The cost-effectiveness of visual triage of human papillomavirus–positive women in three low- and middle-income countries

Nicole G. Campos, Jose Jeronimo, Vivien Tsu, Philip E. Castle, Mercy Mvundura, Jane J. Kim

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: World Health Organization guidelines support human papillomavirus (HPV) testing alone (followed by treatment with cryotherapy) or in conjunction with visual inspection with acetic acid (VIA) triage testing. Our objective was to determine the cost-effectiveness of VIA triage for HPV-positive women in low-resource settings. Methods: We calibrated mathematical simulation models of HPV infection and cervical cancer to epidemiologic data from India, Nicaragua, and Uganda. Using cost and test performance data from the START-UP demonstration projects, we assumed screening took place either once or three times in a lifetime between ages 30 and 40 years. Strategies included (i) HPV alone, followed by cryotherapy for all eligible HPV-positive women; and (ii) HPV testing with VIA triage for HPV-positive women, followed by cryotherapy for eligible women who were also VIA-positive (HPV-VIA). Model outcomes included lifetime risk of cervical cancer and incremental cost-effectiveness ratios (ICERs; international dollars/year of life saved). Results: In all three countries, HPV alone was more effective than HPV-VIA. In Nicaragua and Uganda, HPV alone was also less costly than HPV-VIA; ICERs associated with screening three times in a lifetime (HPV alone) were below per capita GDP. In India, both HPV alone and HPV-VIA had ICERs below per capita GDP. Conclusions: VIA triage of HPV-positive women is not likely to be cost-effective in settings with high cervical cancer burden. HPV alone followed by treatment may achieve greater health benefits and value for public health dollars. Impact: This study provides early evidence on the cost-effectiveness of HPV testing followed by VIA triage versus an HPV screen-and-treat strategy.

Original languageEnglish (US)
Pages (from-to)1500-1510
Number of pages11
JournalCancer Epidemiology Biomarkers and Prevention
Volume26
Issue number10
DOIs
StatePublished - Oct 1 2017

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Triage
Cost-Benefit Analysis
Acetic Acid
Cryotherapy
Nicaragua
Uterine Cervical Neoplasms
Uganda
India
Costs and Cost Analysis
Papillomavirus Infections

ASJC Scopus subject areas

  • Epidemiology
  • Oncology

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The cost-effectiveness of visual triage of human papillomavirus–positive women in three low- and middle-income countries. / Campos, Nicole G.; Jeronimo, Jose; Tsu, Vivien; Castle, Philip E.; Mvundura, Mercy; Kim, Jane J.

In: Cancer Epidemiology Biomarkers and Prevention, Vol. 26, No. 10, 01.10.2017, p. 1500-1510.

Research output: Contribution to journalArticle

Campos, Nicole G. ; Jeronimo, Jose ; Tsu, Vivien ; Castle, Philip E. ; Mvundura, Mercy ; Kim, Jane J. / The cost-effectiveness of visual triage of human papillomavirus–positive women in three low- and middle-income countries. In: Cancer Epidemiology Biomarkers and Prevention. 2017 ; Vol. 26, No. 10. pp. 1500-1510.
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