OBJECTIVES: The clinical superiority of HPV testing for cervical cancer (CC) screening is steering the international society to lean in its favor. However, the choice between the different HPV testing methods is crucial, as it can determine the efficiency of the screening programs. Simultaneous 16/18 genotyping testing offers the potential to save resources by avoiding retesting for the respective oncogenic HPV types. Aim of this study was to compare the economic impact of HPV 16/18 genotyping to HPV reflex genotyping in Greece.

METHODS: Given that the two methods have been proved equally effective, a cost-minimization analysis was performed to compare HPV 16/18 genotyping test versus HPV reflex genotyping as primary screening methods every 3 years for women 25-65 years old. The time horizon was two screening cycles. A decision tree and a Markov model were developed to simulate the screening algorithm and the natural history of CC. Clinical inputs were drawn from the HERMES study and cost inputs from the official price list and the international literature. Both one way and probabilistic sensitivity analysis were conducted.

RESULTS: The two methods were proved of equal effectiveness detecting 94.1% and 88.7% of Cervical Intraepithelial Neoplasia 2+ (CIN2+) and CCs, respectively. However, the HPV 16/18 genotyping strategy was found to save 14.8 million € (41%) annually for the social insurance (21.4 million € vs 36.2 million €). The total cost per screened patient/year (screening, diagnostic and treatment cost) was estimated at 24€ and 40€ for the 16/18 and the reflex genotyping methods, respectively. The cost per case of CIN2+ was found 69.2% higher for the reflex genotyping algorithm (21,127€ vs 12,482€).

CONCLUSIONS: According to the above the efficiency of a an HPV CC screening program is maximized by choosing the method with simultaneous 16/18 genotyping as it can provide the same outcomes with substantially less cost.