Liquid-based cervical cytology using ThinPrep technology: weighing the pros and cons in a cost-effectiveness analysis

• Published in: Cancer causes & control 2012-08, Vol.23 (8), p.1323-1331
• Main Authors: de Bekker-Grob, Esther W., de Kok, Inge M. C. M., Bulten, Johan, van Rosmalen, Joost, Vedder, Judith E. M., Arbyn, Marc, Klinkhamer, Paul J. J. M., Siebers, Albertus G., van Ballegooijen, Marjolein
• Format: Article
• Language: English
• Subjects: Accuracy; Adult; Biomedical and Life Sciences; Biomedicine; Cancer Research; Cancer screening; Cellular biology; Cervical cancer; Cervical Intraepithelial Neoplasia - economics; Cervical Intraepithelial Neoplasia - pathology; Cervical Intraepithelial Neoplasia - virology; Cost analysis; Cost effectiveness analysis; Cost efficiency; Cost-Benefit Analysis; Cytological Techniques - economics; Cytological Techniques - methods; Cytology; Early Detection of Cancer - economics; Early Detection of Cancer - methods; Epidemiology; Female; Hematology; Human papillomavirus; Humans; Laboratories; Land classification; Medical screening; Middle Aged; Netherlands; Oncology; Original Paper; Papillomaviridae - genetics; Papillomaviridae - isolation & purification; Papillomavirus Infections - pathology; Papillomavirus Infections - virology; Pathology; Public Health; Reagent Kits, Diagnostic - economics; Screening tests; Triage; Unit costs; Uterine Cervical Neoplasms - economics; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - virology; Utilities costs; Womens health
• ISSN: 0957-5243; 1573-7225
• DOI: 10.1007/s10552-012-0011-1

Purpose: Cervical cancer screening with liquid-based cytology (LBC) has been developed as an alternative to the conventional Papanicolaou (CP) smear. Cost-effectiveness is one of the issues when evaluating LBC. Based on the results of a Dutch randomised controlled trial, we conducted cost-effectiveness threshold analyses to investigate under what circumstances manually screened ThinPrep LBC is cost-effective for screening. Methods: The MISCAN-Cervix microsimulation model and data from the Dutch NETHCON trial (including 89,784 women) were used to estimate the costs and (quality-adjusted) life years ((QA)LYs) gained for EU screening schedules, varying cost-effectiveness threshold values. Screening strategies were primary cytological screening with LBC or CP, and triage with human papillomavirus (HPV) testing. Results: Threshold analyses showed that screening with LBC as a primary test can be cost-effective if LBC is less than €3.2 more costly per test than CP, if the sensitivity of LBC is at least 3-5 % points higher than CP, if the quality of life for women in triage follow-up is only 0.39, or if the rate of inadequate CP smears is at least 16.2 %. Conclusions: Regarding test characteristics and costs of LBC and CP, only under certain conditions will a change from CP to manually screened ThinPrep LBC be cost-effective. If none of these conditions are met, implementation of manually screened ThinPrep LBC seems warranted only if there are advantages other than cost-effectiveness. Further research is needed to establish whether other LBC systems will be more favorable with regard to cost-effectiveness.