Denmark has a well-established cervical cancer screening program with nationwide screening guidelines issued by the National Board of Health. In women aged 30–59 years, guidelines recommend cytology-based screening with high-risk HPV testing for ASC-US triage. In women aged 60–64, primary HPV testing is recommended. Current algorithms utilize pooled HPV assays where either no HPV genotypes or only types 16/18 are differentiated. New technologies are available which can differentiate all 14 high-risk HPV types, potentially offering greater ability to stratify patients based on individual risk.
In this study, a health economic model was developed to estimate the impact of adopting extended HPV genotyping within the Danish cervical cancer screening program. Current screening strategies using no or partial HPV genotyping were compared with strategies using extended genotyping in terms of number of colposcopies and CIN2+ detection.
A budget impact model was constructed in Excel using data from the published literature on population size, HPV prevalence and disease outcomes. For ages 30–59 years, we compared 1) HPV triage of ASC-US without genotyping with 2) HPV triage of ASC-US using extended genotyping. For ages 60–64 years, we compared 1) HPV primary screening using HPV16/18 genotyping with 2) HPV primary screening using extended genotyping. In the extended genotyping algorithms, women with HPV16, 18, 31, 33, 45, 52, or 58 were sent to colposcopy, while women with lower risk genotypes (35, 39, 51, 56, 59, 66, or 68) were sent to a 1-year follow-up.
Preliminary analyses indicated that using extended HPV genotyping for ASC-US triage in women aged 30–59 would reduce the number of colposcopies by 29.7%, at the cost of a slight (4.8%) increase in the number of CIN2/3 cases referred to 1-year follow-up instead of immediate colposcopy. Extended genotyping for HPV primary screening at ages 60–64 would reduce colposcopies by 13.9%, while slightly (4.6%) increasing the number of CIN2/3 cases referred to 1-year return instead of immediate colposcopy.
Extended HPV genotyping may potentially reduce colposcopies in the Danish population with minimal sacrifice for disease detection. The CIN2/3 cases referred to 1-year return in the extended genotyping algorithms were attributed to lower risk HPV genotypes and likely had low probability of progressing to cancer within a year. Further analyses will be presented at the conference, including the budgetary impact of extended genotyping and the performance of extended genotyping for HPV primary screening of women aged ≥30.