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For unvaccinated women, switching at age 34 years to primary HPV testing every 4 years was optimal given the Norwegian cost-effectiveness threshold ($83 000 per year of life saved).
The optimal strategy, with an ICER of $76 000 per YLS, entails switching at age 31 years to primary HPV DNA testing every 4 years with reflex LBC (Table 2; top panel).
For unvaccinated women, the optimal (cost-effective) strategy involves switching at age 34 years to primary HPV DNA testing with a 4-year screening interval.
Our data are not exception from this rule and suggest "a program of aging" switching on at early age [ 3, 8].
We varied the switch-age, screening interval, and triage strategies for women with HPV-positive results.
Determining the optimal switch age is inherently dependent on the natural history of HPV in older women.
The optimal strategy involved a 6-year screening interval after the switch-age of 31 years and requires two additional HPV+/Cyt− results 12 months apart, before colposcopy referral (Table 2; bottom panel).
For vaccinated women, the preferred screening strategy involves extension of the screening interval to every 6 years after the switch-age of 34 years with the same follow-up of HPV+/Cyt− women as for unvaccinated women.
In all multivariate analyses (Cox, logistic, and linear regressions), patient group (i.e. RIS-OLZ group or OLZ-RIS group) served as the main explanatory variable while adjusting for the influence of the following key covariates: time of switch; age; gender; region; and CGI-SCH overall score before switching.
Data analysed in these two age groups were based on age at ART initiation and patients were not switched between age groups during follow-up.
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