Cost-Effectiveness of Different Cervical Screening Strategies in Islamic Republic of Iran: A Middle-Income Country with a Low Incidence Rate of Cervical Cancer

Abstract

ObjectiveInvasive cervical cancer (ICC) is the fourth most common cancer among women worldwide. Cervical screening programs have reduced the incidence and mortality rates of ICC. We studied the cost-effectiveness of different cervical screening strategies in the Islamic Republic of Iran, a Muslim country with a low incidence rate of ICC.MethodsWe constructed an 11-state Markov model, in which the parameters included regression and progression probabilities, test characteristics, costs, and utilities; these were extracted from primary data and the literature. Our strategies included Pap smear screening and human papillomavirus (HPV) DNA testing plus Pap smear triaging with different starting ages and screening intervals. Model outcomes included lifetime costs, life years gained, quality-adjusted life years (QALY), and incremental cost-effectiveness ratios (ICERs). One-way sensitivity analysis was performed to examine the stability of the results.ResultsWe found that the prevented mortalities for the 11 strategies compared with no screening varied from 26% to 64%. The most cost-effective strategy was HPV screening, starting at age 35 years and repeated every 10 years. The ICER of this strategy was $8,875 per QALY compared with no screening. We found that screening at 5-year intervals was also cost-effective based on GDP per capita in Iran.ConclusionWe recommend organized cervical screening with HPV DNA testing for women in Iran, beginning at age 35 and repeated every 10 or 5 years. The results of this study could be generalized to other countries with low incidence rates of cervical cancer.

Significance of serum antibodies against HPV E7, Hsp27, Hsp20 and Hp91 in Iranian HPV-exposed women

“…As known, HPV DNA test along with routine Pap smear could reduce colposcopy rate in ASCUS patients [5]. A report recommended an organized cervical screening with HPV DNA testing for women in Iran, beginning at age 35 and repeated every 10 or 5 years [6]. However, biomarkers are required to select patients for colposcopy screening in low and middle income countries where DNA and cytology testing are too expensive.…”

Cervical cancer in Iran: integrative insights of epidemiological analysis

“…Khodakarami et al recommended starting the cervical cancer screening at the age of 30 with a repetition of every five years and continuing until the age of 69 [ 54 ]. The results of a study showed that the most cost-effective screening method is screening with HPV that begins at the age of 35 and is repeated every 10 years [ 55 ]. Nokiani et al conducted a study to determine the cost-effectiveness of Pap smear in Kermanshah.…”

Az egészségügyi forrás allokáció aktuális kérdései Iránban; egészségügyi technológiaelemzés (Current issues of healthcare resource allocation in Iran; Health Technology Assessment)

“…Ennek érdekében célszerű, ha több információ áll rendelkezésre a kulcsszereplők elvárásairól, preferenciáiról, értékítéleteiről. Mobinizadeh et al [2016] [Nahvijou et al, 2016], a testsúlycsökkentés műtéti beavatkozással nem járó (non-invasive) lehetőségei [Nojomi et al, 2016], a haemophilus influanzae type B elleni immunizáció költséghatékonysága [Moradi-Lakeh-Shakerian-Esteghamati, 2012], konzerváló és helyreállító fogászat hatékonysága és költséghatékonysága [Mobinizadeh et al, 2014]. A szerzők a teljes találati listát nem közölték.…”