Journal of Medical Screening
J Med Screen 2010;17:79-86
© 2010 Medical Screening Society
Massimo Confortini, Biologist and Director of Molecular Diagnostic Department , Analytical and Biomolecular Cytology Unit, Cancer Prevention and Research Institute, ISPO, Florence, Italy
Paolo Giorgi Rossi, Epidemiologist , Laziosanità – Agency for Public Health, Lazio Region, Rome, Italy
Paolo Barbarino, Gynaecologist , UOC Screening e Prevenzione ASL Roma G, Tivoli (Rome), Italy
Anna Maria Passarelli, Biologist and Laboratory Director , Laboratori Analisi ASL Roma G, Tivoli (Rome), Italy
Letizia Orzella, Economist , Laziosanità – Agency for Public Health, Lazio Region, Rome, Tivoli (Rome), Italy
Maria Concetta Tufi, Gynaecologist and Screening Unit Director , UOC Screening e Prevenzione ASL Roma G, Tivoli (Rome), Italy
Correspondence to: Paolo Giorgi Rossi, Laziosanità – Agency for Public Health, Lazio Region, Rome, Via di S Costanza 53–, Rome 00198, Italy; email@example.com
Objective We report performance indicators and costs of the first round of a cervical cancer screening programme based on the human papillomavirus (HPV)-DNA test.
Methods We implemented a demonstration study using HPV as the primary test in Guidonia, Italy (90,000 inhabitants). All women aged 25–64 were invited to undergo a Hybrid Capture II high-risk HPV test. Two cervical samplings, smear and liquid, were taken. The smear was dyed and interpreted only for HPV-positive (HPV+) women. Women with a non-negative Pap smear were referred for colposcopy, women HPV+/cytology negative were referred to one-year follow-up with HPV. A cost-analysis indicated the price at which the HPV-based and cytological screening would cost the same per screened woman and per lesion found.
Results Of 24,000 women invited, 7639 accepted and 427 (5.6%) were HPV+; 141 (34%) of these had a non-negative Pap test, and 20 cervical intraepithelial neoplasia (CIN) 2 or higher were found (positive predictive value 15%). Compliance to one-year follow-up was 58% (166/286); 90 (54%) were HPV-positive and five additional lesions were found (positive predictive value 9%; overall detection rate 3.4/1000). The cost analysis showed that at a price of 8.3 euros per HPV-DNA test, the strategy using HPV as primary test followed by cytological triage would cost the same per screened woman, while at a price of 12.7 euros it would have the same cost per CIN2+ found.
Conclusion The workload for management of positive women was similar to cytological screening. Low compliance to one-year follow-up was the main barrier to effectiveness. The price of HPV test should be about 9 euros to maintain the same screening budget, and can go as high as 13 euros per lesion found.
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