Primary HPV screening test can be considered as an alternative strategy to current cytology-based cervical cancer screening method. It is a cost saving method from several economic studies by reducing number of screening tests and overall screening costs. The aim of this study is to use the model to compare the cost and benefit of different screening strategies involving HPV 16/18 genotyping, compared with hrHPV testing alone or cytology for detecting CIN2+.
Economical analysis using Markov modelling approach to combine the relevant epidemiological existing data from current population-based study of The National Cancer Institute of Thailand. A cohort of 100,000 hypothetical healthy female population age 30-65 years were simulated in each strategy. The intervention of this study is the management guideline for cervical cancer screening using HPV 16/18 genotyping with reflexed cytology of women aged 30-65 years every five years screening interval vs alternative protocol using hrHPV testing alone or cytology-based screening. The model was based on the assumption of complete screening compliance. The unit costs of screening were modeled from the perspective study of The National Cancer Institute of Thailand and King Chulalongkorn Memorial Hospital. Treatment costs for diseases were not included because of equal occurrence in both groups. The main outcomes were defined as a number of CIN2+ cases and cost per 100,000 women screening over 35 years.
Model predictions indicated that, the most cost-effectiveness strategy is hrHPV testing alone by reducing cost and also increase CIN2+ detection rate. It would turn an additional 130 cases and decrease cost (cost saving) by 46,950,840 THB (1,173,771 EUR) per 100,000 women screened when compared to HPV 16/18 genotyping. Compare with cytology, hrHPV testing decrease cost (cost saving) by 51,279,781 THB (1,281,995 EUR) and detect more 506 cases of CIN2+. Cytology screening is the least effectiveness and costliest method among 3 strategies. From sensitivity analysis, the cost of HPV testing, cost of colposcopy, incidence of HPV infection and sensitivity of cytology may affect the results. HPV 16/18 genotyping would be the most cost effective method if the cost of colposcopy increase to 3,573 THB (89 EUR) or the incidence of HPV infection increase 3 times or more in this study.
The results of this cost-effective analysis support the full scale implementation of HPV testing as a primary cervical cancer screening.