Is a delay in the introduction of human papillomavirus-based cervical screening affordable?

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Abstract

Objective It often takes considerable time for sufficient evidence to accumulate to support implementation of new methods in routine screening. Where national screening programmes are already effective, switching to a more sensitive screening test may not be a priority. Although risk associated with overly rapid implementation exists, postponement is also associated with a (to date unquantified) missed opportunity to prevent deaths. This risk tends not to be addressed where effective screening methods are already in use. We here estimate the monetary value of a one-year delay in replacing cytology cervical screening with human papillomavirus testing. Methods Using a previously validated model, we calculated the number of incident and fatal cervical cancers that would be diagnosed by 2030 in England, under the assumption that human papillomavirus testing replaces cytology in 2020 rather than 2019, and the monetary value of the quality-adjusted life years lost in preventable cases. Results A one-year delay in the implementation of human papillomavirus screening would miss the opportunity to prevent 581 cases of cervical cancer, and lead to a loss of 1595 quality-adjusted life years (3.5% discount rate) with a monetary value of £32 million (at £20,000 per quality-adjusted life year). Conclusion This is a measurable loss and should be considered in prioritising decision-making in screening.

Original languageEnglish
Pages (from-to)969141318800355
JournalJournal of Medical Screening
Early online date3 Oct 2018
DOIs
Publication statusE-pub ahead of print - 3 Oct 2018

Keywords

  • HPV primary screening
  • QALY
  • cervical cancer screening
  • screening implementation
  • implementation delays

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