The researchers analyzed various screening strategies in 451 English- or Spanish-speaking women between the ages of 21 and 65 years old who were enrolled at San Francisco health clinics tested, taking into account the women's screening preferences, direct medical costs and the cost-effectiveness of each approach, the estimated quality of life associated with each strategy, and other outcomes.
"Both the American College of Obstetricians and Gynecologists and the American Cancer Society consider co-testing the preferred cervical cancer screening strategy, and the US Preventive Services Task Force considers it an alternative strategy," the authors wrote. "Our findings challenge these endorsements."
Testing with hrHPV alone once every five years, in combination with an HPV genotype-based triage for ASC-US, appeared to be the lowest cost option when started at age 30, the investigators explained, and showed higher sensitivity than the cytologic test. They noted that all of the screening strategies considered appeared to save money compared with no screening.
"Cytologic testing every three years for women aged 21 to 29 years with either continued cytologic testing every three years, or switching to a low-cost hrHPV test every five years, confers a reasonable balance of benefits, harms, and costs," the authors wrote, adding that "[c]omparative modeling is needed to confirm the association of these novel utilities with cost-effectiveness."