Primary HPV screening compared with other cervical cancer screening strategies in women with HIV: a cost-effectiveness study

• Published in: AIDS (London) Vol. 38; no. 15; pp. 2030 - 2039
• Main Authors: Zhao, Ran, Sanstead, Erinn, Alarid-Escudero, Fernando, Huchko, Megan, Silverberg, Michael, Smith-McCune, Karen, Gregorich, Steven E., Leyden, Wendy, Kuppermann, Miriam, Sawaya, George F., Kulasingam, Shalini
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.12.2024
• Subjects: Adult; Colposcopy - economics; Cost-Benefit Analysis; Early Detection of Cancer - economics; Early Detection of Cancer - methods; Female; HIV Infections - diagnosis; HIV Infections - economics; Humans; Mass Screening - economics; Mass Screening - methods; Middle Aged; Papillomavirus Infections - complications; Papillomavirus Infections - diagnosis; United States; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - virology; Young Adult; United States; cervical cancer screening; cost-effectiveness; HPV test; women with HIV; decision model
• ISSN: 0269-9370; 1473-5571; 1473-5571
• DOI: 10.1097/QAD.0000000000004002

Objective:To compare the model-predicted benefits, harms, and cost-effectiveness of cytology, cotesting, and primary HPV screening in US women with HIV (WWH).Design:We adapted a previously published Markov decision model to simulate a cohort of US WWH.Setting:United States.Subjects, participants:A hypothetical inception cohort of WWH.Intervention:We simulated five screening strategies all assumed the same strategy of cytology with HPV triage for ASCUS for women aged 21-29 years. The different strategies noted are for women aged 30 and older as the following: continue cytology with HPV triage, cotesting with repeat cotesting triage, cotesting with HPV16/18 genotyping triage, primary hrHPV testing with cytology triage, and primary hrHPV testing with HPV16/18 genotyping triage.Main outcome measure(s):The outcomes include colposcopies, false-positive results, treatments, cancers, cancer deaths, life-years and costs, and lifetime quality-adjusted life-years.Results:Compared with no screening, screening was cost-saving, and >96% of cervical cancers and deaths could be prevented. Cytology with HPV triage dominated primary HPV screening and cotesting. At willingness-to-pay thresholds under $250 000, probabilistic sensitivity analyses indicated that primary HPV testing was more cost-effective than cotesting in over 98% of the iterations.Conclusions:Our study suggests the current cytology-based screening recommendation is cost-effective, but that primary HPV screening could be a cost-effective alternative to cotesting. To improve the cost-effectiveness of HPV-based screening, increased acceptance of the HPV test among targeted women is needed, as are alternative follow-up recommendations to limit the harms of high false-positive testing.