Cost-Effectiveness Analysis of HPV Screening Strategies in Tunisia: A Modeling Study

Cost-Effectiveness Analysis of HPV Screening Strategies in Tunisia: A Modeling Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Cost-Effectiveness Analysis of HPV Screening Strategies in Tunisia: A Modeling Study Anas Lahdhiri, Beya Benzina, Emna Ennaifer, Ahlem Gzara, Soumaya Rammeh-Rommani, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5267309/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 31 Jul, 2025 Read the published version in Scientific Reports → Version 1 posted 11 You are reading this latest preprint version Abstract Background: In Tunisia, cervical cancer ranks as the 14th most common cancer, largely driven by high-risk of Human Papillomavirus (HPV) types, notably HPV 16 and 18. Current screening efforts are limited, with only 17% of all women aged 35-60 undergoing Pap-smear testing. The introduction of the HPV vaccine in 2025 through the national school vaccination program, targeting girls aged 11-12, is expected to reduce the burden of cervical cancer. However, alongside vaccination, enhanced screening strategies are essential for early detection and prevention of HPV-related cancers. Aim: This study aims to assess the cost-effectiveness of different HPV screening strategies in Tunisia, specifically examining the combination of varying HPV screening frequencies and a vaccination program targeting girls aged 11-12. The objective is to determine the most cost-efficient screening strategy to complement vaccination efforts in reducing cervical cancer incidence. Methods: A cost-effectiveness analysis was conducted from the perspective of the Tunisian healthcare system using the HPVsim model, a multi-agent-based simulation tool that captures HPV transmission dynamics and cervical cancer progression. Four approaches were compared: (1) maintaining the current Pap-smear screening strategy combined with vaccination; (2) introducing HPV DNA testing once between ages 35-40; (3) introducing HPV DNA testing twice between ages 35-45, with a 5-year interval; and (4) introducing HPV DNA testing every 5 years for women aged 35-60. All approaches were combined with the vaccination program. Screening coverage rates of 15%, 25%, 33%, 50%, and 70% were tested for each approach. Primary outcomes included the number of cancer cases averted, total intervention costs, and cost increase per cancer case averted. Academic literature and existing evidence were included on the demographic variables, cervical cancer incidence and mortality, treatment costs, vaccine delivery costs and other model parameters. Results: All interventions resulted in substantial reductions in cervical cancer cases, with decreases ranging from 41% to 59% in cumulative cases between 2025 and 2090. The most intensive approach, involving HPV DNA testing every 5 years for women aged 35-60, achieved the largest reduction, with a 59% decrease in cumulative cervical cancer cases by 2090, although it also incurred the highest costs. The least costly option, which retained current Pap-smear testing alongside vaccination, reduced cervical cancer cases by 41%. Although the introduction of HPV DNA testing significantly increases costs, a high frequency of screening allows for quicker public health benefits. The scenario combining vaccination and maintaining current screening practices is found to be the most cost-effective for the Tunisian context. If the price of the HPV DNA test is reduced to $9 USD, the most frequent testing strategy would become the most cost-effective option, offering both high effectiveness and financial viability. Conclusion: Lowering the cost of HPV DNA testing could make more frequent screening financially sustainable, providing greater public health benefits. These findings offer valuable guidance for decision-makers in shaping future strategies for cervical cancer prevention in Tunisia. Biological sciences/Cancer/Cancer prevention Biological sciences/Cancer/Cancer screening Health sciences/Health care/Health care economics Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 31 Jul, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 28 Feb, 2025 Reviews received at journal 03 Feb, 2025 Reviewers agreed at journal 08 Jan, 2025 Reviewers agreed at journal 08 Jan, 2025 Reviews received at journal 22 Dec, 2024 Reviewers agreed at journal 25 Nov, 2024 Reviewers invited by journal 22 Nov, 2024 Editor assigned by journal 22 Nov, 2024 Editor invited by journal 14 Nov, 2024 Submission checks completed at journal 12 Nov, 2024 First submitted to journal 15 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5267309","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":383554000,"identity":"edf4680b-5711-4beb-bce2-8e5ee7a469fe","order_by":0,"name":"Anas Lahdhiri","email":"","orcid":"","institution":"University of Tunis El Manar","correspondingAuthor":false,"prefix":"","firstName":"Anas","middleName":"","lastName":"Lahdhiri","suffix":""},{"id":383554001,"identity":"8f3fe825-a29b-4689-ba42-5333b6349234","order_by":1,"name":"Beya Benzina","email":"","orcid":"","institution":"University of Tunis El 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Current screening efforts are limited, with only 17% of all women aged 35-60 undergoing Pap-smear testing. The introduction of the HPV vaccine in 2025 through the national school vaccination program, targeting girls aged 11-12, is expected to reduce the burden of cervical cancer. However, alongside vaccination, enhanced screening strategies are essential for early detection and prevention of HPV-related cancers.\u003c/p\u003e\n\u003cp\u003eAim: This study aims to assess the cost-effectiveness of different HPV screening strategies in Tunisia, specifically examining the combination of varying HPV screening frequencies and a vaccination program targeting girls aged 11-12. The objective is to determine the most cost-efficient screening strategy to complement vaccination efforts in reducing cervical cancer incidence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA cost-effectiveness analysis was conducted from the perspective of the Tunisian healthcare system using the HPVsim model, a multi-agent-based simulation tool that captures HPV transmission dynamics and cervical cancer progression. Four approaches were compared: (1) maintaining the current Pap-smear screening strategy combined with vaccination; (2) introducing HPV DNA testing once between ages 35-40; (3) introducing HPV DNA testing twice between ages 35-45, with a 5-year interval; and (4) introducing HPV DNA testing every 5 years for women aged 35-60. All approaches were combined with the vaccination program. Screening coverage rates of 15%, 25%, 33%, 50%, and 70% were tested for each approach. Primary outcomes included the number of cancer cases averted, total intervention costs, and cost increase per cancer case averted. Academic literature and existing evidence were included on the demographic variables, cervical cancer incidence and mortality, treatment costs, vaccine delivery costs and other model parameters.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e All interventions resulted in substantial reductions in cervical cancer cases, with decreases ranging from 41% to 59% in cumulative cases between 2025 and 2090. The most intensive approach, involving HPV DNA testing every 5 years for women aged 35-60, achieved the largest reduction, with a 59% decrease in cumulative cervical cancer cases by 2090, although it also incurred the highest costs. The least costly option, which retained current Pap-smear testing alongside vaccination, reduced cervical cancer cases by 41%. Although the introduction of HPV DNA testing significantly increases costs, a high frequency of screening allows for quicker public health benefits. The scenario combining vaccination and maintaining current screening practices is found to be the most cost-effective for the Tunisian context. If the price of the HPV DNA test is reduced to $9 USD, the most frequent testing strategy would become the most cost-effective option, offering both high effectiveness and financial viability.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Lowering the cost of HPV DNA testing could make more frequent screening financially sustainable, providing greater public health benefits. These findings offer valuable guidance for decision-makers in shaping future strategies for cervical cancer prevention in Tunisia.\u003c/p\u003e","manuscriptTitle":"Cost-Effectiveness Analysis of HPV Screening Strategies in Tunisia: A Modeling Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-29 05:58:48","doi":"10.21203/rs.3.rs-5267309/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-02-28T05:29:34+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-02-03T16:31:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"150431509137340915738265584876984888068","date":"2025-01-08T08:33:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"192079063817959192663265935068835083548","date":"2025-01-08T08:09:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-22T10:23:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"257021433891878266522463912705610031212","date":"2024-11-25T07:12:44+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-22T13:55:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-22T13:50:32+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-11-14T17:05:41+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-12T12:39:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-10-15T08:59:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"565247b2-1709-4578-b795-7196893460d2","owner":[],"postedDate":"November 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":40859576,"name":"Biological sciences/Cancer/Cancer prevention"},{"id":40859577,"name":"Biological sciences/Cancer/Cancer screening"},{"id":40859578,"name":"Health sciences/Health care/Health care economics"}],"tags":[],"updatedAt":"2025-08-04T16:40:11+00:00","versionOfRecord":{"articleIdentity":"rs-5267309","link":"https://doi.org/10.1038/s41598-025-13423-3","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-07-31 16:12:59","publishedOnDateReadable":"July 31st, 2025"},"versionCreatedAt":"2024-11-29 05:58:48","video":"","vorDoi":"10.1038/s41598-025-13423-3","vorDoiUrl":"https://doi.org/10.1038/s41598-025-13423-3","workflowStages":[]},"version":"v1","identity":"rs-5267309","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5267309","identity":"rs-5267309","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}