Estimated Quality of Life and Economic Outcomes Associated With 12 Cervical Cancer Screening Strategies
Many cervical cancer screening strategies are now recommended in the United States, but the benefits, harms, and costs of each option are unclear. The objective of this article, written by George F. Sawaya,Erinn Sanstead &Fernando Alarid-Escudero, is estimate the cost-effectiveness of 12 cervical cancer screening strategies.
Design, Setting, and Participants
The cross-sectional portion of this study enrolled a convenience sample of 451 English-speaking or Spanish-speaking women aged 21 to 65 years from September 22, 2014, to June 16, 2016, identified at women’s health clinics in San Francisco. In this group, utilities (preferences) were measured for 23 cervical cancer screening–associated health states and were applied to a decision model of type-specific high-risk human papillomavirus (hrHPV)–induced cervical carcinogenesis. Test accuracy estimates were abstracted from systematic reviews. The evaluated strategies were cytologic testing every 3 years for women aged 21 to 65 years with either repeat cytologic testing in 1 year or immediate hrHPV triage for atypical squamous cells of undetermined significance (ASC-US), cytologic testing every 3 years for women age 21 to 29 years followed by cytologic testing plus hrHPV testing (cotesting), or primary hrHPV testing alone for women aged 30 to 65 years. Screening frequency, abnormal test result management, and the age to switch from cytologic testing to hrHPV testing (25 or 30 years) were varied. Analyses were conducted from both the societal and health care sector perspectives.
Sawaya GF, Sanstead E, Alarid-Escudero F, et al. Estimated Quality of Life and Economic Outcomes Associated With 12 Cervical Cancer Screening Strategies: A Cost-effectiveness Analysis. JAMA Intern Med. Published online May 13, 2019179(7):867–878. doi:10.1001/jamainternmed.2019.0299 http://hdl.handle.net/11651/3531