Cost-Effectiveness Evaluation of Combined Cervical Cancer Screening With CINtec PLUS in the Czech Republic
Author(s)
Vojtech Kamensky, Ing. PhD1, Ondrej Gajdoš, PhD1, Lullien Gurvan, MSc2, Juliana Grand Mullerova, MSc3.
1Czech Technical University in Prague, Kladno, Czech Republic, 2Université Claude Bernard Lyon 1, Lyon, France, 3Project manager, CEEOR, Bratislava, Slovakia.
1Czech Technical University in Prague, Kladno, Czech Republic, 2Université Claude Bernard Lyon 1, Lyon, France, 3Project manager, CEEOR, Bratislava, Slovakia.
OBJECTIVES: Current cervical cancer screening in the Czech Republic includes cytology and limited HPV testing at ages 35, 45, and 55. However, limitations in the sensitivity and specificity of Pap tests, particularly in cases of ASC-US or LSIL cytology, pose challenges for early detection of high-grade lesions. This study evaluates the cost-effectiveness of a combined screening strategy incorporating cytology, high-risk HPV DNA testing, and triage with the p16/Ki-67 dual-stain CINtec PLUS test, compared to the current standard of care.
METHODS: A Markov microsimulation model simulated lifetime costs and health outcomes for a cohort of 10,000 women aged 30 over a 30-year horizon. The model used Czech epidemiological and cost data and included progression from HPV infection through CIN stages to cervical cancer. Outcomes included QALYs, cervical cancer incidence, and prevalence of CIN2 and CIN3. Costs were assessed from the healthcare payer perspective, with deterministic and probabilistic sensitivity analyses. Scenario analysis evaluated a 5-year Pap test interval combined with HPV testing and 40-year and lifetime horizons.
RESULTS: The combined screening strategy increased average costs by CZK 2,797 per woman and resulted in an incremental gain of 0.045 QALYs, yielding an ICER of CZK 62,099 per QALY—well below the Czech willingness-to-pay threshold. The strategy reduced cervical cancer incidence by up to 48% and led to a 14% higher detection rate of CIN2/3 lesions compared to standard screening. CIN2 and CIN3 prevalence was reduced by 18% and 17%, respectively. With extended Pap test intervals and alternative time horizons, combined screening achieves better effectiveness despite higher costs, and the ICER remains below the willingness-to-pay threshold.
CONCLUSIONS: The combined screening approach using CINtec PLUS is a cost-effective, clinically beneficial strategy for cervical cancer prevention. Its implementation could substantially reduce the burden of HPV-related diseases in the Czech Republic and improve early detection of high-grade precancerous lesions.
METHODS: A Markov microsimulation model simulated lifetime costs and health outcomes for a cohort of 10,000 women aged 30 over a 30-year horizon. The model used Czech epidemiological and cost data and included progression from HPV infection through CIN stages to cervical cancer. Outcomes included QALYs, cervical cancer incidence, and prevalence of CIN2 and CIN3. Costs were assessed from the healthcare payer perspective, with deterministic and probabilistic sensitivity analyses. Scenario analysis evaluated a 5-year Pap test interval combined with HPV testing and 40-year and lifetime horizons.
RESULTS: The combined screening strategy increased average costs by CZK 2,797 per woman and resulted in an incremental gain of 0.045 QALYs, yielding an ICER of CZK 62,099 per QALY—well below the Czech willingness-to-pay threshold. The strategy reduced cervical cancer incidence by up to 48% and led to a 14% higher detection rate of CIN2/3 lesions compared to standard screening. CIN2 and CIN3 prevalence was reduced by 18% and 17%, respectively. With extended Pap test intervals and alternative time horizons, combined screening achieves better effectiveness despite higher costs, and the ICER remains below the willingness-to-pay threshold.
CONCLUSIONS: The combined screening approach using CINtec PLUS is a cost-effective, clinically beneficial strategy for cervical cancer prevention. Its implementation could substantially reduce the burden of HPV-related diseases in the Czech Republic and improve early detection of high-grade precancerous lesions.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE229
Topic
Economic Evaluation, Health Policy & Regulatory
Disease
Oncology, Reproductive & Sexual Health