Comparative Cost Analysis Of Cervical Cancer Screening Programme Based On Molecular Detection Of HPV In Spain

Abstract

Background: HPV cervical cancer screening (CCS) must use validated HPV tests based on the molecular detection of either viral mRNA (Aptima HPV Assay – AHPV) or DNA. AHPV has demonstrated the same cross-sectional and longitudinal sensitivity for the detection of HSIL/CIN2+ lesions but with greater specificity than HPV-DNA tests. The study aimed to estimate the total costs of a CCS with a primary HPV test based on the detection of mRNA compared to DNA in women aged 35-65 years for the National Health System.Methods: A decision-tree-based model to estimate the cost of the CCS until the first colposcopy was designed based on Spanish CCS guidelines. The total cost (€,2019) for CCS with AHPV or DNA tests (HC2 and Cobas) was calculated, including HPV test, liquid-based cytology (LBC) and colposcopy, for a population of 7,263,529 women aged 35-65 years (assuming 70% coverage). Clinical inputs derived from a literature review were validated by a multidisciplinary expert panel. Data from head-to-head studies between different HPV tests were selected. Results: The use of AHPV showed reduction of 290,541 (-35%) and 355,913 (-40%) LBC compared to HC2 or Cobas, respectively. Furthermore, AHPV avoided 151,699 (-47%) colposcopies vs HC2 and 151,165 (-47%) vs Cobas. The total cost of CCS was €282,747,877 with AHPV, €322,587,588 with HC2 and €324,614,490 with Cobas. Therefore, AHPV savings €-39,839,711 vs HC2 and €-41,866,613 vs Cobas.Conclusions: Assuming that 70% of women from 35-65 years attend the CCS programme, the cost of screening up to the first colposcopy using AHPV would provide cost savings of up to €41.9 million vs DNA tests in Spain.