Modelling the choice of high-risk human papillomavirus (HR-HPV) assay in the English cervical screening programme

Aquarius developed a decision tree model to compare the use of the Aptima mRNA HR-HPV assay to a DNA HR-HPV assay in the HPV primary screening algorithm in England. Robust results from the model demonstrate that using the mRNA HR-HPV assay is cost saving and avoids unnecessary HPV recall tests, cytology tests and colposcopies compared to using a DNA HR-HPV assay.

In England, women are invited for cervical cancer screening starting at age 25 and are recalled at regular intervals until age 64. In the HPV primary screening algorithm, cervical samples are tested first for HR-HPV. Positive HPV samples are then tested using liquid based cytology to identify abnormal cells.

Aquarius developed a cost consequence analysis decision tree taking the perspective of NHS England and modelling the HPV primary screening algorithm for one simulated cohort of 2,247,439 women aged 25-64 from baseline screen through recall visits. The model endpoint was discharge to routine recall, loss-to-follow up, or referral to colposcopy. A micro-costing approach was used to estimate costs for screening in England, using published data. Head-to-head comparison of mRNA to DNA tests at baseline and with follow-up was not available for the English population. Therefore, data from the HORIZON study in Denmark with similar positivity to that in England was used.

The model indicated that using an mRNA versus DNA assay in the HPV primary screening algorithm in England can save an estimated £15.4 million and require 28,009 fewer unnecessary colposcopies, 90,605 few HR-HPV tests and 253,477 fewer cytology tests.  Uncertainty and scenario analyses demonstrate cost and resource savings will almost certainly be achieved using the mRNA assay.

PublicationWeston G, Dombrowski C, Harvey MJ, et al Use of the Aptima mRNA high-risk human papillomavirus (HR-HPV) assay compared to a DNA HR-HPV assay in the English cervical screening programme: a decision tree model based economic evaluation BMJ Open2020; 10:e031303. doi: 10.1136/bmjopen-2019-031303

How to prevent cervical cancer: HPV – we are coming to get you!

Prevention of cervical cancer in women is the focus of vaccination and screening programmes globally. However, there is no consensus on the best way to approach screening, and screening across Europe varies considerably. Innovations in diagnostic testing and new ways to engage women in screening may improve screening uptake and increase the efficiency of screening pathways. In this talk, we explore opportunities for a rapid or point of care test for HPV as part of the screening pathway, and how self-sampling may be an effective way to engage women in screening.

presentation_icon
Adams EJ. How to prevent cervical cancer: HPV – we are coming to get you! EUROGIN. June 15-18, 2016. Salzburg, Austria.

 

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Cervical screening and HPV testing: Opportunities for rapid tests

Problem:  Our client Cepheid has developed a rapid HPV PCR test that can be used as a point-of-care test (POCT). They wanted to understand where in the cervical cancer screening and treatment pathway the test would be most beneficial to patients and the healthcare system. This comes during a time of uncertainty about how best to screen women, and how to organise laboratory services around screening. It is also unclear how screening may differ across Europe and the burden of cervical disease.

 Approach:  We conducted a literature review of the evidence about the current national cervical screening programme in the UK. Then, we conducted 25 semi-structured interviews with key opinion leaders across the UK to gain additional insight about the pathway and the opportunities for using a POCT in the screening pathway. Results also contributed to a European tool to understand cervical cancer diagnosis and burden.

 Impact:  We have presented our findings at international conferences (EUROGIN 2015, IPC 2015), and results have helped our client as they communicate the opportunities and value of a POCT for HPV to their stakeholders and customers. We have engaged with the international community on the requirements for the creation of a standardised international cervical cancer data repository, to inform better evidence-based decision making.

 

Testimonial

“While perfectly responding to the originally given mission, the Aquarius team painted a comprehensive picture of how healthcare is really delivered currently in Europe. This opened up our minds to new ways of improving patient care. The Aquarius team under Elisabeth’s leadership is highly professional, very creative and great fun to work with, without ever taking short cuts. I cannot imagine better results for us.”

  • Dr Anne Postulka, Senior Director Medical & Economic Value, Cepheid

 

Related publications

presentation_iconAdams EJ, Glover R, Vecino A, Postulka A. Exploring the value of a rapid, on-demand test for the detection of human papillomavirus. 30th International Papillomavirus Conference. Lisbon, Portugal. September 17 -21, 2015.

 

presentation_iconAdams EJ, Glover R, Vecino A, Postulka A. How can European countries improve cervical cancer prevention for women? 30th International Papillomavirus Conference. Lisbon, Portugal. September 17 -21, 2015.

How can European countries improve cervical cancer prevention for women?

We conducted a literature review on cervical cancer incidence, screening algorithms and coverage across Europe. Data on the structure and provision of screening programmes are sparse, with large heterogeneity reported by sources. A lack of comparable data across countries makes it challenging for researchers and policy-makers to assess screening effectiveness and what is most beneficial for women. A central data repository could facilitate effectiveness and cost-effectiveness analyses to support the adoption of the best screening algorithm.

presentation_iconAdams EJ, Glover R, Vecino A, Postulka A. How can European countries improve cervical cancer prevention for women? 30th International Papillomavirus Conference. Lisbon, Portugal. September 17 -21, 2015.

 

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Exploring the value of a rapid, on-demand test for the detection of human papillomavirus

We explored the use of a rapid, on-demand human papillomavirus (HPV) test as part of a cervical screening programme. Through semi-structured interviews with experts from across the UK, we found that a co-located, laboratory-based, and on-demand HPV test following cytology could reduce the time to results by up to a week, whilst a near-patient test under primary HPV screening followed by cytology triage could radically change the testing paradigm, with most women notified the same day.

presentation_iconAdams EJ, Glover R, Vecino A, Postulka A. Exploring the value of a rapid, on-demand test for the detection of human papillomavirus. 30th International Papillomavirus Conference. Lisbon, Portugal. September 17 -21, 2015.

 

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