Cost‐effectiveness analysis of cervical cancer prevention based on a rapid human papillomavirus screening test in a high‐risk region of China

Abstract

This study assessed the cost-effectiveness of a new, rapid human papillomavirus (HPV)-DNA screening test for cervical cancer prevention in the high-risk region of Shanxi, China. Using micro-costing methods, we estimated the resources needed to implement preventive strategies using cervical cytology or HPV-DNA testing, including the Hybrid Capture 2 (hc2) test (QIAGEN Corp., Gaithersburg, MD) and the rapid HPV-DNA careHPV TM test (QIAGEN). Data were used in a previously published model and empirically calibrated to country-specific epidemiological data. Strategies differed by initial test, targeted age, frequency of screening, number of clinic visits required (1, 2 or 3) and service delivery setting (national, county and township levels).Outcomes included lifetime risk of cancer, years of life saved (YLS), lifetime costs and incremental cost-effectiveness ratios (cost per YLS). For all screening frequencies, the most efficient strategy used 2-visit rapid HPV-DNA testing at the county level, including screening and diagnostics in the first visit, and treatment in the second visit. Screening at ages 35, 40 and 45 reduced cancer risk by 50% among women compliant with all 3 screening rounds, and was US$ 150 per YLS, compared with this same strategy applied twice per lifetime. This would be considered very cost-effective evaluated against China's percapita gross domestic product (US$ 1,702). By enhancing the linkage between screening and treatment through a reduced number of visits, rapid HPV-DNA testing 3 times per lifetime is more effective than traditional cytology, and is likely to be cost-effective in high-risk regions of China.Cervical cancer affects millions of individuals worldwide and is a leading cause of cancer death among women in developing countries. 1 Although China registers a low average incidence of cervical cancer compared to many other regions of the world, the overall burden is large due to the size of the country's population. Moreover, there is considerable heterogeneity in terms of risk, with cervical cancer mortality rates in poor provinces such as Shanxi and Gansu exceeding 30 cases per 100,000. 2 Data available from one survey indicate that the prevalence of carcinogenic types of human papillomavirus (HPV) is 20.8% among 35-to 50-year-old women. 3Since a national cervical cancer prevention program does not exist, most women have not been screened. 2 Cervical cancer has been reduced in countries able to implement organized secondary prevention programs that screen women with cytology at regular closely spaced intervals. 4 Unfortunately, the requirement for high-quality laboratory and cytotechnologist support, coupled with the need for multiple visits, has proven difficult to implement in lowresource settings. Screening approaches that use HPV-DNA testing may prove more practical when incorporated into strategies less dependent on existing laboratory infrastructure and requiring fewer visits. 5,6 Most recently, a randomized trial in Osmanabad district in India demonstrated a single round of HP...

A Systematic Review of Economic Aspects of Cervical Cancer Screening Strategies Worldwide: Discrepancy between Economic Analysis and Policymaking

“…In Sweden, Bisoleti et al showed that combined HPV DNA testing and cervical cytology three times per life time starting at age 32 was the most cost effective method (Bistoletti et al, 2008). Levin suggested rapid HPV DNA testing three times in a lifetime and starting at age 35 was the most cost-effective strategy at the national, township and county level in China (Levin et al, 2010).…”

“…Four articles in four high income countries (Goldie et al, 2001;2004;Mandelblatt et al, 2002a;Bistoletti et al, 2008;Burger et al, 2012;de Kok et al, 2012), nine middle income countries from seven articles Andres-Gamboa et al, 2008;Vijayaraghavan et al, 2009;Chow et al, 2010;Levin et al, 2010) and 1 article in low income countries suggested starting age after age 30 (Table 1).…”

“…Burger in Norway, suggested screening with cytology for younger women and HPV DNA testing strategy every four years after the age of 34 years (Burger et al, 2012). Seven papers suggested a five-year interval with various strategies such as HPV DNA testing (Andres-Gamboa et al, 2008;Kulasingam et al, 2009;Levin et al, 2010), HPV DNA triage (Berkhof et al, 2010;Chow et al, 2010), and primary HPV DNA in both types of co-screening or triage (de Kok et al, 2012). Mandelblatt suggested VIA with immediate treatment every five years as the most costeffective method in Thailand (Mandelblatt et al, 2002b).…”

“…In four articles 5 years interval was recommended (Mandelblatt et al, 2002a;Andres-Gamboa et al, 2008;Chow et al, 2010;Levin et al, 2010)and six countries in 2 articles indicated that 10 years interval was cost effective Vijayaraghavan et al, 2009)…”

“…The table clearly shows that the various strategies were found to be the most cost-effective based on Markov modeling in each setting. The most recommended strategy by authors was HPV DNA testing (Goldie et al, 2001;Andres-Gamboa et al, 2008;Kulasingam et al, 2009;Levin et al, 2010;Sroczynski et al, 2011;Burger et al, 2012;de Kok et al, 2012). However, the most cost-effective strategy in three articles was not related to our PICOD (Goldie et Mandelblatt et al, 2002a;Goldie et al, 2005).…”