Is the HPV-test more cost-effective than cytology in cervical cancer screening? An economic analysis from a middle-income country

Abstract

Objective To report a modelling study using local health care costs and epidemiological inputs from a population-based program to access the cost-effectiveness of adopting hrHPV test. Methods A cost-effectiveness analysis based on a microsimulation dynamic Markov model. Data and costs were based on data from the local setting and literature review. The setting was Indaiatuba, Brazil, that has adopted the hrHPV test in place of cytology since 2017. After calibrating the model, one million women were simulated in hypothetical cohorts. Three strategies were tested: cytology to women aged 25 to 64 every three years; hrHPV test to women 25–64 every five years; cytology to women 25–29 years every three years and hrHPV test to women 30–64 every five years (hybrid strategy). Outcomes were Quality-adjusted life-years (QALY) and Incremental Cost-Effectiveness Ratio (ICER). Results The hrHPV testing and the hybrid strategy were the dominant strategies. Costs were lower and provided a more effective option at a negative incremental ratio of US$ 37.87 for the hybrid strategy, and negative US$ 6.16 for the HPV strategy per QALY gained. Reduction on treatment costs would influence a decrease in ICER, and an increase in the costs of the hrHPV test would increase ICER. Conclusions Using population-based data, the switch from cytology to hrHPV testing in the cervical cancer screening program of Indaiatuba is less costly and cost-effective than the old cytology program.

Assessing national cervical cancer screening guidelines: Results from an HIV testing clinic also screening for cervical cancer and HPV in Soweto, South Africa

“…The Roche Linear Array, as used in this study for HPV genotyping, is not yet an approved primary screening test in South Africa, despite studies reporting it fulfills the clinical accuracy requirements to detect cervical intraepithelial neoplasia of grade 2 or worse (CIN2 +) [24][25][26]. Given that evidence has shown that HPV-based screening provides 60-70% greater protection against invasive cervical carcinomas compared with cytology [27] and is more cost-effective in the long-term [28], additional research is needed to determine other practical implementation impacts of changing from cytology-to HPV-based primary screening for cervical cancer (i.e. ; financial, operational, etc.)…”

Cervical Cancer Prophylaxis—State-of-the-Art and Perspectives

“…Another study predicting the cost-effectiveness of screening with hrHPV testing showed a decrease in the incremental cost-effectiveness ratio (ICER) of (USD −6.16) relative to conventional cervical cytology. Quality-adjusted life-years (QALYs) were 386.98 for cytology and 390.80 for hrHPV-based testing, respectively [ 58 , 59 ]. A combination of LBC and HPV testing methods is called co-testing.…”

Improving intervention design to promote cervical cancer screening among hard-to-reach women: assessing beliefs and predicting individual attendance probabilities in Bogotá, Colombia

“…Our results highlight the need to conduct an economic evaluation of alternatives to strength the cervical cancer screening program in Bogotá. For example, including HPV testing and self-sampling have shown positive impacts in Argentina, Brazil and Mexico [ 80 – 83 ].…”