Additional Findings From Sensitivity Analyses of the Economic Evaluation

Dr. Yi-Sheng Chao; Michelle Clark; Elizabeth Carson; Dr. Laura Weeks; Kristen Moulton; Dr. Susan McFaul; Dr. C.M McLauchlin; Dr. Bernice Tsoi; Umair Majid; Sujane Kandasamy; Neha Arora; Dr. Meredith Vanstone; Dr. Lynette Reid; Timothy Krahn; Kasia Kaluzny; Kelly Farrah; Caitlyn Ford

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Chao YS, Clark M, Carson E, et al. HPV Testing for Primary Cervical Cancer Screening: A Health Technology Assessment [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019 Mar. (CADTH Optimal Use Report, No. 7.1b.)

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HPV Testing for Primary Cervical Cancer Screening: A Health Technology Assessment [Internet].

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Appendix 11Additional Findings From Sensitivity Analyses of the Economic Evaluation

Table 56Additional Sensitivity Analyses Findings for Future Incident Cohort

Analysis	Strategy	Expected		Incremental		Sequential ICER
Analysis	Strategy	Cost($)	QALYs	Cost($)	QALYs	Sequential ICER
Future Incident Cohort
Reference case	C3: Primary HPV w/ cytology triage (5 yrs; 30 to 69)	1,471	39.956	Reference
	A1: Primary cytology (3 yrs; 21 to 69)	2,021	39,961	551	0.005	112,717
	B2: Primary cytology w/ HPV triage (3 yrs; 30 to 69)	1,580	39.956	109	0.000	Ex. dom.
	C4: Primary HPV w/ cytology triage (5 yrs; 25 to 69)	1,601	39.957	130	0.001	Ex. dom.
	B1: Primary cytology w/ HPV triage (3 yrs; 25 to 69)	1,744	39.957	273	0.001	Ex. dom.
	B1: Primary cytology w/ HPV triage (3 yrs; 25 to 69)	1,847	39.958	376	0.002	Ex. dom.
	A2: Primary cytology (3 yrs; 25 to 69)	1,855	39.958	384	0.002	Ex. dom.
	C1: Primary HPV w/ cytology triage (3 yrs; 30 to 69)	1,857	39.959	387	0.002	Ex. dom.
	C2: Primary HPV w/ cytology triage (3 yrs; 25 to 69)	2,065	39.960	594	−0.001	Dominated
Vaccination uptake (12.40%)	C3: Primary HPV w/ cytology triage (5 yrs; 30 to 69)	1,665	39.944	Reference
	A1: Primary cytology (3 yrs; 21 to 69)	2,241	39.953	575	0.0100	60,345
	C4: Primary HPV w/ cytology triage (5 yrs; 25 to 69)	1,784	39.945	119	0.0071	Ex. dom.
	B2: Primary cytology w/ HPV triage (3 yrs; 30 to 69)	1,784	39.945	119	0.0068	Ex. dom.
	B1: Primary cytology w/ HPV triage (3 yrs; 25 to 69)	1,946	39.946	281	0.0068	Ex. dom.
	A3: Primary cytology (3 yrs; 30 to 69)	2,045	39.949	380	0.0062	Ex. dom.
	C1: Primary HPV w/ cytology triage (3 yrs; 30 to 69)	2,046	39.950	381	0.0059	Ex. dom.
	A2: Primary cytology (3 yrs; 25 to 69)	2,061	39.950	396	0.0062	Ex. dom.
	C2: Primary HPV w/ cytology triage (3 yrs; 25 to 69)	2,262	39.952	21	0.0058	Dominated
Vaccination uptake (88.20%)	C3: Primary HPV w/ cytology triage (5 yrs; 30 to 69)	1,356	39.966	Reference
	A1: Primary cytology (3 yrs; 21 to 69)	1,868	39.968	512	0.001	428,893
	B2: Primary cytology w/ HPV triage (3 yrs; 30 to 69)	1,461	39.966	105	−0.001	Dominated
	C4: Primary HPV w/ cytology triage (5 yrs; 25 to 69)	1,478	39.967	122	0.001	Ex. dom.
	B1: Primary cytology w/ HPV triage (3 yrs; 25 to 69)	1,609	39.966	253	−0.001	Dominated
	A3: Primary cytology (3 yrs; 30 to 69)	1,722	39.967	366	0.000	Ex. dom.
	A2: Primary cytology (3 yrs; 25 to 69)	1,725	39.967	368	0.000	Ex. dom.
	C1: Primary HPV w/ cytology triage (3 yrs; 30 to 69)	1,742	39.967	386	0.001	Ex. dom.
	C2: Primary HPV w/ cytology triage (3 yrs; 25 to 69)	1,935	39.967	67	−0.001	Dominated
Discount rate (0%)	C3: Primary HPV w/ cytology triage (5 yrs; 30 to 69)	2,689	63.606	Reference
	A1: Primary cytology (3 yrs; 21 to 69)	3,473	63.616	784	0.010	76,279
	C4: Primary HPV w/ cytology triage (5 yrs; 25 to 69)	2,862	63.607	173	0.001	Ex. dom.
	B2: Primary cytology w/ HPV triage (3 yrs; 30 to 69)	2,863	63.605	174	−0.000	Dominated
	B1: Primary cytology w/ HPV triage (3 yrs; 25 to 69)	3,088	63.607	399	0.001	Ex. dom.
	A2: Primary cytology (3 yrs; 25 to 69)	3,264	63.611	575	0.005	Ex. dom.
	A3: Primary cytology (3 yrs; 30 to 69)	3,270	63.610	581	0.004	Ex. dom.
	C1: Primary HPV w/ cytology triage (3 yrs; 30 to 69)	3,340	63.612	650	0.006	Ex. dom.
	C2: Primary HPV w/ cytology triage (3 yrs; 25 to 69)	3,619	63.615	146	−0.001	Dominated
Discount rate (5%)	C3: Primary HPV w/ cytology triage (5 yrs; 30 to 69)	447	19.462	Reference
	C2: Primary HPV w/ cytology triage (3 yrs; 25 to 69)	684	19.463	237	0.001	318,284
	B2: Primary cytology w/ HPV triage (3 yrs; 30 to 69)	487	19.462	40	0.000	Ex. dom.
	C4: Primary HPV w/ cytology triage (5 yrs; 25 to 69)	514	19.462	67	0.000	Ex. dom.
	B1: Primary cytology w/ HPV triage (3 yrs; 25 to 69)	572	19.462	125	0.000	Ex. dom.
	C1: Primary HPV w/ cytology triage (3 yrs; 30 to 69)	572	19.462	126	0.000	Ex. dom.
	A3: Primary cytology (3 yrs; 30 to 69)	594	19.462	147	0.000	Ex. dom.
	A2: Primary cytology (3 yrs; 25 to 69)	616	19.462	169	0.001	Ex. dom.
	A1: Primary cytology (3 yrs; 21 to 69)	417	19.463	31	−0.000	Dominated
Alternative incidence rates	C3: Primary HPV w/ cytology triage (5 yrs; 30 to 69)	1,480	39.956	Reference
	A1: Primary cytology (3 yrs; 21 to 69)	2,025	39.961	5,454	0.005	119,689
	B2: Primary cytology w/ HPV triage (3 yrs; 30 to 69)	1,589	39.956	109	0.000	Ex. dom.
	C4: Primary HPV w/ cytology triage (5 yrs; 25 to 69)	1,611	39.957	131	0.001	Ex. dom.
	B1: Primary cytology w/ HPV triage (3 yrs; 25 to 69)	1,751	39.957	271	0.001	Ex. dom.
	A3: Primary cytology (3 yrs; 30 to 69)	1,856	39.958	376	0.002	Ex. dom.
	A2: Primary cytology (3 yrs; 25 to 69)	1,863	39.958	383	0.002	Ex. dom.
	C1: Primary HPV w/ cytology triage (3 yrs; 30 to 69)	1,865	39.958	385	0.002	Ex. dom.
	C2: Primary HPV w/ cytology triage (3 yrs; 25 to 69)	2,073	39.960	48	−0.001	Dominated
Screening participation rate (80%)	C3: Primary HPV w/ cytology triage (5 yrs; 30 to 69)	1,479	39.957	Reference
	A1: Primary cytology (3 yrs; 21 to 69)	2,056	39.961	576	0.005	124,553
	B2: Primary cytology w/ HPV triage (3 yrs; 30 to 69)	1,606	39.957	127	−0.000	Dominated
	C4: Primary HPV w/ cytology triage (5 yrs; 25 to 69)	1,609	39.957	130	0.001	Ex. dom.
	B1: Primary cytology w/ HPV triage (3 yrs; 25 to 69)	1,770	39.958	291	0.001	Ex. dom.
	A3: Primary cytology (3 yrs; 30 to 69)	1,868	39.959	389	0.002	Ex. dom.
	C1: Primary HPV w/ cytology triage (3 yrs; 30 to 69)	1,881	39.959	402	0.002	Ex. dom.
	A2: Primary cytology (3 yrs; 25 to 69)	1,883	39.959	404	0.003	Ex. dom.
	C2: Primary HPV w/ cytology triage (3 yrs; 25 to 69)	2,093	39.961	37	−0.001	Dominated
Missed screening	C3: Primary HPV w/ cytology triage (5 yrs; 30 to 69)	1,349	39.953	Reference
	A1: Primary cytology (3 yrs; 21 to 69)	1,823	39.959	473	0.006	80,599
	C4: Primary HPV w/ cytology triage (5 yrs; 25 to 69)	1,455	39.954	106	0.001	Ex. dom.
	B2: Primary cytology w/ HPV triage (3 yrs; 30 to 69)	1,458	39.955	109	0.002	Dominated
	B1: Primary cytology w/ HPV triage (3 yrs; 25 to 69)	1,588	39.955	239	0.002	Ex. dom.
	A2: Primary cytology (3 yrs; 25 to 69)	1,682	39.956	333	0.003	Ex. dom.
	C1: Primary HPV w/ cytology triage (3 yrs; 30 to 69)	1,683	39.957	334	0.004	Ex. dom.
	A3: Primary cytology (3 yrs; 30 to 69)	1,713	39.957	364	0.004	Ex. dom.
	C2: Primary HPV w/ cytology triage (3 yrs; 25 to 69)	1,863	39.958	40	−0.001	Dominated
Alternate utility values (based on TTO)	C3: Primary HPV w/ cytology triage (5 yrs; 30 to 69)	1,471	39.953	Reference
	C2: Primary HPV w/ cytology triage (3 yrs; 25 to 69)	2,065	39.956	594	0.003	215,497
	B2: Primary cytology w/ HPV triage (3 yrs; 30 to 69)	1,580	39.953	0.0037	109	Ex. dom.
	C4: Primary HPV w/ cytology triage (5 yrs; 25 to 69)	1,601	39.953	0.0039	130	Ex. dom.
	B1: Primary cytology w/ HPV triage (3 yrs; 25 to 69)	1,744	39.953	0.0038	273	Ex. dom.
	A3: Primary cytology (3 yrs; 30 to 69)	1,847	39.953	0.0033	376	Ex. dom.
	C1: Primary HPV w/ cytology triage (3 yrs; 30 to 69)	1,855	39.954	0.0032	384	Ex. dom.
	A2: Primary cytology (3 yrs; 25 to 69)	1,857	39.953	0.0034	387	Ex. dom.
	A1: Primary cytology (3 yrs; 21 to 69)	2,021	39.954	0.0033	551	Ex. dom.
	A3: Primary cytology (3 yrs; 30 to 69)	1,847	39.958	474	0.002	Ex. dom.
	A2: Primary cytology (3 yrs; 25 to 69)	1,857	39.959	485	0.002	Ex. dom.
Disutility from abnormal screening results	C3: Primary HPV w/ cytology triage (5 yrs; 30 to 69)	1,471	39.946	Reference
	B2: Primary cytology w/ HPV triage (3 yrs; 30 to 69)	1,580	39.951	109	0.006	19,547
	C4: Primary HPV w/ cytology triage (5 yrs; 25 to 69)	1,601	39.944	21	−0.007	Dominated
	B1: Primary cytology w/ HPV triage (3 yrs; 25 to 69)	1,744	39.951	164	0.000	Dominated
	A3: Primary cytology (3 yrs; 30 to 69)	1,847	39.945	267	−0.006	Dominated
	C1: Primary HPV w/ cytology triage (3 yrs; 30 to 69)	1,855	39.942	275	−0.010	Dominated
	A2: Primary cytology (3 yrs; 25 to 69)	1,857	39.941	277	−0.010	Dominated
	A1: Primary cytology (3 yrs; 21 to 69)	2,021	39.941	441	−0.010	Dominated
	C2: Primary HPV w/ cytology triage (3 yrs; 25 to 69)	2,065	39.940	485	−0.011	Dominated
HPV costs	C3: Primary HPV w/ cytology triage (5 yrs; 30 to 69)	1,373	39.956	Reference
	C2: Primary HPV w/ cytology triage (3 yrs; 25 to 69)	1,877	39.960	504	0.004	127,316
	A1: Primary cytology (3 yrs; 21 to 69)	2,021	39.961	144	0.001	156,188
	C4: Primary HPV w/ cytology triage (5 yrs; 25 to 69)	1,484	39.957	111	0.001	Ex. dom.
	B2: Primary cytology w/ HPV triage (3 yrs; 30 to 69)	1,562	39.956	189	0.000	Ex. dom.
	C1: Primary HPV w/ cytology triage (3 yrs; 30 to 69)	1,696	39.958	324	0.002	Ex. dom.
	B1: Primary cytology w/ HPV triage (3 yrs; 25 to 69)	1,722	39.957	349	0.001	Ex. dom.
	A3: Primary cytology (3 yrs; 30 to 69)	1,847	39.958	474	0.002	Ex. dom.
	A2: Primary cytology (3 yrs; 25 to 69)	1,857	39.959	485	0.002	Ex. dom.

: Ex. dom. = extendedly dominated; ICER = incremental cost-effectiveness ratio; QALY= quality-adjusted life-years; TTO = time trade-off; w/ = with; yrs. = years.

Table 57Sensitivity Analyses Results for the Incident Cohort

Sensitivity Analysis	Strategy	Expected		Incremental		Sequential ICER
Sensitivity Analysis	Strategy	Cost($)	QALYs	Cost($)	QALYs	Sequential ICER
Reference case	C3: Primary HPV w/ cytology triage (5 yrs; 30 to 69)	1,714	35.244	Reference
	A3: Primary cytology (3 yrs; 30 to 69)	1,924	35.246	210	0.002	88,163
	A2: Primary cytology (3 yrs; 25 to 69)	2,112	35.247	188	0.001	321,477
	A1: Primary cytology (3 yrs; 21 to 69)	2,210	35.247	97	0.000	361,158
	C4: Primary HPV w/ cytology triage (5 yrs; 25 to 69)	1,836	35.244	121	−0.000	Dominated
	B2: Primary cytology w/ HPV triage (3 yrs; 30 to 69)	1,838	35.245	124	0.001	Ex. dom.
	B1: Primary cytology w/ HPV triage (3 yrs; 25 to 69)	1,994	35.246	70	−0.001	Dominated
	C1: Primary HPV w/ cytology triage (3 yrs; 30 to 69)	2,144	35.247	31	−0.000	Dominated
	C2: Primary HPV w/ cytology triage (3 yrs; 25 to 69)	2,346	35.247	136	−0.000	Dominated
Discount rate (0%)	C3: Primary HPV w/ cytology triage (5 yrs; 30 to 69)	2,684	53.009	Reference
	A3: Primary cytology (3 yrs; 30 to 69)	2,970	53.014	286	0.0049	58,830
	A2: Primary cytology (3 yrs; 25 to 69)	3,174	53.015	204	0.0011	186,167
	A1: Primary cytology (3 yrs; 21 to 69)	3,278	53.016	104	0.0005	227,452
	C4: Primary HPV w/ cytology triage (5 yrs; 25 to 69)	2,814	53.009	130	−0.0001	Dominated
	B2: Primary cytology w/ HPV triage (3 yrs; 30 to 69)	2,849	53.011	164	0.0015	Ex. dom.
	B1: Primary cytology w/ HPV triage (3 yrs; 25 to 69)	3,022	53.012	52	−0.0020	Dominated
	C1: Primary HPV w/ cytology triage (3 yrs; 30 to 69)	3,290	53.015	12	−0.0009	Dominated
	C2: Primary HPV w/ cytology triage (3 yrs; 25 to 69)	3,510	53.015	233	−0.0001	Dominated
Discount rate (5%)	C3: Primary HPV w/ cytology triage (5 yrs; 30 to 69)	741	18.083	Reference
	A3: Primary cytology (3 yrs; 30 to 69)	848	18.084	108	0.0005	207,621
	A1: Primary cytology (3 yrs; 21 to 69)	1,085	18.084	237	0.0003	902,421
	B2: Primary cytology w/ HPV triage (3 yrs; 30 to 69)	807	18.084	66	0.0002	Ex. dom.
	C4: Primary HPV w/ cytology triage (5 yrs; 25 to 69)	837	18.083	96	0.0000	Ex. dom.
	B1: Primary cytology w/ HPV triage (3 yrs; 25 to 69)	930	18.084	82	−0.0002	Dominated
	C1: Primary HPV w/ cytology triage (3 yrs; 30 to 69)	948	18.084	100	−0.0000	Dominated
	A2: Primary cytology (3 yrs; 25 to 69)	999	18.084	151	0.0002	Ex. dom.
	C2: Primary HPV w/ cytology triage (3 yrs; 25 to 69)	1,110	18.084	25	−0.0001	Dominated
Alternative incidence rates	C3: Primary HPV w/ cytology triage (5 yrs; 30 to 69)	1,714	35.244	Reference
	A3: Primary cytology (3 yrs; 30 to 69)	1,924	35.246	210	0.0024	88,163
	A2: Primary cytology (3 yrs; 25 to 69)	2,112	35.247	188	0.0006	321,477
	A1: Primary cytology (3 yrs; 21 to 69)	2,210	35.247	97	0.0003	361,158
	C4: Primary HPV w/ cytology triage (5 yrs; 25 to 69)	1,836	35.244	121	−0.0000	Dominated
	B2: Primary cytology w/ HPV triage (3 yrs; 30 to 69)	1,838	35.245	124	0.0008	Ex. dom.
	B1: Primary cytology w/ HPV triage (3 yrs; 25 to 69)	1,994	35.246	70	−0.0009	Dominated
	C1: Primary HPV w/ cytology triage (3 yrs; 30 to 69)	2,144	35.247	31	−0.0004	Dominated
	C2: Primary HPV w/ cytology triage (3 yrs; 25 to 69)	2,346	35.247	136	−0.0002	Dominated
Missed screening	C3: Primary HPV w/ cytology triage (5 yrs; 30 to 69)	1,584	35.241	Reference
	A3: Primary cytology (3 yrs; 30 to 69)	1,779	35.245	195	0.0035	56,073
	C1: Primary HPV w/ cytology triage (3 yrs; 30 to 69)	1,957	35.245	178	0.0008	211,333
	C4: Primary HPV w/ cytology triage (5 yrs; 25 to 69)	1,685	35.241	101	0.0001	Ex. dom.
	B2: Primary cytology w/ HPV triage (3 yrs; 30 to 69)	1,687	35.242	103	0.0011	Ex. dom.
	B1: Primary cytology w/ HPV triage (3 yrs; 25 to 69)	1,824	35.244	45	−0.0010	Dominated
	A2: Primary cytology (3 yrs; 25 to 69)	1,930	35.245	152	0.0005	Ex. dom.
	A1: Primary cytology (3 yrs; 21 to 69)	2,014	35.245	57	−0.0005	Dominated
	C2: Primary HPV w/ cytology triage (3 yrs; 25 to 69)	2,131	35.245	174	−0.0005	Dominated
Screening participation rate (80%)	C3: Primary HPV w/ cytology triage (5 yrs; 30 to 69)	1,731	35.244	Reference
	A3: Primary cytology (3 yrs; 30 to 69)	1,957	35.247	226	0.0022	101,435
	A2: Primary cytology (3 yrs; 25 to 69)	2,143	35.248	185	0.0011	168,971
	C2: Primary HPV w/ cytology triage (3 yrs; 25 to 69)	2,377	35.248	235	0.0001	3,064,364
	C4: Primary HPV w/ cytology triage (5 yrs; 25 to 69)	1,853	35.244	122	0.0001	Ex. dom.
	B2: Primary cytology w/ HPV triage (3 yrs; 30 to 69)	1,859	35.245	128	0.0008	Ex. dom.
	B1: Primary cytology w/ HPV triage (3 yrs; 25 to 69)	2,020	35.245	63	−0.0010	Dominated
	C1: Primary HPV w/ cytology triage (3 yrs; 30 to 69)	2,173	35.247	30	−0.0004	Dominated
	A1: Primary cytology (3 yrs; 21 to 69)	2,244	35.248	102	0.0003	Ex. dom.
Alternate utility values (based on TTO)	C3: Primary HPV w/ cytology triage (5 yrs; 30 to 69)	1,714	35.240	Reference
	B2: Primary cytology w/ HPV triage (3 yrs; 30 to 69)	1,838	35.240	124	0.0005	230,008
	C1: Primary HPV w/ cytology triage (3 yrs; 30 to 69)	2,144	35.241	306	0.0012	250,166
	C4: Primary HPV w/ cytology triage (5 yrs; 25 to 69)	1,836	35.239	121	−0.0004	Dominated
	A3: Primary cytology (3 yrs; 30 to 69)	1,924	35.240	86	0.0002	Ex. dom.
	B1: Primary cytology w/ HPV triage (3 yrs; 25 to 69)	1,994	35.240	157	0.0001	Ex. dom.
	A2: Primary cytology (3 yrs; 25 to 69)	2,112	35.240	275	0.0001	Ex. dom.
	A1: Primary cytology (3 yrs; 21 to 69)	2,210	35.240	66	−0.0016	Dominated
	C2: Primary HPV w/ cytology triage (3 yrs; 25 to 69)	2,346	35.241	202	−0.0001	Dominated
Disutility from abnormal screening results	C3: Primary HPV w/ cytology triage (5 yrs; 30 to 69)	1,714	35.232	Reference
	B2: Primary cytology w/ HPV triage (3 yrs; 30 to 69)	1,838	35.239	124	0.0072	17,117
	C4: Primary HPV w/ cytology triage (5 yrs; 25 to 69)	1,836	35.230	121	−0.0020	Dominated
	A3: Primary cytology (3 yrs; 30 to 69)	1,924	35.229	86	−0.0097	Dominated
	B1: Primary cytology w/ HPV triage (3 yrs; 25 to 69)	1,994	35.239	157	−0.0004	Dominated
	A2: Primary cytology (3 yrs; 25 to 69)	2,112	35.227	275	−0.0122	Dominated
	C1: Primary HPV w/ cytology triage (3 yrs; 30 to 69)	2,144	35.227	306	−0.0119	Dominated
	A1: Primary cytology (3 yrs; 21 to 69)	2,210	35.226	372	−0.0133	Dominated
	C2: Primary HPV w/ cytology triage (3 yrs; 25 to 69)	2,346	35.224	508	−0.0147	Dominated
HPV costs	C3: Primary HPV w/ cytology triage (5 yrs; 30 to 69)	1,600	35.244	Reference
	A3: Primary cytology (3 yrs; 30 to 69)	1,924	35.246	324	0.0024	136,060
	C1: Primary HPV w/ cytology triage (3 yrs; 30 to 69)	1,959	35.247	35	0.0002	181,909
	C2: Primary HPV w/ cytology triage (3 yrs; 25 to 69)	2,131	35.247	172	0.0005	377,723
	A1: Primary cytology (3 yrs; 21 to 69)	2,210	35.247	78	0.0002	378,354
	C4: Primary HPV w/ cytology triage (5 yrs; 25 to 69)	1,703	35.244	102	−0.0000	Dominated
	B2: Primary cytology w/ HPV triage (3 yrs; 30 to 69)	1,816	35.245	216	0.0008	Ex. dom.
	B1: Primary cytology w/ HPV triage (3 yrs; 25 to 69)	1,969	35.246	10	−0.0011	Dominated
	A2: Primary cytology (3 yrs; 25 to 69)	2,112	35.247	154	0.0004	Ex. dom.

: Ex. dom. = extendedly dominated; ICER = incremental cost-effectiveness ratio; QALY= quality-adjusted life-years; TTO = time trade-off; w/ = with; yrs. = years.

Table 58Sensitivity Analyses Results for the Prevalent Cohort

Analysis	Strategy	Expected		Incremental		Sequential ICER
Analysis	Strategy	Cost($)	QALYs	Cost($)	QALYs	Sequential ICER
Reference case	C3/C4: Primary HPV w/ cytology triage (5 yrs)	2,241	31.546	Reference
	C1/C2: Primary HPV w/ cytology triage (3 yrs)	2,704	31.549	463	0.002	194,777
	B1/B2: Primary cytology w/ HPV triage (3 yrs)	2,381	31.546	139	−0.000	Dominated
	A1/A2/A3: Primary cytology (3 yrs)	2,427	31.544	186	−0.003	Dominated
Discount rate (0%)	C3/C4: Primary HPV w/ cytology triage (5 yrs)	3,093	44.320	Reference
	B1/B2: Primary cytology w/ HPV triage (3 yrs)	3,311	44.328	218	0.0084	25,885
	A1/A2/A3: Primary cytology (3 yrs)	3,394	44.330	83	0.0022	37,250
	C1/C2: Primary HPV w/ cytology triage (3 yrs)	3,703	44.335	309	0.0046	67,749
Discount rate (5%)	C3/C4: Primary HPV w/ cytology triage (5 yrs)	1,172	17.292	Reference
	B1/B2: Primary cytology w/ HPV triage (3 yrs)	1,298	17.293	126	0.0013	99,627
	A1/A2/A3: Primary cytology (3 yrs)	1,381	17.294	83	0.0004	224,807
	C1/C2: Primary HPV w/ cytology triage (3 yrs)	1,538	17.294	156	0.0005	324,379
Alternative incidence rates	C3/C4 Primary HPV w/ cytology triage (5 yrs)	2,171	31.281	Reference
	B1/B2: Primary cytology w/ HPV triage (3 yrs)	2,352	31.286	182	0.0047	38,510
	A1/A2/A3: Primary cytology (3 yrs)	2,438	31.287	86	0.0011	79,666
	C1/C2: Primary HPV w/ cytology triage (3 yrs)	2,686	31.289	247	0.0024	105,202
Missed screening	C3/C4: Primary HPV w/ cytology triage (5 yrs)	2,023	31.272	Reference
	B1/B2: Primary cytology w/ HPV triage (3 yrs)	2,199	31.280	176	0.0076	23,199
	A1/A2/A3: Primary cytology (3 yrs)	2,269	31.282	70	0.0027	25,583
	C1/C2: Primary HPV w/ cytology triage (3 yrs)	2,481	31.286	212	0.0036	59,652
Screening participation rate (80%)	C3/C4: Primary HPV w/ cytology triage (5 yrs)	2,241	31.546	Reference
	C1/C2: Primary HPV w/ cytology triage (3 yrs)	2,704	31.549	463	0.0024	194,777
	B1/B2: Primary cytology w/ HPV triage (3 yrs)	2,381	31.546	139	0.0005	Dominated
	A1/A2/A3: Primary cytology (3 yrs)	2,427	31.544	186	−0.0025	Dominated
Alternative utility values (based on TTO)	C3/C4: Primary HPV w/ cytology triage (5 yrs)	2,171	31.271	Reference
	B1/B2: Primary cytology w/ HPV triage (3 yrs)	2,352	31.275	182	0.0041	43,789
	C1/C2: Primary HPV w/ cytology triage (3 yrs)	2,686	31.277	333	0.0023	144,978
	A1/A2/A3: Primary cytology (3 yrs)	2,438	31.273	86	−0.0020	Dominated
Disutility from abnormal screening results	C3/C4: Primary HPV w/ cytology triage (5 yrs)	2,171	31.266	Reference
	B1/B2: Primary cytology w/ HPV triage (3 yrs)	2,352	31.278	182	0.0124	14,681
	A1/A2/A3: Primary cytology (3 yrs)	2,438	31.265	86	−0.0128	Dominated
	C1/C2: Primary HPV w/ cytology triage (3 yrs)	2,686	31.265	106	−0.0131	Dominated
HPV costs	C3/C4: Primary HPV w/ cytology triage (5 yrs)	2,031	31.281	Reference
	C1/C2: Primary HPV w/ cytology triage (3 yrs)	2,460	31.289	429	0.0081	52,634
	B1/B2: Primary cytology w/ HPV triage (3 yrs)	2,324	31.286	293	0.0047	Ex. dom.
	A1/A2/A3: Primary cytology (3 yrs)	2,438	31.287	407	0.0011	Ex. dom.

: Ex. dom. = extendedly dominated; ICER = incremental cost-effectiveness ratio; QALY= quality-adjusted life-years; TTO = time trade-off; w/ = with; yrs. = years.

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Chao YS, Clark M, Carson E, et al. HPV Testing for Primary Cervical Cancer Screening: A Health Technology Assessment [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019 Mar. (CADTH Optimal Use Report, No. 7.1b.) Appendix 11, Additional Findings From Sensitivity Analyses of the Economic Evaluation.
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