Beware of Kinked Frontiers: A Systematic Review of the Choice of Comparator Strategies in Cost-Effectiveness Analyses of Human Papillomavirus Testing in Cervical Screening

This seminar presents the findings of a recently published systematic review that examined the choice of comparator strategies in cost-effectiveness analyses (CEAs) of cervical screening programmes. Although the importance of comparator strategies has been long recognised in CEA, the review shows that many recently published CEAs of cervical screening have failed to include sufficient comparator strategies. This is likely to result in the underestimation of incremental cost-effectiveness ratios (ICERs) for certain strategies, which may lead to sub-optimal policy choices. This study employs the idea of the “policy-relevant” portion of the efficient frontier, where the ICERs approach the cost-effectiveness threshold. The analysis demonstrates the importance of correctly estimating ICERs along this portion of the frontier. The findings of this review apply more generally, as similar problems of comparator omission can also be found in the breast and colorectal screening CEA literature.