Background
Methods
Overview
Markov model of cervical carcinogenesis
Natural history
Screening strategies
Test or test combination
|
Strategy
|
Frequency (years)
| Age when screening strategy begins | ||
---|---|---|---|---|---|
18 years | 25 years | 18-24 via Miller1, 25+ via strategy | |||
Pap only | Pap1
| 1 (age 18 to 20) and 3 (age 21+) | X (Screening Strategy (SS) 1) | ||
Pap | 1 | X (SS 2) | |||
Pap | 2 | X (SS 3) | |||
HPV testing only2
| HPV | 3 | X (SS 4) | X (SS 5) | X (SS 6) |
HPV | 5 | X (SS 7) | X (SS 9) | X (SS 9) | |
Co-testing3
| Pap + HPV | 2 | X (SS 10) | X (SS 11) | X (SS 12) |
Pap + HPV | 3 | X (SS 13) | X (SS 14) | X (SS 15) | |
Pap + HPV | 5 | X (SS 16) | X (SS 17) | X (SS 18) | |
Triage (Pap followed by HPV)4
| Pap with HPV triage | 1 | X (SS 19) | X (SS 20) | X (SS 21) |
Triage (HPV followed by Pap)5
| HPV with Pap triage | 3 | X (SS 22) | X (SS 23) | X (SS 24) |
HPV with Pap triage | 5 | X (SS 25) | X (SS 26) | X (SS 27) |
Screening Adherence (1)
| |||
---|---|---|---|
<20 | 0.5-0.75 (0.35-1.0) | ||
20-29 | 0.5-0.8 (0.35-1.0) | ||
30-39 | 0.7-0.9 (0.5-1.0) | ||
40-49 | 0.6-0.9 (0.4-1.0) | ||
50+ | 0.3-1.0 (0.2-1.0) | ||
Age <30 | Age 30+ | ||
Pap sensitivity for CIN 1+ | 0.42 (0.31-0.72) | 0.32 (0.30-0.66) | |
Pap specificity for <CIN 1 | 0.98 (0.80-0.95) | 0.94 (0.82-0.95) | |
HPV sensitivity for CIN 1+ | 0.83 (0.68-1.0) | 0.71 (0.65-1.0) | |
HPV specificity for <CIN 1 | 0.83 (0.80-0.97) | 0.97 (0.94-1.0) | |
HPV and Pap sensitivity for CIN 1+ | 0.88 (0.72-1.0) | 0.75 (0.69-1.0) | |
HPV and Pap specificity for <CIN 1 | 0.82 (0.79-0.96) | 0.95 (0.92-1.0) | |
Canada and Ontario | Alberta | Newfoundland | |
Conventional Pap | $28 ($14-$56) | $30 ($15-$59) | $29 ($14-$58) |
Liquid-based Pap | $32 ($16-64) | $35($17-$70) | $33 ($16-$65) |
HPV test (hc2) | $53 ($14-$106) | $50 ($14-$100) | $53 ($14-$106) |
Colposcopy + biopsy | $337 ($168-$673) | $376 ($188-$752) | $412 ($206-$824) |
LEEP | $965 ($83-$1930) | $1082 ($541-$2164) | $1044 ($522-$2088) |
Stage I Cancer | $11153 ($5576-$22305) | $12126 ($6063-$24253) | $11898 ($5949-$23797) |
Stage II - III Cancer | $17644 ($8822-$35288) | $19185 ($9592-$38369) | $18824 ($9412-$37648) |
Stage IV - Cancer | $24110 ($12055-$48220) | $26215 ($13107-$52430) | $25722 ($21861-$51445) |
Utilities[32]4
| |||
False-positive screening test result | -.02 | ||
Duration | 2 1/2 months[8] | ||
Stage I Cancer | 0.76 | ||
Duration | 5 years 5
| ||
Stage II - IV Cancer | 0.67 | ||
Duration | 5 years 5
|
Screening test(s) sensitivity and specificity
Costs
Utilities
Analysis
Results
Model calibration
Base case results
Strategy | False Positives | Cancer (All Stages) |
---|---|---|
No Intervention (Natural history) 1
| - | 2,145 |
HPV with Pap Triage, q5, age 25
1
(SS 26)
|
2,871
|
736
|
HPV with Pap Triage, q3, age 25
1
(SS 23)
|
5,585
|
467
|
HPV with Pap Triage, q5, age 18 (SS 25) | 7,044 | 679 |
HPV with Pap Triage, q3, age 18
1
(SS 22)
|
9,872
|
437
|
Miller at age 18, then HPV with Pap Triage, q5, age 25 (SS 27)
| 11,404 | 658 |
Miller at age 18, then HPV with Pap Triage, q3, age 25 (SS 24)
| 14,160 | 411 |
Miller strategy (Pap q1 beginning at age 18, then q3 at age 21) (SS 1)
| 20,529 | 809 |
HPV only, q5, age 25 (SS 8)
| 22,437 | 586 |
Pap only, q2, age 18 (SS 3)
| 25,103 | 600 |
Pap with HPV Triage, q1, age 25 (SS 20)
| 27,660 | 364 |
Pap and HPV, q5, age 25 (SS 17)
| 30,817 | 548 |
Miller at age 18, then Pap with HPV Triage, q1, age 25
1
(SS 21)
|
37,034
|
330
|
HPV only, q3, age 25 (SS 5)
| 40,789 | 361 |
HPV only, q5, age 18 (SS 7)
| 40,957 | 538 |
Pap with HPV Triage, q1, age 18
1
(SS 19)
|
44,903
|
309
|
Pap only, q1, age 18
1
(SS 2)
|
46,337
|
303
|
Pap and HPV, q5, age 18 (SS16)
| 50,790 | 500 |
Pap and HPV, q3, age 25 (SS 14)
| 54,835 | 335 |
HPV only, q3, age 18 (SS 4)
| 60,456 | 330 |
Miller at age 18, then HPV only, q5, age 25 (SS 9)
| 61,375 | 517 |
Miller at age 18, then Pap and HPV, q5, age 25 (SS 18)
| 73,470 | 481 |
Pap and HPV, q3, age 18 (SS 13)
| 76,438 | 304 |
Miller at age 18, then HPV only, q3, age 25 (SS 6)
| 79,887 | 301 |
Pap and HPV, q2, age 25 (SS 11)
| 82,340 | 229 |
Miller at age 18, then Pap and HPV, q3, age 25 (SS 15)
| 97,645 | 283 |
Pap and HPV, q2, age 18
1
(SS 10)
|
118,646
|
180
|
Miller at age 18, then Pap and HPV, q2, age 252 (SS 12)
| 125,229 | 184 |