Analytical approach:
A Dutch based microsimulation screening analysis model (MISCAN) was previously developed to simulate cervical cancer natural history in the Netherlands (see Other Publications of Related Interest)). The model was adapted and used to combine published data for this study. The time horizon of the study was the lifetime of the patient. The authors reported that an adjusted societal perspective (which did not take account of productivity losses due to illness and death) was adopted in the economic analysis.
Effectiveness data:
The study used the MISCAN model, so much of the effectiveness information used in the analysis had already been identified within the study that developed the model. Therefore, effectiveness data for this study were mostly similar to those used in the MISCAN model. The main effectiveness estimates used for this analysis were sensitivity and specificity of HPV test and cytology, which were derived from previously published studies and the authors’ own assumptions.
Monetary benefit and utility valuations:
Utilities estimates were derived from Dutch and international published studies.
Measure of benefit:
The benefit measure was quality-adjusted life years (QALYs) discounted using an annual discount rate of 3%.
Cost data:
Direct costs included in the analysis were for: invitation to screening; primary and repeat cytology screening (included laboratory tests, organisation, doctor visits, time and travel to tests and programme costs); primary and repeat HPV screening (included laboratory tests, organisation, doctor visits, time and travel to tests and programme costs); and diagnosis and treatment of pre-invasive cervical intraepithelial neoplasia and invasive cancer. The cost estimates were derived from Dutch published studies. All costs were reported in 2009 Euros (€) and discounted using an annual discount rate of 3%.
Analysis of uncertainty:
A series of scenario analysis compared all the policy-strategy combinations simulated in the analysis for five different scenarios: differing cervical cancer risks, presence of previous screening programmes, quality associated with test characteristics, costs of the test and prevalence of HPV.