Cost effectiveness of high-risk HPV DNA testing for cervical cancer screening in South Africa

Abstract

a b s t r a c t a r t i c l e i n f oObjective. To determine the cost effectiveness of several cervical cancer screening strategies utilizing HPV testing in South Africa.Methods. We developed a lifetime Markov model of the costs, quality of life, and survival associated with screening and treating cervical cancer and its precursors. Screening strategies evaluated included: 1) conventional cytology, 2) cytology followed by HPV testing for triage of equivocal cytology, 3) HPV testing, 4) HPV testing followed by cytology for triage of HPV-positive women, and 5) co-screening with cytology and HPV testing. Primary outcome measures included quality-adjusted life-years saved (QALYs), incremental cost-effectiveness ratios, and lifetime risk of cervical cancer. Costs are in 2006 South African Rand (R).Results. In a cohort of 100,000 women, starting at age 30 and screening once every 10 years reduced the lifetime risk of cervical cancer by 13-52k depending on the screening strategy used, at an incremental cost of R13,000-R42,000 per QALY. When strategies were compared incrementally, cytology with HPV triage was less expensive and more effective than screening using cytology alone. HPV testing with the use of cytology triage was a more effective strategy and costs an additional R42,121 per QALY. HPV testing with colposcopy for HPV-positive women was the next most effective option at an incremental cost of R1541 per QALY. Simultaneous HPV testing and cytology co-screening was the most effective strategy and had an incremental cost of R25,414 per QALY.Conclusions. In our model, HPV testing to screen for cervical cancer and its precursors is a cost-effective strategy in South Africa.

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

“…Methods for calculating the ICER in six articles were; cost/ QALY (Mandelblatt et al, 2002b, Berkhof et al, 2010Chuck, 2010;Chow et al, 2010;Vijayaraghavan et al, 2009;2010a), in 13 studies the ICER were estimated by cost/LYG (Brown and Garber, 1999;Maxwell et al, 2002;Mandelblatt et al, 2002a;Goldie et al, 2001;2004;Kim et al, 2005;Bidus et al, 2006;Andres-Gamboa et al, 2008;Kulasingam et al, 2009;Levin et al, 2010;Sroczynski et al, 2011;Burger et al, 2012). Two studies did not report their ICER (Bistoletti et al, 2008;de Kok et al, 2012).…”

“…Chuck et al remarked that Pap smear screening every three years for all Canadian women and HPV triage for women older than 30 years with ASCUS were the most cost-effective strategies (Chuck, 2010 (Maxwell et al, 2002;Bidus et al, 2006). Berkhof et al (2010) in the Netherlands, indicated that starting screening with HPV triage with 5 years interval was the most cost effective strategies (Berkhof et al, 2010).Vijayaraghavan in South Africa reported that coscreening with HPV testing was less costly and the most effective strategy (Vijayaraghavan et al, 2009). Based on income we just found 5 articles in high income countries suggested starting age of screening below age 30 (Mandelblatt et al, 2002b;Kulasingam et al, 2009;Chuck, 2010;Vijayaraghavan et al, 2010a;Sroczynski et al, 2011)(Table1).…”

“…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).…”

“…Bistoletti studied the cost-effectiveness of screening methods in Sweden and concluded that co-screening strategy at nine-year intervals was the most effective strategy (Bistoletti et al, 2008). Two articles indicated that 10-year intervals with HPV DNA testing was the most cost-effective strategy for five less developed countries and a co-screening strategy for South Africa (Vijayaraghavan et al, 2009).…”

“…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)…”