Cost Effectiveness of Human Papillomavirus 16/18 Genotyping in Cervical Cancer Screening

Objectives: The aim of this study was to evaluate the cost-effectiveness of cervical cancer screening with a human papillomavirus (HPV) 16/18 genotyping test in Korea. Methods: We compared seven strategies with a Markov cohort model: 1) cytology with reflex HPV testing for atypical squamous cells of undetermined significance (ASC-US) (‘cytology’) (routine screening interval 1 year), 2–4) HPV with 16/18 genotyping with liquid-based cytology triage co-testing (‘co-testing’) (routine screening interval 1, 2, 3 year), and 5–7) HPV with 16/18 genotyping and reflex cytology (ASC-US threshold) (‘HPV with genotyping’) (routine screening interval 1, 2, 3 year). Screening start age was 30-year-old and screening was performed over 40 years. Screening sensitivity and specificity values for cervical intraepithelial neoplasia 3 were obtained from ‘Addressing THE Need for Advanced HPV Diagnostics,’ trial. Screening costs and cancer treatment costs were calculated from a payer’s perspective in 2012. Costs and quality adjusted life-years (QALYs) were discounted at 5% annually. Results: Applying a KRW ￦20–30 million/QALY threshold, ‘co-testing’ with 1 year interval and “HPV with genotyping” with 1 year interval were not cost effective, but ‘co-testing’ with 2, 3 year interval and “HPV with genotyping” with 2, 3 year interval were cost effective versus ‘cytology’ with 1 year. Conclusion: Compared with the existing ‘cytology’ with 1 year, HPV 16/18 genotyping with 2, 3 year interval can be cost effective. Especially, ‘co-testing’ with 2 year interval was the most cost-effectiveness strategy.ope