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Nghiem VT , Davies KR , Beck JR , Follen M , MacAulay C , Guillaud M , Cantor SB
Economic evaluation of DNA ploidy analysis vs liquid-based cytology for cervical screening
Br J Cancer. 2015 Jun 9;112(12) :1951-7
PMID: 25919612 PMCID: PMC4580387
AbstractBACKGROUND: DNA ploidy analysis involves automated quantification of chromosomal aneuploidy, a potential marker of progression toward cervical carcinoma. We evaluated the cost-effectiveness of this method for cervical screening, comparing five ploidy strategies (using different numbers of aneuploid cells as cut points) with liquid-based Papanicolaou smear and no screening. METHODS: A state-transition Markov model simulated the natural history of HPV infection and possible progression into cervical neoplasia in a cohort of 12-year-old females. The analysis evaluated cost in 2012 US$ and effectiveness in quality-adjusted life-years (QALYs) from a health-system perspective throughout a lifetime horizon in the US setting. We calculated incremental cost-effectiveness ratios (ICERs) to determine the best strategy. The robustness of optimal choices was examined in deterministic and probabilistic sensitivity analyses. RESULTS: In the base-case analysis, the ploidy 4 cell strategy was cost-effective, yielding an increase of 0.032 QALY and an ICER of $18 264/QALY compared to no screening. For most scenarios in the deterministic sensitivity analysis, the ploidy 4 cell strategy was the only cost-effective strategy. Cost-effectiveness acceptability curves showed that this strategy was more likely to be cost-effective than the Papanicolaou smear. CONCLUSION: Compared to the liquid-based Papanicolaou smear, screening with a DNA ploidy strategy appeared less costly and comparably effective.
NotesNghiem, V T Davies, K R Beck, J R Follen, M MacAulay, C Guillaud, M Cantor, S B CA016672/CA/NCI NIH HHS/United States P01 CA082710/CA/NCI NIH HHS/United States P30 CA006927/CA/NCI NIH HHS/United States R25 CA057712/CA/NCI NIH HHS/United States R25 CA57712/CA/NCI NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't England Br J Cancer. 2015 Jun 9;112(12):1951-7. doi: 10.1038/bjc.2015.95. Epub 2015 Apr 28.