OBJECTIVES

Cervical cancer is responsible for the deaths of approximately 1,100 women every year in France, a number that has increased in recent years. Screening programs have become widely established, employing either cytology or human papilloma virus (HPV) testing, or a combination of both. As part of the 2014-19 Cancer Plan, a nationwide screening program is being established in France. A cost-effectiveness model was developed to predict the clinical and economic benefits of 5-yearly primary HPV screening with mRNA versus DNA, in France.

METHODS

A Markov cohort model with ancillary decision trees was built from a healthcare payer perspective, with a screening lifetime time horizon (ages 35 to 65) and 4% discount rate for costs/outcomes. Compliance to screening was included, and the simulated treatment algorithm accounted for HPV, Pap grade and cervical intraepithelial neoplasia (CIN) distribution within the population. Inputs were informed by recent models published in the disease area, targeted literature reviews and clinical validation. Screening, diagnosis and treatment costs were based on French national tariffs and reimbursement codes. Deterministic sensitivity analysis (DSA) was conducted to identify key model drivers.

RESULTS

Over the 30-year time horizon, primary mRNA screening reduced the total number of negative colposcopies by 24% (603) compared to DNA, resulting in fewer unnecessary colposcopies due to increased specificity. mRNA screening was cost-saving per patient (245.33€ versus 251.38€), with very little differences in quality-adjusted life years. There was little difference (<5%) between screening strategies for the detection of CIN 2/3 cases and invasive cervical cancer. The DSA identified screening costs, test accuracy and health state utility values as key drivers.

CONCLUSIONS

The model predicted 5-yearly primary mRNA HPV screening to be cost-saving compared to primary DNA HPV. Further, it results in fewer colposcopies per patient, whilst maintaining similar clinical outcomes in terms of detection of disease.