School of Public Health, Indian Council Medical Research-National Institute of Epidemiology, Chennai, Tamil Nadu, India.
Health Technology Assessment Resource Centre, Indian Council Medical Research-National Institute of Epidemiology, Chennai, Tamil Nadu, India.
PLoS One. 2024 Aug 13;19(8):e0300556. doi: 10.1371/journal.pone.0300556. eCollection 2024.
Primary Human Papilloma Virus (HPV) testing offers higher sensitivity and specificity over Visual Inspection using Acetic acid (VIA) in cervical cancer screening. Self-sampling is a promising strategy to boost participation and reduce disparities. However, concerns about the initial costs hinder HPV testing adoption in low and middle-income countries. This study assesses the cost-utility of home-based HPV self-sampling versus VIA for cervical cancer screening in India.
A cross-sectional study was conducted in East district, Sikkim, India, comparing the costs and utility outcomes of population-based cervical cancer screening through VIA and primary HPV screening through self-sampling. Cost-related data were collected from April 2021 to March 2022 using the bottom-up micro-costing method, while utility measures were collected prospectively using the EuroQoL-5D-5L questionnaire. The utility values were converted into quality-adjusted life days (QALDs) for an 8-day period. The willingness to pay threshold (WTP) was based on per capita GDP for 2022. If the calculated Incremental Cost-Effectiveness Ratio (ICER) value is lower than the WTP threshold, it signifies that the intervention is cost-effective.
The study included 95 women in each group of cervical cancer screening with VIA & HPV self-sampling. For eight days, the QALD was found to be 7.977 for the VIA group and 8.0 for the HPV group. The unit cost per woman screened by VIA and HPV self-testing was ₹1,597 (US$ 19.2) and ₹1,271(US$ 15.3), respectively. The ICER was ₹-14,459 (US$ -173.6), which was much below the WTP threshold for eight QALDs, i.e. ₹ 4,193 (US$ 50.4).
The findings support HPV self-sampling as a cost-effective alternative to VIA. This informs policymakers and healthcare providers for better resource allocation in cervical cancer screening in Sikkim.
与醋酸视觉检查（VIA）相比，原发性人乳头瘤病毒（HPV）检测在宫颈癌筛查中具有更高的敏感性和特异性。自我采样是提高参与度和减少差异的有前途的策略。然而，对初始成本的担忧阻碍了 HPV 检测在中低收入国家的采用。本研究评估了基于家庭的 HPV 自我采样与 VIA 在印度进行宫颈癌筛查的成本-效用。
在印度锡金邦东区进行了一项横断面研究，比较了通过 VIA 进行基于人群的宫颈癌筛查和通过自我采样进行原发性 HPV 筛查的成本和效用结果。从 2021 年 4 月至 2022 年 3 月，使用自下而上的微观成本法收集与成本相关的数据，同时使用 EuroQoL-5D-5L 问卷前瞻性收集效用测量值。效用值转换为 8 天的质量调整生命天数（QALDs）。意愿支付阈值（WTP）基于 2022 年的人均国内生产总值。如果计算出的增量成本效益比（ICER）值低于意愿支付阈值，则表示干预措施具有成本效益。
该研究包括 VIA 和 HPV 自我采样组各 95 名妇女。在八天内，VIA 组的 QALD 为 7.977，HPV 组为 8.0。通过 VIA 和 HPV 自我检测筛查每位女性的单位成本分别为 ₹1597（19.2 美元）和 ₹1271（15.3 美元）。ICER 为 ₹-14459（-173.6 美元），远低于 8 个 QALDs 的意愿支付阈值，即 ₹ 4193（50.4 美元）。
研究结果支持 HPV 自我采样作为 VIA 的一种具有成本效益的替代方案。这为决策者和医疗保健提供者提供了信息，以便在锡金邦更好地分配宫颈癌筛查资源。
