Estimating the value of point-of-care HPV testing in three low- and middle-income countries: a modeling study

BMC Cancer

Research Article

Nicole G. Campos¹  Jane J. Kim¹  Jose Jeronimo²  Mercy Mvundura³  Vivien Tsu⁴ 

[1] Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, 718 Huntington Avenue, 2nd Floor, 02115, Boston, Massachusetts, USA;Global Coalition against Cervical Cancer, Arlington, Virginia, USA;PATH, Devices and Tools Program, P.O. Box 90922, Seattle, Washington, USA;PATH, Reproductive Health Global Program, P.O. Box 900922, Seattle, Washington, USA;

关键词: Cancer screening;    Cost-effectiveness analysis;    Human papillomavirus (HPV);    HPV DNA tests;    Uterine cervical neoplasms;    Decision analysis;   

DOI  :  10.1186/s12885-017-3786-3

 received in 2016-04-21, accepted in 2017-11-14,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundWhere resources are available, the World Health Organization recommends cervical cancer screening with human papillomavirus (HPV) DNA testing and subsequent treatment of HPV-positive women with timely cryotherapy. Newer technologies may facilitate a same-day screen-and-treat approach, but these testing systems are generally too expensive for widespread use in low-resource settings.MethodsTo assess the value of a hypothetical point-of-care HPV test, we used a mathematical simulation model of the natural history of HPV and data from the START-UP multi-site demonstration project to estimate the health benefits and costs associated with a shift from a 2-visit approach (requiring a return visit for treatment) to 1-visit HPV testing (i.e., screen-and-treat). We estimated the incremental net monetary benefit (INMB), which represents the maximum additional lifetime cost per woman that could be incurred for a new point-of-care HPV test to be cost-effective, depending on expected loss to follow-up between visits (LTFU) in a given setting.ResultsFor screening three times in a lifetime at 100% coverage of the target population, when LTFU was 10%, the INMB of the 1-visit relative to the 2-visit approach was I$13 in India, I$36 in Nicaragua, and I$17 in Uganda. If LTFU was 30% or greater, the INMB values for the 1-visit approach in all countries was equivalent to or exceeded total lifetime costs associated with screening three times in a lifetime. At a LTFU level of 70%, the INMB of the 1-visit approach was I$127 in India, I$399 in Nicaragua, and I$121 in Uganda.ConclusionsThese findings indicate that point-of-care technology for cervical cancer screening may be worthy of high investment if linkage to treatment can be assured, particularly in settings where LTFU is high.

【 授权许可】

CC BY   
© The Author(s). 2017