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Cervical cancer screening by cotesting method for Vietnamese women 25-55 years old: a cost-effectiveness analysis
Hien Thu Bui1, Van Nu Hanh Pham2, Thang Hong Vu3
1Center for Population Health Science, Hanoi University of Public Health, Hanoi, Vietnam bt.hien610@gmail.com.
Background:
Cervical cancer (CC) is preventable through regular screening and vaccination against human papillomavirus (HPV). However, CC remains a significant public health issue in low-income and middle-income countries (LMICs) like Vietnam, where financial constraints hinder the widespread implementation of HPV vaccination and screening programmes. Currently, Vietnam lacks both a national CC screening intervention and an HPV vaccination programme for women and girls. To date, cost-effectiveness studies evaluating CC screening methods in Vietnam remain limited.
Objectives:
To evaluate the cost-effectiveness of two CC screening strategies for Vietnamese women aged 25-55 years: (1) cotesting combining cytology and HPV testing conducted three times at 5 year intervals (intervention) and (2) cytology-based screening conducted five times at 2 year intervals (comparator). The objective is to provide evidence to inform policy and clinical practice in Vietnam.
Design:
Cost-effectiveness analysis using a Markov model with 1 year cycles to simulate the natural progression of CC.
Setting:
The Vietnamese healthcare system, modelled from the provider's perspective, with parameters adapted to the local context through expert consultations.
Participants:
A simulated cohort of Vietnamese women aged 25-55 years.
Interventions:
The intervention involved cotesting (cytology and HPV testing) three times at 5 year intervals. The comparator was cytology-based screening conducted five times at 2 year intervals.
Primary And Secondary Outcome Measures:
The primary outcome measure was quality-adjusted life years (QALYs). Costs and cost-effectiveness ratios were assessed using Vietnam's gross domestic product (GDP) per capita as the cost-effectiveness threshold (1-3 times GDP per capita). Sensitivity analyses (one-way deterministic and probabilistic) were conducted to account for uncertainties.
Results:
The cotesting strategy was less effective and more costly than cytology-based screening across all age groups. Cotesting resulted in higher costs and fewer QALYs than the comparator. Probabilistic sensitivity analyses confirmed that cotesting was not cost-effective under current conditions in Vietnam.
Conclusions:
Cytology-based screening conducted five times at 2 year intervals is a more cost-effective option for CC screening in Vietnamese women aged 25-55 years. The cotesting strategy cannot be recommended due to its higher cost and lower effectiveness.
