Is the HPV-test more cost-effective than cytology in cervical cancer screening? An economic analysis from a middle-income country

Objective: To report a modelling study using local health care costs and epidemiological inputs from a population-based program to access the cost-effectiveness of adopting hrHPV test. Design: A cost-effectiveness analysis based on a microsimulation dynamic Markov model. Data and costs were based on data from the local setting and literature review. Setting: Indaiatuba, Brazil. The city has adopted the hrHPV test replacing cytology since 2017. Sample: After calibrating the model, one million women were simulated in hypothetical cohorts. Methods: Three strategies were tested: cytology to women aged 25 to 64 every three years; hrHPV test to women 25-64 every five years; cytology to women 25-29 years every 3 years and hrHPV test to women 30-64 every five years (hybrid strategy). Main outcome measure: Quality-adjusted life-years (QALY), assessed by the Incremental Cost-Effectiveness Ratio (ICER). Results: The hrHPV testing and the hybrid strategy were the dominant strategies. Costs were lower and provided a more effective option at a negative incremental ratio of US$ 37.87 for the hybrid strategy, and negative US$ 6.16 for the HPV strategy per QALY gained. Reduction on treatment costs would influence a reduction in ICER, and an increase in the costs of the hrHPV test would increase ICER. Conclusions: Using population-based data, the switch from cytology to hrHPV testing in the cervical cancer screening program of Indaiatuba is less costly and cost-effective than the old cytology program. Funding: UNICAMP (research project), Indaiatuba City and Roche Diagnostics (program).