Aquarius Population Health

The results of our economic evaluation comparing the use of mRNA and DNA assays in screening for cervical cancer in England were published in BMJ Open and are now available online. Results show large cost savings from avoiding unnecessary testing and follow-up, which can benefit women and healthcare services.

Most cervical cancer is caused by high-risk human papillomavirus (HR-HPV). Until last year, England’s cervical screening programme (CSP) looked for precancerous abnormalities by first testing samples for cytology, followed by HR-HPV testing in samples with abnormal cytology. From 2019, the protocol changed. Now primary HPV screening has been implemented, which means samples are first tested for HR-HPV, and positive HPV samples are then tested by cytology to look for cell changes. This means that many more HR-HPV tests and fewer cytology tests are now performed.

There are two types of tests available for HR-HPV testing: DNA and mRNA (messenger-RNA) tests. Both tests are approved for use in England, and labs around the country are now using both for primary HPV screening. Both tests have a similarly high sensitivity, meaning that there are few false positive results and those women who have HPV and cell changes are identified correctly. However, the mRNA test has a higher specificity than the DNA test, which means it is less likely to give a false positive result. This is very important, as women with a false positive are sent for unnecessary colposcopy (an invasive procedure) and retested more frequently.

Our economic evaluation looked at the impact of using a DNA versus mRNA assay in the English primary HPV cervical cancer screening programme. We created a decision tree model to simulate the current screening algorithm and used data from England and other published sources.

In our cohort of 2.25 million women (aged 26-65 years) with 3-year follow-up undergoing cervical screening in England, using an mRNA assay resulted in a saving of £15.4 million. It also reduced the number of unnecessary colposcopies by 28,009 (29% reduction), unnecessary HR-HPV tests by 90,605, and unnecessary cytology tests by >250,000. The results were very robust to changes in the model inputs and assumptions.

We conclude that using the mRNA test would benefit the NHS, by saving unnecessary resources, and benefit women, who would be spared unnecessary testing and colposcopy. This is a very important consideration, particularly in an era of rationalising resource use and constrained budgets for the NHS.

This is one of many health economic analyses we have done that has been commissioned by diagnostic companies, government bodies and healthcare providers in the UK and internationally. If you are interested in finding out more about Aquarius and the evidence generation we provide, please email