Cervical cancer screening in low-resource settings: A cost-effectiveness framework for valuing tradeoffs between test...

Area of Science:

• Public Health
• Epidemiology
• Health Economics

Background:

• Cervical cancer screening programs face challenges in low-resource settings due to operational constraints.
• Effective protocols are needed to maximize health benefits while managing costs and resource limitations.

Purpose of the Study:

• To develop a framework for evaluating health and economic tradeoffs in cervical cancer screening.
• To guide decision-makers in identifying optimal program investments by analyzing sensitivity, coverage, and follow-up.

Main Methods:

• An individual-based Monte Carlo simulation model was used to simulate HPV and cervical cancer natural history.
• The model was calibrated with epidemiologic data from Uganda, comparing two-visit HPV DNA testing with one-visit visual inspection with acetic acid (VIA).
• Health and economic tradeoffs were assessed across various scenarios of test sensitivity, screening coverage, and loss to follow-up (LTFU).

Main Results:

• A 20% decrease in HPV DNA test sensitivity could be offset by a 20% increase in screening coverage, maintaining health benefits.
• At 10% LTFU, two-visit HPV DNA testing was more effective and cost-effective than VIA, even with increased VIA sensitivity.
• Increased LTFU diminished the effectiveness and cost-effectiveness of two-visit HPV DNA testing compared to VIA.

Conclusions:

• Programmatic decisions for cervical cancer screening must consider setting-specific data on test sensitivity, coverage, and follow-up rates.
• Balancing these factors is crucial for maximizing health gains and economic value in resource-limited environments.
• The choice between HPV DNA testing and VIA depends heavily on achievable LTFU rates and programmatic costs.