OBJECTIVES

: Our objective was to systematically review the current evidence on long-term effectiveness and cost effectiveness of cervical cancer screening in Europe with specific interest on risk-adapted strategies.

METHODS

: We conducted a systematic literature search to identify decision-analytic modelling studies assessing the cost effectiveness of cervical cancer screening strategies in Europe using relevant databases (Medline/Embase/Cochrane Library/CRD/EconLit). Study characteristics and results were summarized in standardized evidence tables. Outcomes included quality-adjusted life-years (QALY), life-years gained (LYG), and incremental cost-effectiveness ratios (ICER). Economic results were converted to 2015 Euros using the GDP-PPP and CPI.

RESULTS

: Fourteen studies mostly from countries with population-based organized screening were eligible for inclusion. HPV-based screening was reported to be more effective in terms of patient-relevant outcomes compared to cytology alone independent of HPV vaccination status. Overall, HPV-based screening strategies were considered to be cost effective at a willingness-to-pay threshold of 50,000 Euro/LYG conditional on screening intervals of at least three years in non-vaccinated women and at least five years in vaccinated women. HPV screening was mostly accompanied with a triage test for HPV-positive women. Most studies recommended starting screening at age 25 using cytology with cross over to HPV-based screening at age 30 years or older and ending screening at 65 years. While studies considering generic cancer risk aspects to restrict screening algorithms, further more personalized screening, follow-up strategies according to a woman’s screening, vaccination history and taking into account other risk factors have not been evaluated.

CONCLUSIONS

: Our research suggests that HPV-based screening is more effective compared to cytology alone, and can be considered cost effective at screening intervals of at least 3 (non-vaccinated) to 5 years (vaccinated women). Current risk-tailored screening programs are based on generic restrictions to a specific age and using triage or follow-up tests for HPV-positive women before referring to colposcopy directed biopsy.