PDF(Pubmed)
Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
摘要：
背景：在宫颈癌筛查中，与使用乙酸（VIA）的视觉检查相比，原发性人乳头瘤病毒（HPV）检测具有更高的灵敏度和特异性。自我抽样是促进参与和缩小差距的有前途的策略。然而,对初始成本的担忧阻碍了HPV检测在低收入和中等收入国家的采用。这项研究评估了印度基于家庭的HPV自采样与VIA在宫颈癌筛查中的成本效用。
方法：在东区进行了一项横断面研究，锡金,印度,比较通过VIA进行的基于人群的宫颈癌筛查和通过自我抽样进行的初次HPV筛查的成本和效用结果.成本相关数据于2021年4月至2022年3月采用自下而上的微观成本法收集，而效用测量是使用EuroQoL-5D-5L问卷前瞻性收集的。将效用值转换为8天的质量调整生命日(QALDs)。支付意愿门槛（WTP）基于2022年的人均GDP。如果计算的增量成本效益比(ICER)值低于WTP阈值，这表明干预措施具有成本效益。
结果：该研究包括95名妇女在宫颈癌筛查中使用VIA和HPV自我取样。八天来,VIA组和HPV组的QALD分别为7.977和8.0.通过VIA和HPV自我检测筛查的每位女性的单位成本为1,597卢比（19.2美元）和1,271卢比（15.3美元），分别。ICER为-14,459（-173.6美元），远低于8个QALD的WTP阈值，即4,193卢比（50.4美元）。
结论：研究结果支持HPV自我取样作为VIA的一种具有成本效益的替代方法。这为政策制定者和医疗保健提供者提供了在锡金宫颈癌筛查中更好的资源分配。
方法：在东区进行了一项横断面研究，锡金,印度,比较通过VIA进行的基于人群的宫颈癌筛查和通过自我抽样进行的初次HPV筛查的成本和效用结果.成本相关数据于2021年4月至2022年3月采用自下而上的微观成本法收集，而效用测量是使用EuroQoL-5D-5L问卷前瞻性收集的。将效用值转换为8天的质量调整生命日(QALDs)。支付意愿门槛（WTP）基于2022年的人均GDP。如果计算的增量成本效益比(ICER)值低于WTP阈值，这表明干预措施具有成本效益。
结果：该研究包括95名妇女在宫颈癌筛查中使用VIA和HPV自我取样。八天来,VIA组和HPV组的QALD分别为7.977和8.0.通过VIA和HPV自我检测筛查的每位女性的单位成本为1,597卢比（19.2美元）和1,271卢比（15.3美元），分别。ICER为-14,459（-173.6美元），远低于8个QALD的WTP阈值，即4,193卢比（50.4美元）。
结论：研究结果支持HPV自我取样作为VIA的一种具有成本效益的替代方法。这为政策制定者和医疗保健提供者提供了在锡金宫颈癌筛查中更好的资源分配。
