The Clinical Benefits and Costs of Potential Cervical Cancer Screening Strategies in the Czech Republic

OBJECTIVES: Cervical cancer is still an important public health concern also in high-income countries. However, given its long natural history, it is a preventable disease. A properly implemented screening program can therefore reduce both its incidence and mortality. Our aim was to evaluate clinical benefits and costs of the three potential cervical screening strategies in the Czech Republic.

METHODS: We developed a microsimulation model as a tool to predict outcomes of three different screening strategies (annual Pap screening, annual Pap screening and HPV test in 35 and 45 years of age in case of negative Pap screening, annual Pap screening up to 30 years then HPV test every 5 years). Strategies with HPV test were compared to annual Pap screening strategy. Transition probabilities between health states were derived from published literature and calibrated to the Czech National Cancer Registry data. In this model analysis, we evaluated a hypothetical cohort of 100,000 women. Sensitivity analyses were performed.

RESULTS: In our modelling analysis, annual Pap screening with HPV co-testing in 35 and 45 years of age can reduce the incidence of cervical cancer by 9.8% and mortality by 8.4%, compared to annual Pap screening, the cost is 41,000 CZK (1,630 EUR) per one life-year saved. In the second alternative strategy (annual Pap screening up to the age of 30, then HPV test every 5 years) we can observe a decrease in incidence by 6.8% and mortality by 8.5% compared to annual Pap screening strategy, the cost is 142,000 CZK (5,670 EUR) per one life-year saved.

CONCLUSIONS: Based on our results, the annual Pap screening with age-specific HPV co-testing achieved higher health benefits than the annual Pap screening. The increase in screening costs is partially offset by a reduction in the costs of treatment of patients with cervical cancer.