Evaluation of primary HPV-DNA testing in relation to visual inspection methods for cervical cancer screening in rural China: an epidemiologic and cost-effectiveness modelling study

• Main Authors: Kang Yoon-Jung, Ma Li, Simonella Leonardo, Ning Yan, Legood Rosa, Zhao Fang-Hui, Lew Jie-Bin, Canfell Karen, Shi Ju-Fang, Zhang Yong-Zhen, Smith Megan A, Chen Jun-Feng, Feng Xiang-Xian, Qiao You-Lin
• Format: Article
• Language: English
• Published: BMC 2011-06-01
• Series: BMC Cancer
• Online Access: http://www.biomedcentral.com/1471-2407/11/239

<p>Abstract</p> <p>Background</p> <p>A new lower-cost rapid-throughput human papillomavirus (HPV) test (<it>care</it>HPV, Qiagen, Gaithersburg, USA) has been shown to have high sensitivity for the detection of high grade cervical intraepithelial neoplasia.</p> <p>Methods</p> <p>We assessed the outcomes and cost-effectiveness of <it>care</it>HPV screening in rural China, compared to visual inspection with acetic acid, when used alone (VIA) or in combination with Lugol's iodine (VIA/VILI). Using data on sexual behaviour, test accuracy, diagnostic practices and costs from studies performed in rural China, we estimated the cost-effectiveness ratio (CER) and associated lifetime outcomes for once-lifetime and twice-lifetime screening strategies, and for routine screening at 5-yearly, 10-yearly and IARC-recommended intervals. The optimal age range for once-lifetime screening was also assessed.</p> <p>Results</p> <p>For all strategies, the relative ordering of test technologies in reducing cervical cancer incidence and mortality was VIA (least effective); VIA/VILI; <it>care</it>HPV@1.0 pg/ml and <it>care</it>HPV@0.5 pg/ml (most effective). For once-lifetime strategies, maximum effectiveness was achieved if screening occurred between 35-50 years. Assuming a participation rate of ~70%, once-lifetime screening at age 35 years would reduce cancer mortality by 8% (for VIA) to 12% (for <it>care</it>HPV@0.5) over the long term, with a CER of US$557 (for VIA) to $959 (for <it>care</it>HPV@1.0) per life year saved (LYS) compared to no intervention; referenced to a 2008 GDP per capita in Shanxi Province of $2,975. Correspondingly, regular screening with an age-standardised participation rate of 62% (which has been shown to be achievable in this setting) would reduce cervical cancer mortality by 19-28% (for 10-yearly screening) to 43-54% (using IARC-recommended intervals), with corresponding CERs ranging from $665 (for 10-yearly VIA) to $2,269 (for IARC-recommended intervals using <it>care</it>HPV@1.0) per LYS.</p> <p>Conclusions</p> <p>This modelled analysis suggests that primary <it>care</it>HPV screening compares favourably to visual inspection screening methodologies in rural China, particularly if used as part of a regular screening program.</p>