High-risk human papillomavirus testing for underscreened populations: cost-effectiveness and affordability in three country settings
BMC Public Health, vol. 25, pp. 2570
Abstract
BACKGROUND: The high-risk human papillomavirus (hrHPV)-based screening recommended by the World Health Organization is expected to lead to worldwide reduction of the cervical cancer burden, but the countries burdened most by cervical cancer also struggle with the costs of transitioning to this approach. Country-specific evaluations are needed to inform policymakers on implementation of hrHPV-based screening for their setting. Following initial implementation in Uganda, Bangladesh and Slovakia focused on underscreened women in the PRESCRIP-TEC project, we investigated the potential cost-effectiveness and affordability of hrHPV-based screening strategies. METHODS: Country-specific model-based cost-effectiveness and budget impact analyses were conducted for the three countries, comparing the PRESCRIP-TEC strategy with the existing screening strategy in each setting. Data from initial project implementation informed the relevant model parameters. RESULTS: The PRESCRIP-TEC strategy resulted in disability-adjusted life year (DALY) gains in all three countries. The cervical cancer incidence rate was reduced by a third for Uganda, 15% for Bangladesh and 11% for Slovakia. The incremental cost-effectiveness ratios were UGX 0.56 million per DALY for Uganda (I$ 475), BDT 76 thousand per DALY for Bangladesh (I$ 1698) and EUR 1782 (I$ 3637) per DALY for Slovakia. Substantial additional funding will be required to enable implementation, particularly in relation to the initial start-up costs. CONCLUSIONS: The provided estimates can serve to inform policymakers and researchers in the context of implementing hrHPV-based screening in diverse settings.
Authors 19
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Marat Sultanov corresponding
University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Health Sciences, Global Health Unit, University Medical Center Groningen, University of Groningen, Groningen, Netherlands. m.sultanov@umcg.nl
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University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Health Sciences, Global Health Unit, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Health Sciences, Global Health Unit, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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University Medical Center Groningen · University of Groningen · Medisch Centrum Leeuwarden
Affiliation as printed
Department of Health Sciences, Global Health Unit, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden, Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Gynecology, Leiden University Medical Center, Leiden University, Leiden, Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Gynecology, Leiden University Medical Center, Leiden University, Leiden, Netherlands
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Affiliation as printed
Uganda Cancer Institute, Kampala, Uganda
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Stockholm University · Uganda Cancer Institute
Affiliation as printed
Department of Computer and Systems Science, The Swedish Program for ICT in Developing Regions (SPIDER), Stockholm University, Stockholm, Sweden
Uganda Cancer Institute, Kampala, Uganda
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Affiliation as printed
Uganda Cancer Institute, Kampala, Uganda
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Affiliation as printed
Friendship NGO, Dhaka, Bangladesh
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Affiliation as printed
Friendship NGO, Dhaka, Bangladesh
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International Centre for Diarrhoeal Disease Research
Affiliation as printed
International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
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Affiliation as printed
Department of Public Health, Faculty of Health Care and Social Work, Institute for Global Health and Epidemiology, Trnava University, Trnava, Slovak Republic
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Affiliation as printed
Department of Public Health, Faculty of Health Care and Social Work, Institute for Global Health and Epidemiology, Trnava University, Trnava, Slovak Republic
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Affiliation as printed
Department of Laboratory Medicine, Faculty of Health Care and Social Work, Center for Microbiology and Infection Prevention, Trnava University, Trnava, Slovak Republic
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University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
Department of Health Sciences, Global Health Unit, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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