Evidence map›Paper›PMID 22251259›Full record

ArticleBJOG : an international journal of obstetrics and gynaecology2012

Cost-effectiveness of cervical cancer screening: cytology versus human papillomavirus DNA testing.

J van Rosmalen, I M C M de Kok, M van Ballegooijen

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Article in BJOG : an international journal of obstetrics and gynaecology, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
23citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

23 citing papers in PubMed, 2 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

3 authors.

J van RosmalenDepartment of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands. j.vanrosmalen@erasmusmc.nl
I M C M de Kok
M van Ballegooijen

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo determine the most cost-effective screening programme for cervical cancer.

designCost-effectiveness analysis from a societal perspective.

settingThe Netherlands. POPULATION: Dutch women who have not been invited for human papillomavirus (HPV) vaccination.

methodsWe calibrated the microsimulation screening analysis (MISCAN) model to Dutch epidemiological data. We used this model to consider nine screening strategies that use: (i) cytological testing with cytology triage for borderline/mildly abnormal smears; (ii) HPV testing with cytology triage for HPV-positive smears; or (iii) cytological testing with HPV triage for borderline/mildly abnormal smears. For each strategy, we varied the number of screening rounds, the time interval, the age of the first screening, and the type of cytological testing (conventional or liquid-based cytology).

main outcome measuresQuality-adjusted life years (QALYs) gained and costs from a societal perspective.

resultsUnder the base-case assumptions, primary HPV testing with cytology triage is the most cost-effective strategy. Using cost-effectiveness thresholds of € 20,000 and € 50,000 per QALY gained yields optimal screening programmes with three and seven screening rounds, respectively. The results are sensitive to several uncertain model inputs, most importantly the costs of the HPV test. For women aged 32 years or younger, primary cytology screening is more cost-effective than primary HPV testing.

conclusionsIncreasing the interval between screening rounds and changing the primary test from cytology to HPV testing can improve the effectiveness and decrease the costs of cervical cancer screening in the Netherlands.

Indexed as

AdultCost-Benefit AnalysisDNA, ViralEarly Detection of CancerFemaleHumansMass ScreeningNetherlandsPapillomaviridaePapillomavirus InfectionsQuality-Adjusted Life YearsSensitivity and SpecificityUterine Cervical NeoplasmsVaginal SmearsDNA, Viral

Identifiers

PMID22251259
PMCPMC3489039

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.