A model to evaluate the costs and clinical effectiveness of human papilloma virus screening compared with annual papanicolaou cytology in Germany

Eur J Obstet Gynecol Reprod Biol. 2017 May;212:132-139. doi: 10.1016/j.ejogrb.2017.03.029. Epub 2017 Mar 19.


Objectives: We modelled human papilloma virus (HPV) primary screening scenarios compared with Pap cytology to evaluate clinical effectiveness and projected annual costs in Germany.

Study design: A Markov cohort model was built to compare the budget impact of annual Pap cytology with different 5-yearly HPV screening scenarios: (1) a positive HPV test followed by Pap cytology; (2) a positive HPV test followed by p16/Ki-67 dual-stained cytology; (3) a positive HPV test followed by colposcopy if HPV-16/18-positive or p16/Ki-67 dual-stained cytology if positive for other subtypes; (4) co-testing with HPV and Pap. Screening scenarios were based on a 10-year horizon.

Results: All HPV screening scenarios in the model were associated with fewer deaths from missed diagnosis of cervical cancer compared with Pap screening; 10-year totals n=172-344 (1.5-3 per 100,000) versus n=477 (4.1 per 100,000), respectively. Total annual costs were lower with HPV screening than Pap cytology. The projected average annual cost for HPV screening ranged from €117 million to €136 million compared with €177 million for Pap screening, representing annual savings of €41-60 million. The greatest clinical impact was achieved with primary HPV screening (with genotyping) followed by colposcopy for HPV 16/18-positive women or p16/Ki-67 dual-stained cytology for women positive for other HPV subtypes.

Conclusion: Screening strategies including primary HPV testing for high-risk subtypes (HPV-16/18) in conjunction with p16/Ki-67 dual-stained cytology can improve the detection of cervical cancer at a lower total annual cost than conventional Pap cytology screening.

Keywords: Human papilloma virus; Screening cervical cancer.

Publication types

  • Comparative Study

MeSH terms

  • Cohort Studies
  • Colposcopy / economics
  • Colposcopy / standards
  • Colposcopy / statistics & numerical data
  • Cost-Benefit Analysis*
  • Female
  • Germany / epidemiology
  • Human papillomavirus 16 / isolation & purification
  • Human papillomavirus 18 / isolation & purification
  • Humans
  • Incidence
  • Mass Screening / economics*
  • Mass Screening / standards
  • Mass Screening / statistics & numerical data
  • Papanicolaou Test / economics*
  • Papanicolaou Test / standards
  • Papanicolaou Test / statistics & numerical data
  • Papillomavirus Infections / diagnosis*
  • Papillomavirus Infections / epidemiology
  • Uterine Cervical Neoplasms / diagnosis
  • Uterine Cervical Neoplasms / epidemiology
  • Uterine Cervical Neoplasms / prevention & control*