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T he comparative and cost‐effectiveness of HPV‐based cervical cancer screening algorithms in E l S alvador
Author(s) -
Campos Nicole G.,
Maza Mauricio,
Alfaro Karla,
Gage Julia C.,
Castle Philip E.,
Felix Juan C.,
Cremer Miriam L.,
Kim Jane J.
Publication year - 2015
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.29438
Subject(s) - medicine , colposcopy , cervical cancer , referral , pap test , cryotherapy , gynecology , cervical cancer screening , obstetrics , cancer , cancer screening , algorithm , family medicine , surgery , computer science
Cervical cancer is the leading cause of cancer death among women in El Salvador. Utilizing data from the Cervical Cancer Prevention in El Salvador (CAPE) demonstration project, we assessed the health and economic impact of HPV‐based screening and two different algorithms for the management of women who test HPV‐positive, relative to existing Pap‐based screening. We calibrated a mathematical model of cervical cancer to epidemiologic data from El Salvador and compared three screening algorithms for women aged 30–65 years: ( i ) HPV screening every 5 years followed by referral to colposcopy for HPV‐positive women (Colposcopy Management [CM]); ( ii ) HPV screening every 5 years followed by treatment with cryotherapy for eligible HPV‐positive women (Screen and Treat [ST]); and ( iii ) Pap screening every 2 years followed by referral to colposcopy for Pap‐positive women (Pap). Potential harms and complications associated with overtreatment were not assessed. Under base case assumptions of 65% screening coverage, HPV‐based screening was more effective than Pap, reducing cancer risk by ∼60% (Pap: 50%). ST was the least costly strategy, and cost $2,040 per year of life saved. ST remained the most attractive strategy as visit compliance, costs, coverage, and test performance were varied. We conclude that a screen‐and‐treat algorithm within an HPV‐based screening program is very cost‐effective in El Salvador, with a cost‐effectiveness ratio below per capita GDP.