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

Nicole G. Campos, Mauricio Maza, Karla Alfaro, Julia C. Gage, Philip E. Castle, Juan C. Felix, Miriam L. Cremer, Jane J. Kim

Research output: Contribution to journalArticle

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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 Pap-based 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 cost-effective in El Salvador, with a cost-effectiveness ratio below per capita GDP. What's new? While most high-income countries have reduced cervical cancer incidence through widespread Pap smear testing, Pap-based screening programs in low-resource settings have faced challenges achieving adequate population coverage, quality, and management of abnormal Pap results. Utilizing data from the Cervical Cancer Prevention in El Salvador (CAPE) demonstration project - a phased project implementing HPV DNA-based screening with the careHPV test - the authors assessed the cost-effectiveness of two algorithms for the management of women who test HPV-positive, relative to existing Pap-based screening. This is one of the earliest assessments of the cost-effectiveness of careHPV testing incorporating data from a real-world demonstration project.

LanguageEnglish (US)
Pages893-902
Number of pages10
JournalInternational Journal of Cancer
Volume137
Issue number4
DOIs
StatePublished - Aug 15 2015

Fingerprint

El Salvador
Early Detection of Cancer
Uterine Cervical Neoplasms
Cost-Benefit Analysis
Colposcopy
Costs and Cost Analysis
Referral and Consultation
Papanicolaou Test
Cryotherapy
Compliance
Cause of Death
Neoplasms
Theoretical Models
Economics
DNA
Incidence
Health

Keywords

  • cancer screening
  • decision analysis
  • El Salvador
  • HPV DNA tests
  • human papillomavirus (HPV)
  • mathematical model
  • uterine cervical neoplasms

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

The comparative and cost-effectiveness of HPV-based cervical cancer screening algorithms in El Salvador. / Campos, Nicole G.; Maza, Mauricio; Alfaro, Karla; Gage, Julia C.; Castle, Philip E.; Felix, Juan C.; Cremer, Miriam L.; Kim, Jane J.

In: International Journal of Cancer, Vol. 137, No. 4, 15.08.2015, p. 893-902.

Research output: Contribution to journalArticle

Campos, Nicole G. ; Maza, Mauricio ; Alfaro, Karla ; Gage, Julia C. ; Castle, Philip E. ; Felix, Juan C. ; Cremer, Miriam L. ; Kim, Jane J. / The comparative and cost-effectiveness of HPV-based cervical cancer screening algorithms in El Salvador. In: International Journal of Cancer. 2015 ; Vol. 137, No. 4. pp. 893-902.
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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 Pap-based 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 cost-effective in El Salvador, with a cost-effectiveness ratio below per capita GDP. What's new? While most high-income countries have reduced cervical cancer incidence through widespread Pap smear testing, Pap-based screening programs in low-resource settings have faced challenges achieving adequate population coverage, quality, and management of abnormal Pap results. Utilizing data from the Cervical Cancer Prevention in El Salvador (CAPE) demonstration project - a phased project implementing HPV DNA-based screening with the careHPV test - the authors assessed the cost-effectiveness of two algorithms for the management of women who test HPV-positive, relative to existing Pap-based screening. This is one of the earliest assessments of the cost-effectiveness of careHPV testing incorporating data from a real-world demonstration project.",
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