{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T09:21:50Z","timestamp":1777627310782,"version":"3.51.4"},"reference-count":36,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2021,4,2]],"date-time":"2021-04-02T00:00:00Z","timestamp":1617321600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["MCT82072"],"award-info":[{"award-number":["MCT82072"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The Human Papillomavirus FOr CervicAL cancer (HPV FOCAL) trial is a large randomized controlled trial comparing the efficacy of primary HPV testing to cytology among women in the population\u2010based Cervix Screening Program in British Columbia, Canada. We conducted a cost\u2010effectiveness analysis based on the HPV FOCAL trial to estimate the incremental cost per detected high\u2010grade cervical intraepithelial neoplasia of grade 2 or worse lesions (CIN2+). A total of 19,009 women aged 25 to 65 were randomized to one of two study groups. Women in the intervention group received primary HPV testing with reflex liquid\u2010based cytology (LBC) upon a positive finding with a screening interval of 48\u00a0months. Women in the control group received primary LBC testing, and those negative returned at 24\u00a0months for LBC and again at 48\u00a0months for exit screening. Both groups received HPV and LBC co\u2010testing at the 48\u2010month exit. Incremental costs during the course of the trial were comparable between the intervention and control groups. The intervention group had lower overall costs and detected a larger number of CIN2+ lesions, resulting in a lower mean cost per CIN2+ detected ($7551) than the control group ($8325), a difference of \u2010$773 [all costs in 2018 USD]. Cost per detected lesion was sensitive to the costs of sample collection, HPV testing, and LBC testing. The HPV FOCAL Trial results suggest that primary HPV testing every 4\u00a0years produces similar outcomes to LBC\u2010based testing every 2\u00a0years for cervical cancer screening at a lower cost.<\/jats:p>","DOI":"10.1002\/cam4.3864","type":"journal-article","created":{"date-parts":[[2021,4,3]],"date-time":"2021-04-03T03:42:02Z","timestamp":1617421322000},"page":"2996-3003","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Cost\u2010effectiveness analysis of primary human papillomavirus testing in cervical cancer screening: Results from the HPV FOCAL Trial"],"prefix":"10.1002","volume":"10","author":[{"given":"Ian","family":"Cromwell","sequence":"first","affiliation":[{"name":"Canadian Centre for Applied Research in Cancer Control BC Cancer Research Institute Vancouver BC Canada"},{"name":"British Columbia Cancer Agency Cancer Control Research BC Cancer Research Institute Vancouver BC Canada"},{"name":"Canadian Agency for Drugs and Technologies in Health Ottawa ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9463-1713","authenticated-orcid":false,"given":"Laurie W.","family":"Smith","sequence":"additional","affiliation":[{"name":"British Columbia Cancer Agency Cancer Control Research BC Cancer Research Institute Vancouver BC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kim","family":"van der Hoek","sequence":"additional","affiliation":[{"name":"Canadian Centre for Applied Research in Cancer Control BC Cancer Research Institute Vancouver BC Canada"},{"name":"British Columbia Cancer Agency Cancer Control Research BC Cancer Research Institute Vancouver BC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9552-1324","authenticated-orcid":false,"given":"Lindsay","family":"Hedden","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences Simon Fraser University Burnaby BC Canada"},{"name":"BC Academic Health Sciences Network Vancouver BC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew J.","family":"Coldman","sequence":"additional","affiliation":[{"name":"British Columbia Cancer Agency Cancer Control Research BC Cancer Research Institute Vancouver BC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1958-120X","authenticated-orcid":false,"given":"Darrel","family":"Cook","sequence":"additional","affiliation":[{"name":"British Columbia Centre for Disease Control Vancouver BC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eduardo L.","family":"Franco","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology McGill University Montreal QC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mel","family":"Krajden","sequence":"additional","affiliation":[{"name":"British Columbia Centre for Disease Control Vancouver BC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruth","family":"Martin","sequence":"additional","affiliation":[{"name":"British Columbia Cancer Agency Cervical Cancer Screening Program Vancouver BC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5771-1899","authenticated-orcid":false,"given":"Marette H.","family":"Lee","sequence":"additional","affiliation":[{"name":"British Columbia Cancer Agency Cervical Cancer Screening Program Vancouver BC Canada"},{"name":"Vancouver General Hospital Gynecologic Oncology Vancouver BC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gavin","family":"Stuart","sequence":"additional","affiliation":[{"name":"Faculty of Medicine The University of British Columbia Vancouver BC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dirk","family":"van Niekerk","sequence":"additional","affiliation":[{"name":"British Columbia Cancer Agency Cervical Cancer Screening Program Vancouver BC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gina","family":"Ogilvie","sequence":"additional","affiliation":[{"name":"British Columbia Centre for Disease Control Vancouver BC Canada"},{"name":"Faculty of Medicine The University of British Columbia Vancouver BC Canada"},{"name":"Women\u2019s Health Research Institute BC Women\u2019s Hospital Vancouver BC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8243-8721","authenticated-orcid":false,"given":"Stuart","family":"Peacock","sequence":"additional","affiliation":[{"name":"Canadian Centre for Applied Research in Cancer Control BC Cancer Research Institute Vancouver BC Canada"},{"name":"British Columbia Cancer Agency Cancer Control Research BC Cancer Research Institute Vancouver BC Canada"},{"name":"Faculty of Health Sciences Simon Fraser University Burnaby BC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,4,2]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Canadian Cancer Society's Advisory Committee on Cancer Statistics.Canadian cancer statistics 2017.2017;cancer.ca\/Canadian\u2010CancerStatistics\u20102017\u2010EN.pdf"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/2046-4053-2-35"},{"key":"e_1_2_8_4_1","unstructured":"BC Provincial Colposcopy Program.Management algorithms for abnormal cervical cytology and colposcopy.2015; Management Algorithms for Abnormal Cervical Cytology and Colposcopy. Accessed April 11 2018."},{"key":"e_1_2_8_5_1","volume-title":"Canada Sets Goal to Become First Country in the World to Eliminate Cervical Cancer","author":"The Society of Obstetricians and Gynaecologists of Canada"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.7464"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.30454"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.10897"},{"key":"e_1_2_8_9_1","volume-title":"Liquid\u2010Based Techniques for Cervical Cancer Screening: Systematic Review and Cost\u2010Effectiveness Analysis","author":"Krahn M","year":"2008"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-015-1332-8"},{"key":"e_1_2_8_11_1","unstructured":"BCCA.HPV FOCAL Study.2012;http:\/\/www.bccancer.bc.ca\/PPI\/Screening\/Cervical\/hpvfocal\/default.htm. Accessed February 19 2014."},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2012.11.013"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1701-2163(16)35241-0"},{"key":"e_1_2_8_14_1","first-page":"CD008054","article-title":"Human papillomavirus testing versus repeat cytology for triage of minor cytological cervical lesions","author":"Arbyn M","year":"2013","journal-title":"Cochrane Database Systematic Rev"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(17)30007-5"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/1073274820922540"},{"key":"e_1_2_8_17_1","article-title":"Cost\u2010effectiveness of HPV\u2010based cervical screening based on first year results in the Netherlands : A modelling study","author":"Jansen EEL","year":"2020","journal-title":"BJOG"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0151619"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2012.94"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4733.2009.00611.x"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2011.03.006"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2407-11-239"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e670"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2011.03228.x"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40258-014-0135-4"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2012.489"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2407-10-111"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2015.02.001"},{"key":"e_1_2_8_29_1","unstructured":"BC Medical Services Commission.Medical Services Plan Payment Schedule.2018;https:\/\/www2.gov.bc.ca\/assets\/gov\/health\/practitioner\u2010pro\/medical\u2010services\u2010plan\/msc\u2010payment\u2010schedule\u2010may\u20102018.pdf. Accessed August 20 2018."},{"key":"e_1_2_8_30_1","volume-title":"Nurses Provincial Collective Agreement \u2013 Nurses Wage Schedule","author":"Health Employers Association of BC","year":"2018"},{"key":"e_1_2_8_31_1","unstructured":"Van NiekerkD.BC Cervical Cancer Screening Program estimates of laboratory and technical pathology costs for LEEP. Personal Communication BC Cancer.2018."},{"key":"e_1_2_8_32_1","unstructured":"Province of British Columbia.Negotiated Agreements with the Doctors of BC \u2010 Service Contract & Salary Agreement Ranges.2018;https:\/\/www2.gov.bc.ca\/assets\/gov\/health\/practitioner\u2010pro\/medical\u2010services\u2010plan\/service\u2010contract\u2010ranges\u2010april\u20101\u20102018.pdf. Accessed August 20 2018."},{"key":"e_1_2_8_33_1","unstructured":"Bank of Canada.Annual 2018 exchange for Canadian Dollars to U.S.A dollars. Published at:https:\/\/www.bankofcanada.ca\/rates\/exchange\/annual\u2010average\u2010exchange\u2010rates\/. Accessed February 2 2021."},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1186\/1741-7015-7-69"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03404377"},{"issue":"1","key":"e_1_2_8_36_1","doi-asserted-by":"crossref","first-page":"77","DOI":"10.12927\/hcq.2013.23275","article-title":"Comparative models of cervical cancer screening in Manitoba","volume":"16","author":"DeRiviere L","year":"2013","journal-title":"Healthc Q"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0266462308080264"}],"container-title":["Cancer Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cam4.3864","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cam4.3864","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cam4.3864","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T13:28:07Z","timestamp":1724765287000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/cam4.3864"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,2]]},"references-count":36,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2021,5]]}},"alternative-id":["10.1002\/cam4.3864"],"URL":"https:\/\/doi.org\/10.1002\/cam4.3864","archive":["Portico"],"relation":{},"ISSN":["2045-7634","2045-7634"],"issn-type":[{"value":"2045-7634","type":"print"},{"value":"2045-7634","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,2]]},"assertion":[{"value":"2020-10-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-02-25","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-04-02","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}