Table 3.

Metrics of balance of screening benefits and harms cumulated over a lifetime; average (minimum–maximum) predictions of 55 parameter sets.

Net QALY gainColposcopiesScreening tests (NNS)
Screening testTriageAgesEqual HPV test preferencea: per 100,000 women (years)Lower HPV test preferencea: per 100,000 women (years)Per CIN2/3 detectedPer CIN3 detectedPer cancer preventedPer cancer death preventedPer life-year gainedPer CIN2/3 detectedPer CIN3 detectedPer cancer preventedPer cancer death preventedPer life-year gained
Perfect screening adherenceb
CytologyLow colposcopy referralc25–70 y10,499 (4,719–17,663)10,499 (4,719–17,663)1.3 (1.2–1.6)3.2 (1.9–6.6)5 (4–9)14 (11–29)0.7 (0.5–1.1)195 (103–386)483 (214–868)754 (511–1,240)2,103 (1,350–3,606)99 (67–161)
CytologyHigh colposcopy referralc25–70 y10,735 (5,040–17,797)10,735 (5,040–17,797)4.7 (3.0–8.3)11.5 (5.6–20.9)17 (12–26)48 (34–85)2.3 (1.6–3.3)204 (107–406)501 (220–899)744 (509–1,203)2,076 (1,342–3,490)98 (67–156)
Cytology (25) and HPV testing (≥30)Cytology25–60 y12,179 (5,036–19,329)11,618 (4,497–18,772)9.2 (4.9–19.5)28.0 (12.3–60.4)32 (18–76)90 (55–227)4.1 (2.4–9.8)106 (58–203)323 (129–614)363 (252–554)1,042 (685–1,657)47 (33–72)
Cytology (25) and HPV testing (≥30)HPV16/18 and cytology25–60 y12,443 (5,316–19,590)11,881 (4,777–19,032)10.2 (5.3–21.1)32.1 (13.9–69.0)34 (20–81)99 (61–243)4.5 (2.6–10.4)106 (58–203)335 (131–647)358 (250–542)1,032 (681–1,629)47 (33–70)
HPV testingCytology25–60 y11,690 (4,409–18,742)10,790 (3,543–17,857)11.2 (5.9–22.6)38.8 (16.4–85.3)37 (23–86)108 (69–261)4.9 (2.9–11.1)107 (58–205)370 (141–738)355 (247–534)1,031 (680–1,626)46 (32–69)
HPV testingHPV16/18 and cytology25–60 y11,971 (4,717–19,015)11,070 (3,851–18,130)13.0 (6.8–25.4)47.8 (19.4–107.0)42 (26–94)124 (80–288)5.5 (3.4–12.2)107 (58–206)394 (146–803)350 (245–522)1,022 (677–1,598)46 (32–67)
Imperfect screening adherenced
CytologyLow colposcopy referralc20–70 y9,172 (3,822–16,061)9,172 (3,822–16,061)1.3 (1.2–1.7)3.0 (1.9–5.9)5 (4–9)14 (11–30)0.7 (0.5–1.2)194 (100–389)444 (203–757)748 (490–1,287)2,071 (1,291–3,744)98 (64–166)
CytologyHigh colposcopy referralc20–70 y9,455 (4,176–16,232)9,455 (4,176–16,232)4.8 (3.0–8.6)10.8 (5.5–18.7)17 (12–27)48 (34–87)2.3 (1.6–3.5)201 (103–407)459 (209–781)734 (486–1,236)2,033 (1,279–3,580)96 (64–160)
Cytology (<30) and HPV testing (≥30)Cytology20–70 y10,464 (3,686–17,466)10,016 (3,255–17,020)5.4 (3.0–11.5)14.1 (6.8–30.9)19 (12–47)54 (34–137)2.5 (1.5–6.1)135 (71–256)354 (151–622)483 (326–764)1,349 (868–2,214)63 (43–99)
Cytology (<30) and HPV testing (≥30)HPV16/18 and cytology20–70 y10,973 (4,219–17,996)10,525 (3,788–17,549)7.0 (3.7–14.7)19.1 (9.1–43.2)24 (14–58)68 (42–169)3.2 (1.8–7.5)134 (71–257)369 (155–653)469 (321–728)1,316 (854–2,120)61 (42–94)
HPV testingCytology25–70 y10,361 (3,515–17,260)9,711 (2,888–16,617)6.7 (3.7–14.0)17.6 (8.4–38.1)24 (14–56)66 (42–163)3.1 (1.8–7.3)110 (58–208)289 (123–505)386 (260–606)1,078 (693–1,755)51 (34–78)
HPV testingHPV16/18 and cytology25–70 y10,954 (4,136–17,875)10,303 (3,508–17,232)9.1 (4.8–18.5)25.6 (11.9–56.4)31 (19–71)87 (55–206)4.1 (2.4–9.2)110 (58–209)309 (128–544)374 (255–574)1,050 (681–1,675)49 (33–74)
HPV testingCytology25–60 y10,508 (3,809–17,313)9,886 (3,211–16,699)6.8 (3.7–14.2)18.0 (8.6–39.3)23 (14–56)66 (42–167)3.0 (1.8–7.1)100 (53–192)267 (113–466)346 (231–548)980 (622–1,634)45 (30–70)
HPV testingHPV16/18 and cytology25–60 y11,099 (4,421–17,934)10,476 (3,821–17,319)9.3 (4.8–18.8)26.2 (12.2–58.3)31 (19–70)88 (55–211)4.0 (2.4–9.0)101 (53–193)284 (117–501)334 (226–518)952 (611–1,552)43 (29–66)
Imperfect screening adherence sensitivity analysese
HPV testing over-screeningCytology20–70 y9,395 (1,955–16,448)7,970 (575–15,048)9.2 (5.1–17.3)30.6 (13.5–63.5)32 (21–71)92 (62–212)4.2 (2.7–9.2)163 (89–310)544 (217–1,038)573 (395–866)1,644 (1,077–2,594)75 (52–112)
HPV testing over-screeningHPV16/18 and cytology20–70 y9,939 (2,600–16,976)8,513 (1,218–15,573)13.7 (7.4–26.8)50.9 (21.2–107.6)46 (30–94)133 (90–284)6.0 (3.9–12.3)167 (91–319)618 (234–1,198)558 (390–829)1,611 (1,065–2,494)73 (51–108)
HPV testing under-screeningCytology25–60 y9,796 (3,601–16,379)9,329 (3,151–15,922)6.1 (3.3–13.2)14.7 (7.3–33.2)21 (13–51)59 (37–151)2.7 (1.6–6.6)81 (42–156)197 (86–330)281 (184–457)784 (491–1,343)36 (24–58)
HPV testing under-screeningHPV16/18 and cytology25–60 y10,433 (4,205–16,998)9,965 (3,754–16,541)8.2 (4.3–17.3)20.8 (10.1–47.9)27 (16–64)77 (48–190)3.6 (2.1–8.2)81 (42–155)205 (88–346)269 (179–429)756 (479–1,266)35 (23–55)
  • Abbreviations: CIN, cervical intraepithelial neoplasia; HPV, human papillomavirus; NNS, number needed to screen; QALY, quality-adjusted life-years.

  • aLower HPV test preference assumes women have higher QALY losses from a positive HPV test than an abnormal cytology test result (Table 1). Equal test preference assumes women have the same QALY loss from a positive HPV as an abnormal cytology test result.

  • bAll women get screened exactly once every 3 years (cytology-based screening) or every 5 years (HPV-based screening).

  • cCytology-based screening scenarios with low colposcopy referral assume high-grade lesions have an age-specific 65%–97% probability of being immediately referred to colposcopy, whereas low-grade lesions have only a 3%–9% age-specific probability of being immediately referred to colposcopy. Cytology-based screening scenarios with high colposcopy referral assume all abnormal cytology tests have a 65%–97% age-specific probability of being immediately referred to colposcopy.

  • dAssumes 53%–68% of women (depending on age) get screened within a 3-year interval (cytology-based screening) or within a 5-year interval (HPV-based screening).

  • eOver-screening: 53%–68% of women (depending on age) get screened at least once within a 3-year interval, similar to the cytology-based imperfect screening scenario. Under-screening: 53%–68% of women (depending on age) get screened at least once within a 7-year interval.