Liquid-based techniques for cervical cancer screening: systematic review and cost-effectiveness analysis
Krahn M, McLachlin M, Pham B, Rosen B, Sander B, Grootendorst P, Tomlinson G, John-Baptiste A, Frikemerid M, Hong Chen M, Woo G, Anonychuk A, Carcone S, Witteman H, Chen W, Liu K, Sampson M, Tricco A
Record ID 32008000108
English, French
Authors' objectives:
"The objective of this report is to assess the effectiveness and cost-effectiveness of LBC versus CC for cervical cancer screening in a population of sexually active women older than 15 years of age." (executive summary)
Authors' recommendations:
The clinical evidence suggests no statistical differences in sensitivity and specificity between LBC and CC. LBC is estimated to be on average 6% more sensitive and 4% less specific than CC across a range of cytological thresholds. There is an 83% chance that LBC is more sensitive than CC and a 72% chance that it is less specific. On average, LBC classifies approximately 1% more cell abnormalities than CC at the low-grade threshold of LSIL+. At the high-grade threshold of HSIL+, LBC may classify fewer abnormalities than CC, but the difference is not statistically different. On average, LBC may have a lower rate of unsatisfactory specimens, but the estimated differences from individual studies varied.
HPV triage of ASCUS is more sensitive to detect cervical intraepithelial lesions than repeat cytology. HPV triage has a similar specificity compared to repeated cytology. Model projections suggest that, over a woman's lifetime, LBC is likely to improve health outcomes (e.g., cancer incidence and cancer death) and increases costs when compared with CC at the same screening interval. Model projections also suggest that, over a woman's lifetime, HPV triage reduces costs and improves health outcomes when paired with any cytologic screening strategy.
Direct comparison of all screening and triage strategies show that annual screening with CC or LBC is always more costly and less effective than when paired with HPV triage. HPV triage used with LBC screening at two-year intervals is preferred to CC with HPV triage at a willingness-to-pay threshold of CAD50,000 per LY gained, and CC with HPV triage every two years is preferred to LBC with HPV triage at lower willingness-to-pay thresholds. In comparison with current practice, using liquid-based cytology with HPV triage at two-year screening intervals will reduce costs, with a similar or reduced burden of disease. Thus, the health economic evidence suggests that two-year screening strategies using HPV triage, with or without LBC, represents the best use of resources for cervical cancer screening. These results will require revision given the introduction of automated screening, HPV vaccination, and organized screening programs.
Authors' methods:
Systematic review
Details
Project Status:
Completed
Year Published:
2008
English language abstract:
An English language summary is available
Publication Type:
Not Assigned
Country:
Canada
MeSH Terms
- Female
- Specimen Handling
- Mass Screening
- Uterine Cervical Neoplasms
- Vaginal Smears
Contact
Organisation Name:
Canadian Agency for Drugs and Technologies in Health
Contact Address:
600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553; Fax: +1 613 226 5392;
Contact Name:
requests@cadth.ca
Contact Email:
requests@cadth.ca
Copyright:
Canadian Agency for Drugs and Technologies in Health (CADTH)
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.