Cost-Effectiveness Analysis of HPV Extended versus Partial Genotyping for Cervical Cancer Screening in Singapore

Simple Summary Identification of human papillomavirus (HPV) genotypes beyond HPV16 and HPV18 by extended genotyping (XGT) for cervical cancer screening, allows for risk stratification for clinical management. We estimated the resource use, cost, and quality-adjusted life years (QALY) comparing XGT to partial genotyping (PGT) in Singapore. The analysis considers a five-year screening cycle and lifetime outcomes in women diagnosed with CIN2+. Compared to PGT, XGT cost an additional SGD 16,370 per QALY gained (USD 19,465 per QALY gained), with 7130 (19.4%) fewer colposcopies, 6027 (7.0%) fewer cytology tests, 9787 (1.6%) fewer clinical consultations, yet 2446 (0.5%) more HPV tests. XGT can be a cost-effective, risk-based approach to primary cervical cancer screening as it utilizes fewer resources compared to PGT. This analysis, not previously conducted in an Asian context, could guide the use of XGT in Asia. Human papillomavirus (HPV) partial genotyping (PGT) identifies HPV16 and HPV18 individually, alongside 12 other high-risk HPV genotypes (hrHPV) collectively. HPV extended genotyping (XGT) identifies four additional hrHPV individually (HPV31, 45, 51, and 52), and reports the remaining eight in three groups (HPV33|58; 56|59|66; 35|39|68). Quality-adjusted life years (QALY), health care resource use, and costs of XGT were compared to PGT for cervical cancer screening in Singapore using DICE simulation. Women with one of the three hrHPV identified by XGT (HPV35|39|68; 56|59|66; 51), and atypical squamous cells of undetermined significance (ASCUS) on cytology, are recalled for a repeat screening in one year, instead of undergoing an immediate colposcopy with PGT. At the repeat screening, the colposcopy is performed only for persistent same-genotype infections in XGT, while with PGT, all the women with persistent HPV have a colposcopy. Screening 500,122 women, aged 30-69, with XGT, provided an incremental cost-effectiveness ratio (ICER) versus PGT of SGD 16,370/QALY, with 7130 (19.4%) fewer colposcopies, 6027 (7.0%) fewer cytology tests, 9787 (1.6%) fewer clinic consultations, yet 2446 (0.5%) more HPV tests. The XGT ICER remains well below SGD 100,000 in sensitivity analyses, (-SGD 17,736/QALY to SGD 50,474/QALY). XGT is cost-effective compared to PGT, utilizes fewer resources, and provides a risk-based approach as the primary cervical cancer screening method.

Automated summary

Extended genotyping (XGT) for cervical cancer screening, which identifies human papillomavirus (HPV) genotypes beyond HPV16 and HPV18, can provide risk stratification for clinical management. A study in Singapore compared the resource use, cost, and quality-adjusted life years (QALY) of XGT to partial genotyping (PGT). The results showed that XGT was cost-effective, utilized fewer resources, and provided a risk-based approach compared to PGT. This analysis, conducted in an Asian context, could guide the use of XGT in Asia.