Authors' recommendations: There are trade offs in costs and improvements in health outcomes associated with each CC screening/testing algorithm. For instance, increasing screening intervals decreases total costs but results in increased numbers of CC cases and deaths. LBC has a higher sensitivity but lower specificity than PAP, resulting in increased follow-up and confirmatory testing of both appropriate (true positive) and inappropriate (false positive) referrals. Identifying the CC screening/testing algorithm that provides the best balance between costs and improvements in health outcomes for women in Alberta requires careful consideration not only of which test is used (PAP, LBC or HPV) but also of at which stage in the screening/testing process (e.g., primary, triage, or follow-up) it would provide the greatest benefit—all this, while taking into account age, risk, and the natural progression and regression of pre-cancerous lesions. Among the 21 algorithms considered in this analysis, of those that provide equal or better effectiveness than 1yr-PAP+PAP (note that health economic and cancer screening program policy perspectives were used as criteria for cost-effectiveness), 3yr-PAP+HPV+PAP-age emerges as the algorithm that provides the best balance and hence, offers the best value for money. Thus, 3yr-PAP+HPV+PAP-age is considered cost-effective compared to the current Alberta algorithm of 1yr-PAP+PAP, and there is economic evidence to support replacing the current Alberta CC screening/testing algorithm with 3yr-PAP+HPV+PAP-age assuming that clear guidelines are developed and continuing education is provided for clinicians. Additional effectiveness beyond 3yr-PAP+HPV+PAP-age can be achieved with algorithms employing LBC as the primary screening test, but the additional costs are considered too high and not good value for the money. Moreover, regardless of which (if any) algorithm replaces the 1yr-PAP+PAP, it is critical that decision-makers be cognizant of the differential resource implications for testing, physician, inpatient services, outpatient services, and the increase in the number of unnecessary referrals to colposcopy/biopsy.

Project Status: Completed

Year Published: 2009

URL for published report: http://www.ihe.ca/advanced-search/human-papillomavirus-hpv-testing-in-alberta

URL for additional information: http://www.health.alberta.ca/initiatives/health-evidence-reviews-list.html

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Institute of Health Economics

Contact Address: 1200, 10405 – Jasper Avenue, Edmonton, AB T5J 3N4, Canada. Tel: +1 780 448 4881 Fax: +1 780 448 0018

Contact Name: info@ihe.ca

Contact Email: info@ihe.ca

Copyright: Institute of Health Economics (IHE)