The objective of this health technology assessment (HTA) is to address the policy question by assessing the diagnostic test accuracy, clinical utility, safety, cost-effectiveness, patients’ experiences and perspectives, ethical issues, and implementation issues of HPV testing as a primary screening tool for cervical cancer screening. This HTA was conducted to inform decision-making, policy development, capacity planning, and recommendations around primary HPV-based testing for cervical cancer screening.

Contents

• External Reviewers
• Authorship
• Acknowledgements
• Abbreviations
• Protocol Amendments
• Executive Summary
  • Issue
  • Policy Question
  • Objectives
  • Clinical Evidence
  • Economics
  • Qualitative Evidence Synthesis — Patients’ Perspectives and Experiences
  • Ethical Issues
  • Implementation Issues
  • Conclusions
• Introduction
  • Rationale and Policy Issues
  • Policy Issues
  • Policy Question
• Objectives
  • Research Questions
• Clinical Review
  • Methods
  • Results
  • Critical Appraisal
  • Summary of Results
  • Summary of Results
• Economic Analysis
  • Primary Economic Evaluation
  • Results
  • Summary of Results
• Patients Preferences, Perspectives, and Experiences: A Qualitative Evidence Synthesis
  • Methods
  • Results
  • Summary of Results
• Ethics
  • Purpose and Background
  • Methods
  • Results
  • Conclusions
• Implementation Issues
  • Methods
  • Results
  • Summary of Results
• Discussion
  • Acceptance of and Participation in Screening
  • Population Subgroups
  • High Rate of Positive Tests
  • Screening Age and Interval
  • HPV Vaccination
  • Disinvestment
  • Generalizability of Findings
  • Limitations
  • Directions for Future Research
• Conclusions and Implications for Decision- or Policy-Making
• References
• Appendix 1. Literature Search Strategy
• Appendix 2. Study Selection Flow Diagram — Systematic Reviews
• Appendix 3. PRISMA — Primary Studies Published After Systematic Reviews (2015 to Present)
• Appendix 4. List of Excluded Primary Studies
• Appendix 5. Summary of Assessment of Existing Systematic Reviews
• Appendix 6. Strengths and Limitations of Systematic Reviews
• Appendix 7. Characteristics of Included Primary Studies
• Appendix 8. Critical Appraisal of Primary Studies
• Appendix 9. Detailed Outcome Data — Clinical Review Question 1
• Appendix 10. Characteristics of Existing Published Model-Based Economic Evaluations
• Appendix 11. Additional Findings From Sensitivity Analyses of the Economic Evaluation
• Appendix 12. Additional Findings From Sensitivity Analyses of the Economic Evaluation
• Appendix 13. Study Characteristics, Methodological Assessment, Methodologies for Patients’ Perspectives and Experiences Review
• Appendix 14. Prisma Diagram — Patients’ Perspectives and Experiences Review
• Appendix 15. Patients’ Perspectives and Experiences Review — Additional Tables
• Appendix 16. Factors and Themes — Patients’ Perspectives and Experiences Review
• Appendix 17. Patient Experiences — Balance of Factors That Encourage or Discourage Participation in Cervical Cancer Screening
• Appendix 18. Patients’ Perspectives and Experiences Review — Shift of Balance of Factors
• Appendix 19. Ethics Review

Dr. Susan McFaul is the current president of the Canadian Society of Colposcopists, which has received funding from Merk to develop a digital image library. The other authors declared no conflicts of interest relevant to this report.

Suggested citation:

HPV Testing for Primary Cervical Cancer Screening: A Health Technology Assessment. Ottawa: CADTH; 2019 Mar. (CADTH Optimal Use Report; vol. 7, no. 1b).

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