HPV plus Pap every 2 years can add years to life, is cost-effective.(human papillomavirus)(Brief Article)

2002 MAY 30 - (NewsRx.com & NewsRx.net) -- Screening for the human papillomavirus (HPV) virus, which increases the risk of cervical cancer, along with using Pap tests every 2 years appears to save additional years of life at reasonable costs, compared with Pap testing alone, according to an article in the May 8, 2002 issue of the Journal of the American Medical Association.

Jeanne S. Mandelblatt, MD, MPH, of Georgetown University Medical Center and Clinical and Economic Outcomes Core, Lombardi Cancer Center, Washington, DC, and colleagues used a mathematical model of the natural history of cervical cancer to estimate the incremental societal costs and benefits of screening in the average U.S. population using testing for HPV - alone or in combination with a Pap smear - compared with Pap smears alone.

According to background information cited in the article, about 50 million Pap smears are performed in the U.S. each year to screen for cervical cancer. But Pap test characteristics are less than optimal, with false-negative rates of 25-50%. Evolving understanding of the role of HPV infection in increasing the risk of cervical cancer, and advances in technology for HPV detection have prompted exploration of HPV testing as an adjunct or primary screening tool.

The authors compared 18 different general population screening strategies: Pap plus HPV testing, Pap testing alone, and HPV testing alone every 2 or 3 years among hypothetical groups of U.S. women, beginning at age 20 and continuing to age 65, 75, or death.

"Using a comprehensive simulation model of the natural history of HPV-driven cervical carcinogenesis, we found that comparing each strategy to the next least-expensive option, maximal savings in life could be achieved by screening every 2 years from age 20 to death with a combination of HPV and Pap tests," the authors wrote.

"Cessation of screening at age 65 or 75 years is less expensive and captures 86.6% and 97.8% of the benefits of lifetime biennial screening, respectively," they report. "Applying age limits to screening is a viable option to maintain benefits while reducing costs," they suggested.

The authors found that HPV screening alone was equally effective as Pap testing alone at any given screening interval or age when screening stopped, but was more costly. "In sensitivity analyses, HPV testing would be more effective and less costly than Pap testing at a cost threshold of $5 for an HPV test," they wrote (JAMA, 2002;287:2372-2381).