Scaling up primary HPV DNA screening and self-sampling for cervical cancer in Peru: Coverage, cost-utility, and budget impact analysis using public data sources

ObjectivesTo estimate cervical screening coverage and inequities among Peruvian women aged 30-49 years and evaluate lifetime cost-utility and 5-year budget impact of scaling up HPV DNA testing, including self-sampling.SettingPeru, using national ENDES (Demographic and Family Health Survey) data and public sources.MethodsWe linked a cross-sectional ENDES 2015-2024 analysis to a public-payer decision model. Up-to-date screening was Pap or visual inspection with acetic acid within 3 years, or molecular HPV testing within 5 years. A screening decision tree and lifetime state-transition (Markov) model compared current practice with HPV self-sampling, clinician-collected testing, and hybrid expansion. We estimated costs, quality-adjusted life-years (QALYs), sequential incremental cost-effectiveness ratios (ICERs), probabilistic optimality, and budget impact at S/ 25,007 (Peruvian soles) / QALY.ResultsIn 2024, 63.6% were up to date, 36.4% underscreened, 15.0% never screened, and 12.9% reported recent molecular HPV testing. The efficiency frontier was current practice, hybrid expansion to 90%, and clinician-collected HPV testing at 90%; sequential ICERs were S/ 5434 and S/ 10,982/QALY. In 5000 simulations, clinician-collected 90%, self-sampling 90%, and hybrid 90% had optimal-strategy probabilities of 69.46%, 15.46%, and 13.38%. Annualized budget impact was S/ 24.44 million for hybrid 90% and S/ 67.17 million for clinician-collected 90%.ConclusionsClinician-collected HPV testing at 90% maximized expected net monetary benefit under modeled assumptions, while hybrid expansion required less short-term expenditure. Policy should balance lifetime efficiency, feasibility, affordability, and linkage to diagnosis and treatment.