| dc.description.abstract | BACKGROUND: The cervical cancer screening program in Norway is introducing HPV detection as the primary test. HPV is more sensitive compared to cytology and is expected to improve detection against cervical cancer. This will refer to an increased number of women requiring further follow-up visits like re-testing and treatment, and thereby, an initial increase in budget and resource use will follow. Because of this increment, prevention can be performed at earlier stages than anticipated and healthier screening population will advance. For this purpose, primary HPV testing is predicted to reduce additional interventions in a long-term perspective. Our aim was to assess the clinical and budgetary impacts of the new suggested strategy compared to today’s screening program in Norway. METHOD: A decision-tree model was used to estimate clinical and cost implications for screening diagnosis of cytology and HPV-test, in addition to cervical biopsy within a 15-year framework. Initial screening results and follow-up data from 31 655 women in the age 34-69 years in four Norwegian counties were used for developing the model. Costs in the analysis were related from a third-payer perspective and were calculated using different payment schemes. Outputs from the model were to obtain detected cases of diagnosis referred as CIN2+, total costs, as well as resource use in form of tests, colposcopies with biopsies and conizations. RESULTS: Results were given in two scenarios, in case of unadjusted and adjusted positivity rates. In terms of resource use, adjusted HPV screening triggered the least utilization, except for biopsies. Based on the BIA, the recommended intervention reduced a total cost from 66/68 mill NOK to 49/52 mill NOK (22/26 % reduction) in unadjusted/adjusted setting compared to the current strategy. Based on the CEA, cytology screening detected 889/980 and HPV screening 830/901 CIN2+ cases after 15 years. On average, the recommended intervention detected 40% more CIN2+ cases, with an increase from 0.0112/0.0185 to 0.0124/0.0202 in unadjusted and adjusted setting respectively. With a WTP threshold for an additional CIN2+ detected above 45 500 NOK, primary HPV detection can be considered cost-effective. CONCLUSION: The results inform that primary HPV screening is more affordable and produces better clinical outcomes in the long run. However, it must be prepared for an increase resource use and workload. The strategy can be considered cost-effective if the WTP threshold meets the ICER, which should be achievable in the Norwegian healthcare system. If not, there is potential for further research given the feasible value from the VOI analysis. | eng |