Lifetime effects, costs, and cost effectiveness of testing for human papillomavirus to manage low grade cytological abnormalities: results of the NHS pilot studies
Open accessAbstract
OBJECTIVES: To predict the incremental lifetime effects, costs, and cost effectiveness of using human papillomavirus testing to triage women with borderline or mildly dyskaryotic cervical smear results for immediate colposcopy. DESIGN: Modelling study. SETTING: Three centres participating in NHS pilot studies, United Kingdom. Population Women aged 25-64 with borderline or mildly dyskaryotic cervical smear results. INTERVENTIONS: Screening using conventional cytology, liquid based cytology, and four strategies with different age cut-off points and follow up times that used combined liquid based cytology and human papillomavirus testing (adjunctive human papillomavirus testing). RESULTS: The model predicts that compared with using conventional cytology without testing for human papillomavirus, testing for the virus in conjunction with liquid based cytology for women with borderline or mildly dyskaryotic cervical smear results (aged 35 or more) would cost 3735 pounds sterling (5528 euros; 6474 dollars) per life year saved. Extending adjunctive human papillomavirus testing in combination with liquid based cytology to include women aged between 25 and 34 costs an additional 4233 pounds sterling per life year saved. Human papillomavirus testing is likely to reduce lifetime repeat smears by 52%-86% but increase lifetime colposcopies by 64%-138%. CONCLUSIONS: Testing for human papillomavirus to manage all women with borderline or mildly dyskaryotic cervical smear results is likely to be cost effective. The predicted increase in lifetime colposcopies, however, deserves careful consideration.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The Markov model was based on previously published and validated models for cervical cancer.
“Based on the previously published and validated models for cervical cancer, we developed a markov model on MS Excel spread sheet, considering the natural history of HPV infection and cervical cancer (Fig 1). [12–15]”
From Cost effectiveness of strategies for cervical cancer prevention in India (2020) · cites this paper as [15]
These estimates have also been used to parameterize models to evaluate cervical cancer prevention strategies in Thailand, United Kingdom and Germany.
“These estimates have also been used to parameterize models to evaluate cervical cancer prevention strategies in Thailand, United Kingdom and Germany. [13–15]”
From Cost effectiveness of strategies for cervical cancer prevention in India (2020) · cites this paper as [15]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Myers, E. R., McCrory, D. C., Nanda, K., Bastian, L., & Matchar, D. B. (2000) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a010166 · Cited by 470 · see citing works
Flagged first, then by citations
Research works printed but not linked: 17
- Walboomers JMM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 1999;189:12-9.
- Wright TC, Cox JT, Massad LS, Twiggs LB, Wilkinson EJ. 2001 Consensus guidelines for the management of women with cervical cytological abnormalities. JAMA 2004;287:2120-9.
- LBC/HPV Cervical Screening Pilot Studies Group. HPV triage of low grade cytologi- cal abnormality: NHS pilot studies.[REF BMJ/2005/295824 in press] [Author: Status of this paper seems to be rejection with offer for resubmission. Please provide an alternative reference if possible. We give details when papers have 'in press' status- Response: this is the companion paper and ideally should be published at the same time, it is currently with the co-ordinating editor]
- Department of Health. Cervical screening programme. England: 2002-2003. Statistical Bulletin 2003/24. London: DoH, 2003.
- Abryn M, Buntinx F, Van Ranst M, Paraskevaidas E, Martin-Hirsh P, Dillner J. Virologic versus cytologic triage of women with equivocal pap smears: a meta-analysis of the accuracy to detect high grade intraepithelial neoplasia. J Natl Cancer Inst 2004;96:280- 93.
- Payne N, Chilcott J, McGoogan E. Liquid-based cytology in cervical screening: a rapid and systematic review. Health Technol Assess 2000;4:1-73.
- Wolstenholme JL, Whynes DK. Stage-specific treatment costs for cervical cancer in the United Kingdom. Eur J Cancer 1998;34:1889-93.
- Dickson RJ. Management of carcinoma in the cervix. Practitioner 1980;22:899-904.
- Cuzick J, Szareweski A, Terry G, Ho L, Hanby A, Maddox P, et al. Human papillomavi- rus testing in primary cervical screening. Lancet 1995;345:1533-6.
- Nanda K, McCrory DC, Myers ER, Bastian LA, Hasselblad V, Hickey JD, et al. Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: a systematic review. Ann Intern Med 2000;132:810-9.
- Briggs AH, Goeree R, Blackhouse G, O'Brien BJ. Probalistic analysis of cost effective- ness models: choosing between treatment strategies for gastroesophagael reflux disease. Med Decis Making 2002;22:290-308.
- Fenwick E, Claxton K, Sculpher M. Representing uncertainty: the role of cost effective- ness acceptability curves. Health Econ 2001;10:779-87.
- Cuzick J, Szarewki A, Cubie H, Kitchener H, Luesley D, McGoogan E, et al. Management of women who test positive for high-risk types of human papillomavirus: the HART study. Lancet 2003;362:1871-6.
- Peto J, Gilham C, Fletcher O, Matthews F. The cervical cancer epidemic that screening has prevented in the UK. Lancet 2004;364:249-56.
- Kim JJ, Wright TC, Goldie SJ. Cost-effectiveness of alternative triage strategies for atypical squamous cells of undetermined significance. JAMA 2002;287:2382-90.
- Sherlaw-Johnson C, Phillips Z. An evaluation of liquid-based cytology and human pap- illomavirus testing within the UK cervical cancer screening programme. Brit J Cancer 2004;91:84-91.
- Karnon J. Alternative decision modelling techniques for the evaluation of health care technologies: Markov processes versus discrete event simulation. Health Econ 12:837-48. (Accepted 31 October 2005) doi 10.1136/bmj.38698.458866.7C Health Economics Research Centre, Department of Public Health, University of Oxford, Oxford OX3 7LF Rosa Legood senior researcher Alastair Gray professor of health economics Jane Wolstenholme senior researcher Cancer Screening Evaluation Unit, Institute of Cancer Research, Sutton, Surrey SM2 5NG Sue Moss associate director Correspondence to: R Legood rosa.legood@dphpc.ox.ac.uk · DOI
Cited by
Sorted by citations
Cost effectiveness of strategies for cervical cancer prevention in India
Chauhan, A. S., Prinja, S., Srinivasan, R., Rai, B., Malliga, J., Jyani, G., Gupta, N., & Ghoshal, S. (2020) · PLOS ONE · doi:10.1371/journal.pone.0238291 · Cited by 75 · see citing works
- Authors
- Legood, R., Gray, A., Wolstenholme, J., & Moss, S.
- Affiliations
- University of Oxford (GB)
- Institute of Cancer Research (GB)
- Corresponding author
- Legood, Rosa
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2006-01-06
- Volume
- 332
- Issue
- 7533
- Pages
- 79-85
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC1326928
- OpenAlex
- W1968258823
- Cited by
- 68
- References
- 1
- Citations by year
- 2026: 1 · 2025: 1 · 2020: 1 · 2019: 1 · 2017: 1 · 2016: 1 · 2015: 2 · 2014: 2 · 2013: 4 · 2012: 6
- FWCI
- 8.33
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Keywords
- HPV testing, cervical cancer screening, liquid-based cytology, conventional cytology, triage, colposcopy, cost-effectiveness, life-years saved, age cut-off
- MeSH terms
- Adult, Uterine Cervical Dysplasia, Uterine Cervical Neoplasms, Costs and Cost Analysis, Cytological Techniques, Female, Humans, Mass Screening, Middle Aged, Patient Acceptance of Health Care, Pilot Projects, Sensitivity and Specificity, State Medicine, Tumor Virus Infections, Vaginal Smears, Papillomaviridae
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
