Reducing unnecessary referrals for colposcopy in hrHPV-positive women within the Dutch cervical cancer screening programme: A modelling study

Background: With the implementation of primary high-risk human papillomavirus (hrHPV) screening in Netherlands, an increase was observed number unnecessary referrals (?Cervical Intraepithelial Neoplasia (CIN) 1) to colposcopy. We aimed investigate which alternative triage strategies safely reduce HPV-based cervical cancer programmes. Methods: Microsimulation model MISCAN used simulate unvaccinated cohort ten million 30-year old Dutch women. calculated referrals, incidence, mortality, costs and QALYs for 24 strategies. Condition direct referral (atypical squamous cells undetermined significance (ASC-US), low-grade intraepithelial lesions (LSIL), high-grade (HSIL), conditional on HPV-genotype 16/18/other high risk (OHR)), type test (cytology alone or combined with hrHPV) time (6 12 months) varied. Results: The had varying effects ranging from ?72% +35%. Adjusting conditions ‘HPV16/18+ ASC-US+’ ‘HPVOHR+ HSIL+’ extending interval between tests months resulted a reduction 40% (incidence +0%, mortality ?1%). Reduction without genotyping achieved by adjusting LSIL (12 repeat test) (unnecessary ?37%, incidence +2%, +0%). Conclusions: To increasing more than 2% programme, HPV16 HPV16/18 should be implemented testing.