Using novel biomarkers to triage young adult women with minor cervical lesions: a cost-effectiveness analysis

Objective: To evaluate the short-term consequences and cost-effectiveness associated with the use of novel biomarkers to triage young adult women with minor cervical cytological lesions.

Design: Model-based economic evaluation using primary epidemiological data from Norway, supplemented with data from European and American clinical trials.

Setting: Organised cervical cancer screening in Norway.

Population: Women aged 25-33 years with minor cervical cytological lesions detected at their primary screening test.

Methods: We expanded an existing simulation model to compare 12 triage strategies involving alternative biomarkers (i.e. reflex human papillomavirus (HPV) DNA/mRNA testing, genotyping, and dual staining) with the current Norwegian triage guidelines.

Main outcome measures: The number of high-grade precancers detected and resource use (e.g. monetary costs and colposcopy referrals) for a single screening round (3 years) for each triage strategy. Cost-efficiency, defined as the additional cost per additional precancer detected of each strategy compared with the next most costly strategy.

Results: Five strategies were identified as cost-efficient, and are projected to increase the precancer detection rate between 18 and 57%, compared with current guidelines; however, the strategies did not uniformly require additional resources. Strategies involving HPV mRNA testing required fewer resources, whereas HPV DNA-based strategies detected >50% more precancers, but were more costly and required twice as many colposcopy referrals compared with the current guidelines.

Conclusion: Strategies involving biomarkers to triage younger women with minor cervical cytological lesions have the potential to detect additional precancers, yet the optimal strategy depends on the resources available as well as decision-makers' and women's acceptance of additional screening procedures.

Tweetable abstract: Women with minor cervical lesions may be triaged more accurately and effectively using novel biomarkers.