Highlights
- •Transitioning from cytology to primary HPV cervical screening could avert 149 cancer cases and 45 deaths by 2035.
- •Annual primary test volumes will decrease following programme transition, fluctuating with the 5-year screening interval.
- •NCSP costs are predicted to reduce by 16% by 2035 due to the effect of HPV vaccination and primary HPV screening.
- •Colposcopy referrals following a primary test are predicted to reduce from 2.7% to 2.2% by 2035.
- •Findings from this study will be important for planning and communication around the program transition.
Abstract
Background
In response to emergent evidence, many countries are transitioning from cytology-based
to HPV screening. We evaluated the impact of an upcoming transition on health outcomes
and resource utilisation in New Zealand.
Methods
An extensively validated model of HPV transmission, vaccination, natural history and
cervical screening (‘Policy1-Cervix’) was utilised to simulate a transition from three-yearly cytology for women 20–69 years
to five-yearly HPV screening with 16/18 genotyping for women 25–69 years, accounting
for population growth and the impact of HPV immunisation. Cervical cancer rates, resources
use (test volumes), costs, and test positivity rates from 2015 to 2035 were estimated.
Findings
By 2035, the transition to HPV screening will result in declines in cervical cancer
incidence and mortality rates by 32% and 25%, respectively, compared to 2018. A potentially
detectable 5% increase in cervical cancer incidence due to earlier detection is predicted
for the year of transition. Annual numbers of women screened will fluctuate with the
five-year screening interval. Cytology volumes will reduce by over 80% but colposcopy
volumes will be similar to pre-transition rates, and program costs will be reduced
by 16%. A 9% HPV test positivity rate is expected in the first round of HPV screening
(2019–2023), with 2.7% of women referred for colposcopy. Transitioning from cytology
to primary HPV cervical screening could avert 149 cancer cases and 45 deaths by 2035.
Conclusion
Primary HPV screening and vaccination will reduce cervical cancer and resources use.
A small transient apparent increase of invasive cancer rates due to earlier detection
may be detectable at the population level, reflecting the introduction of a more sensitive
screening test. These findings can be used to inform health services planning and
public communications surrounding program implementation.
Keywords
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Article info
Publication history
Accepted:
October 30,
2018
Received in revised form:
October 16,
2018
Received:
June 25,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
