Healthcare Quarterly Vol.16 No.1 2013 87

Comparative Models of Cervical Cancer Screening in Manitoba Linda DeRiviere et al.

FIGURE 5. Cost per case of cervical cancer averted

HPV = human papillomavirus; LBC = liquid-based cytology.

2-LBC, ThinPrep

1-Conventionalcytology (CC)

3 - LBC SurePath 4 - LBC forprimary

testing & HPVtriage

5 - HPV forprimary

testing & LBC

6 - HPV forprimary

testing & LBCimplementover 5 yrs

7 - HPV forprimary

testing & CC

8 - HPV forprimary

testing & CCimplementover 5 yrs

Cost

per

Cas

e Av

erte

d (in

Tho

usan

ds o

f Dol

lars

)

160

140

120

100

80

60

40

20

0

$128.9$135.5 $140.5

$144.7

$54.1

$66.2

$44.1$50.3

86 Healthcare Quarterly Vol.16 No.1 2013

could be used for routine screening of women under 30 years of age and to triage women 30 years and older whose results are HPV positive.

The broader implication of this study is that, with HPV testing, considerable resources could be reallocated to encouraging the uptake of women who are under-screened or unscreened, for example, in geographically remote communities in Canada. It is known that cervical cancer often occurs in women who have not had a Pap test in the past three to five years (Boronow 1998). In addition, there are enhanced linkages between the HPV vaccine, screening and surveillance.

See Appendix A at http://www.longwoods.com/content/23275 for summary of Eight Proposed Models

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CancerCare Manitoba. n.d. Screening Information for the General Public: CervixCheck. Winnipeg, MB: Author. Retrieved September 22, 2012. <http://www.cancercare.mb.ca/home/prevention_and_screening/general_public_screening_programs/manitoba_cervical_cancer_screening_program/>.

Canfell, K., M. Clements and J. Harris. 2008. Cost-Effectiveness of Proposed Changes to the National Cervical Screening Program, A Report to the National Screening Unit, New Zealand Ministry of Health. Wellington and Auckland, New Zealand: National Cervical Screening

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Fleurence, R.L., J.M. Dixon, T.F. Milanova and K.M. Beusterien. 2007. “Review of the Economic and Quality-of-Life Burden of Cervical Human Papillomavirus Disease.” American Journal of Obstetrics and Gynecology 196(3): 206–12.

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Kulasingam, S.L., R. Rajan, Y. St Pierre, C.V. Atwood, E.R. Myers and E.L. Franco. 2009. “Human Papillomavirus Testing with Pap Triage for Cervical Cancer Prevention in Canada: A Cost-Effectiveness Analysis.” BMC Medicine 7(69): 1–11.

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Naucler, P., W. Ryd, S. Törnberg, A. Strand, G. Wadell, K. Elfgren et al. 2009. “Efficacy of HPV DNA Testing with Cytology Triage and/or Repeat HPV DNA Testing in Primary Cervical Cancer Screening.” Journal of the National Cancer Institute 101(2): 88–99.

Raab, S.S., A.L. Steiner and J. Hornberger. 1998. “The Cost-Effectiveness of Treating Women with a Cervical Vaginal Smear Diagnosis of Atypical Squamous Cells of Undetermined Significance.” American Journal of Obstetrics and Gynecology 179: 411–20.

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Stuart, G., G. Taylor, C.M. Bancej, J. Beaulac, T. Colgan, E.L. Franco et al. 2004. “Report of the 2003 Pan-Canadian Forum on Cervical Cancer Prevention and Control.” Journal of Obstetrics and Gynaecology Canada 26(II): 1004–14.

About the Authors Linda DeRiviere, PhD, is associate professor of Public Policy and Public Administration in the Department of Politics at the University of Winnipeg in Winnipeg, Manitoba.

Shelley Stopera, BSc, MSc, PMP, was HPV project manager at Manitoba Health and Health Living in the Public Health Division, Communicable Disease Control Branch in Winnipeg, Manitoba.

Paul Van Caeseele, MD, FRCPC, is medical director of the Cadham Provincial Laboratory and associate professor at the University of Manitoba in Winnipeg, Manitoba.

Robert Lotocki, MD, FRCS(C) is medical director in the Manitoba Cervical Cancer Screening Program at CancerCare Manitoba in Winnipeg, Manitoba.

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