OBJECTIVES: Guidelines recommend cytology screening of cervical cancer every 3-years starting at the age 21 to 29 years. For age 30 onwards primary human papillomavirus (HPV) testing or co-testing (HPV + cytology) is also recommended every 5-years through age 65. The objective of the current review is to summarise the model-based cervical cancer screening studies.

METHODS: An SLR was performed across major biomedical databases (EMBASE, MEDLINE, NHS EED) to identify EEs reporting cervical cancer screening methods in the US, published in the English language over the last 10 years.

RESULTS: A total of 10 studies (9 CEA, 1 BIM) from 14 publications were included, with the majority using the Markov model (N=6), followed by microsimulation (N=3) and dynamic model (N=1). Majority of the studies used lifetime horizon and payer’s perspective. Findings revealed that the current screening practice was not cost-effective relative to guidelines-based strategies. A switch from 3-year cytology to 5-year co-testing is associated with an ICER of $59,440/QALY. However, co-testing at 3-year intervals is predicted to be a cost-effective approach over currently recommended 5-year intervals with an ICER of $18,060/QALY. Co-testing was superior compared to cytology or HPV alone. Co-testing with genotyping was also superior to co-testing without genotyping. One study also reported HPV primary testing as a cost-effective method compared to cytology/HPV co-testing with an ICER of -$22,577. Current guidelines (early (21-year) or more frequent screening than every 5-years) were inefficient and had a high ICER of $200,000/QALY gained. Across already vaccinated women, cytology or HPV testing alone e5y starting at age 25 or 30 were the optimal methods, with an ICER ranging from $34 680-$138 560/QALY gained.

CONCLUSIONS: Less-intensive screening algorithms can provide greater health benefit than current screening guidelines, which do not differentiate based on HPV vaccination status.