screening for cervical cancer in women who have been sexually active and have a cervix (A Recommendation). The USPSTF found good evidence from that screening with cervical cytology (Pap smears) reduces incidence of and mortality from cervical cancer. The USPSTF has made no recommendations regarding the use of a human papillomavirus (HPV) vaccine while the Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination of all females aged 11-12. Direct evidence regarding the impact of the HPV vaccine and the optimal strategy for cervical screening is limited.
Methods: A 19-state Markov microsimulation was developed to model a US birth cohort from ages 13-85 through the natural progression of cervical cancer. The model analyzed several screening strategies in a vaccinated and an unvaccinated population. Results were expressed as quality-adjusted life years (QALYs), lifetime screening and treatment costs, and incremental cost-effectiveness of different screening and vaccination strategies. The specific strategies considered were: tri-annual screening (current USPSTF recommendation), HPV vaccination only, and vaccination with differing screening increments of 1, 2, 3, 4 and 5 years. The model was further extended to consider potential disparities among ethnic groups.
Results: Without vaccination, the current USPSTF recommendation of tri-annual screening provides 1,304 more QALYs/10,000 for a cost effectiveness of $12,375/QALY. A vaccination only strategy would yield an extra 690 QALYs/10,000 for a cost effectiveness of $14,887/QALY. Coupled with vaccination, screening every 4 years ($13,362/QALY) is more cost-effective than annual ($33,616), bi-annual ($22,062), tri-annual ($17,994), and five-year ($15,273) strategies.
Conclusions: These results indicate that for those who obtain HPV vaccination, recent recommendations for less frequent cervical cancer screening could be re-enforced.