Results in a nutshell
HPV testing and LBC are equally sensitive over two screening rounds, but HPV testing is cheaper, permits a longer screening interval and facilitates large scale automation of primary screening.
Earlier this year (see news item for 21st June 2009) the initial results from the ARTISTIC trial informed us that, over two screening rounds, HPV testing does not add significantly to LBC in terms of the sensitivity of detecting CIN3+. The results of the ARTISTIC trial have now been fully reported by HTA, together with detailed information on the cost-effectiveness and the psychosocial effects of HPV testing.
The HTA report confirms that HPV testing does not add significantly to the effectiveness of LBC, and that the addition of HPV testing to LBC (as a combined test)would not be cost effective. However, HPV testing, used either as a triage for low grade cytological abnormalities, or as an initial screening test triaged by cytology, would be cheaper than cytology without HPV testing. Moreover, HPV testing has the twin advantages of a high negative predictive value, which should allow longer screening intervals, and automated platforms enabling high throughput.The report acknowledges that replacing the current cytology-based programme with HPV primary screening "would require major contraction and reconfiguration of laboratory [cytology] services."
The study confirmed that HPV testing did not appear to cause significant psychosocial distress.
The detailed results can be found in Health Technology Assessment 2009 Vol. 13: No. 51 or by following the link below.