The comparative and cost-effectiveness of HPV-based cervical cancer screening algorithms in El Salvador

Abstract

Cervical cancer is the leading cause of cancer death among women in El Salvador. Utilizing data from the Cervical Cancer Prevention in El Salvador (CAPE) demonstration project, we assessed the health and economic impact of HPV-based screening and two different algorithms for the management of women who test HPV-positive, relative to existing Papbased screening. We calibrated a mathematical model of cervical cancer to epidemiologic data from El Salvador and compared three screening algorithms for women aged 30-65 years: (i) HPV screening every 5 years followed by referral to colposcopy for HPV-positive women (Colposcopy Management [CM]); (ii) HPV screening every 5 years followed by treatment with cryotherapy for eligible HPV-positive women (Screen and Treat [ST]); and (iii) Pap screening every 2 years followed by referral to colposcopy for Pap-positive women (Pap). Potential harms and complications associated with overtreatment were not assessed. Under base case assumptions of 65% screening coverage, HPV-based screening was more effective than Pap, reducing cancer risk by~60% (Pap: 50%). ST was the least costly strategy, and cost $2,040 per year of life saved. ST remained the most attractive strategy as visit compliance, costs, coverage, and test performance were varied. We conclude that a screen-and-treat algorithm within an HPV-based screening program is very costeffective in El Salvador, with a cost-effectiveness ratio below per capita GDP.

Scale-Up of an Human Papillomavirus Testing Implementation Program in El Salvador

“…2 Strategies that employ HPV testing and immediate treatment benefit low-resource settings because they are less costly and more feasible than cytology-based methods and result in a higher proportion of women with cervical precancer receiving appropriate treatment. 3–5 Several studies have been conducted with careHPV 6,7 ; however, these primarily investigated clinical outcomes. The public-sector implementation program presented in this article was initiated by the government, with the intention of national scale-up.…”

Cervical Cancer Screening in the United States–Affiliated Pacific Islands

“…30 Another concern is that to keep sensitivity high, quality assurance programs, which are likely to be labor, time, and cost prohibitive, must be in place. 29,35 …”

Human Papillomavirus (HPV) Testing for Secondary Prevention of Cervical Cancer

“…In their study, once-a-lifetime screening of women with HPV DNA testing or VIA at about 35 years of age using the single-or two-visit approach was observed to reduce the lifetime risk of cervical cancer by 25 to 36 % and was cost-effective in most of these resource-limited settings. In a cost-effectiveness analysis based on a cervical cancer screening demonstration project in El Salvador, screenand-treat algorithm within an HPV-based screening program was observed to be very cost-effective, with a costeffectiveness ratio below per capita GDP [43].…”