2022-RA-566-ESGO Cost-effectiveness of cervical cancer screnning strategies among women in Cameroon. (20th October 2022)

• Record Type: Journal Article
• Authors: Sormani, Jessica; Wisniak, Ania; Kenfack, Bruno; Datchoua, Alida Moukam; Vassilakos, Pierre; Petignat, Patrick; Combescure, Christophe
• Is Part Of: International journal of gynecological cancer. Volume 32(2022)Supplement 2
• Page Start: A13
• Page End: A14
• Publication Date: 2022-10-20
• Subjects: Generative organs, Female -- Cancer -- Periodicals; 616.99465
• DOI: 10.1136/ijgc-2022-ESGO.29
• Languages: English
• ISSNs: 1048-891X

Abstract

Abstract : Introduction/Background: Sub-Saharan Africa has the highest cervical cancer burden worldwide. Before implementing a cervical cancer screening programme, National authorities and decision-makers need to balance the benefits and costs of context-sensitive solutions. Our aim was to assess the cost-effectiveness of two cervical cancer screening strategies in Cameroon: i) HPV self-testing (Self-HPV), and (ii) Self-HPV and triage with Visual Inspection with Acid acetic (VIA) (Self-HPV/VIA) at frequencies twice to seven times between 30 and 60 years, at 5 or 10-year intervals. Methodology: A lifetime decision-analytic model has been calibrated to Cameroonian women. Costs parameters have been estimated based on real-life screening activities within the 3T-project in Cameroon. Utilities were accounted for in the model. Cost-effectiveness ratios have been assessed for each strategy and screening frequency compared with the absence of strategy. Results: Four combinations appeared to be the most cost-effective: Self-HPV/VIA at 35–45, and at 30–40–50 years, and Self-HPV every 5 and 10 years between 30 and 60 years old. The incremental cost per QALY gained for Self-HPV/VIA strategies was 403USD (393–413) at 35–45 years, and 690USD (671–708) at 30–40–50 years, 1035USD (1005–1057) for Self-HPV at 30–40–50–60 years, and 1592USD (1553–1620) at 30–35–40–45–50–55–60 years. Cervical cancer mortality was mostly lower with Self-HPV strategies. Whatever the screening frequency, in both strategies, about 50% of costs were related to Self-HPV testing, while for the Self-HPV/VIA strategy, triage accounted for approximately 1% of costs. At equal frequencies, costs of precancerous treatment were higher in Self-HPV than Self-HPV/VIA strategies, due to high overtreatment rate of CIN1 in the absence of triaging. The costs of cancer treatment were comparable in both strategies. Conclusion: Cost-effectiveness depends on the type and frequency of screening. These results may support decision-makers in selecting adequate screening strategies and frequencies according to their willingness to pay per QALY gained.