Economic evaluation of cervical cancer screening strategies in china

Objectives: The aim of this study was to evaluate the cost effectiveness of cervical cancer screening strategies and economic implication of a HPV-16/18 genotyping test which simultaneously detects 12 other high-risk HPV types in China. Methods: A Markov cohort model was developed to calculate the long term cost and effectiveness of different cervical cancer primary screening strategies from the perspective of China's healthcare system. Four strategies were compared, including (1) cytology with reflex HPV testing; (2) HPV with reflex to cytology; (3) HPV with 16/18 genotyping and reflex cytology; and (4) co-testing with cytology and HPV testing. Screening was supposed to begin at the age of 30 and performed once every three years to last 40 years. Results: With 3 times of China GDP per capita as the threshold of the cost-effectiveness evaluation, strategy (3) was more cost effective than strategy (1) & (4) and dominated strategies (2) by reducing costs and acquiring equal QALYs. One way sensitivity analysis demonstrated that the cost effectiveness analysis results of strategy (3) versus strategy (1) were stable. Detecting HPV-16/18 resulted in earlier diagnosis of clinically relevant CIN 3 at initial screening and efficient use of follow-up resources. Conclusions: Incorporating HPV-16/18 genotyping is cost effective and may improve detection of CIN, thereby preventing cervical cancer.