Table 2.

Summary of model parameters for screening, diagnosis, and treatment procedures, and ranges for sensitivity analysis

Parameters	Baseline value	Range for sensitivity analysis (lower bound and upper bound)	Sources
Preintervention burden of disease
Incidence	ASR-W (0–84)=28.4/100 000	N/A	GLOBOCAN, 20181
Mortality	ASR-W (0–74)=18.6/100 000	N/A	GLOBOCAN, 20181
Screening participation and compliance
Screening participation rate	90% of women ever screen; 70% return for their next scheduled routine visit (selected from the 90% ever-screeners)	50%–90%	Based on WHO elimination targets by 203016
Rate of lost to follow-up for same-day treatment with thermal ablation	5%	NA	Assumption based on the trial outcomes
Rate of loss to follow-up (LTFU) of referral for treatment of larger lesions or suspicious cancer investigation	30% for self-collected HPV S&T 30% for VIA		Based on limited health facilities that can offer cancer diagnosis and treatment, as well as the limited access for rural women. (Personal communication with local experts)
LTFU of women after ablative treatment for precancer at 12 m follow-up visit	50% for self-collected HPV S&T 50% for VIA	Lower bound: 10% for self-collected HPV S&T and 10% for VIA screening	Base case: based on limited health facilities and as well as the limited access for rural women. Lower bound: based on the experience of the field trial in PNG.
Screening test characteristics
self-collected HPV	Sensitivity of 91.7% and specificity of 89.8% to detect CIN2+.*	Sensitivity: 89.1%–95.3% and Specificity: 88.6%–90.6% to detect CIN2+	Arbyn et al48 32; Toliman et al6
Primary VIA	Sensitivity of 51.5% and specificity of 81.4% for CIN2+.*	Upper bound: Sensitivity of 70% and specificity of 78% for CIN2+.	Base case: Toliman et al6 Upper bound: Based on the upper 95% CI of VIA test performance Toliman et al6 and a systematic review on VIA test performance categorised for high quality studies.35
Ablation treatment success rate	84.3%–92.4% for CIN1-3; 0% for cancer		Randall et al49
Cancer treatment
% Cancer treatment uptake for symptomatically detected cancers	20% treatment access rate overall. (Detailed assumptions in the Methods section and online supplemental appendix)	Lower bound: 8%. Upper bound: 90% treatment access overall	Base case: Only a few health facilities can offer cancer diagnosis and treatment, which is limited to radical hysterectomy (Based on personal communication with local experts). Lower bound: Based on access rate to radiotherapy estimated by Datta et al.50 Upper bound: Based on WHO cancer treatment target for cervical cancer elimination.16
5- year survival by FIGO stage (%)	FIGO I: 0.64; FIGO II: 0.52; FIGO III: 0.12; FIGO IV: 0.01 (online supplemental table A1)	Lower bound: FIGO I: 0.625; FIGO II: 0.48; FIGO III: 0.101; FIGO IV: 0.011 Upper bound: FIGO I: 0.869; FIGO II: 0.774; FIGO III: 0.599; FIGO IV: 0.117 (online supplemental table A1)	Base case: Informed by stage-specific survival rates for countries with ~20% cancer treatment access to radiotherapy,2 assuming the survival benefits are mostly targeted to Stage 1 and 2, and further adjusted to fit to GLOBOCAN2018 mortality rates. Lower bound: We assumed the same survival rates estimated for PNG as reported in Canfell et al.2 Upper bound: We assumed the same survival rates estimated for countries with 90% treatment access rate across all stages as reported in Canfell et al.2
Costs † (US$) and other health economic parameters
self-collected HPV test cost ‡	US$18	US$8	Base case costs were estimated based on the current screening trial in PNG. Lower cost of HPV test in sensitivity analysis was assumed based on discussions with experts regarding future reduction in HPV test costs.
VIA test cost ‡	US6	NA
Biopsy	US$59	NA
Ablation	US$15	NA
Cancer treatment costs
FIGO I	US$1614 (applied to 80% of FIGO I diagnosed cases)	Upper bound: US$1937	Base case: costs were estimated based on personal communication with local experts. Upper bound: Cancer treatment cost for FIGO I and II was assumed 20% higher than base case. In a sensitivity analysis considering a 90% cancer treatment access, we assumed some treatment options for advanced cancer stages would be available in PNG. We assumed cancer treatment costs for FIGO III were 40% higher than treatment cost for FIGO I and cost for FIGO IV was equal to cost for FIGO I treatment. These factors were derived from previous study.51 (see online supplemental tables A2 and A3)
FIGO II	US$1614 (applied to 20% of FIGO II diagnosed cases)	Upper bound: US$1937
FIGO III	0	Upper bound: 0
FIGO IV	0	Upper bound: 0
Threshold for willingness-to-pay	0.5 X PNG GDP per capita, US$1415 (PGK4723)	1 X PNG GDP per capita, US$ 2829 (PGK9446)	PNG GDP per capita was based on World Bank, 2019.52
Discount rates
Effects	3%	0%	WHO-CHOICE cost-effectiveness analysis guideline.
Costs	3%	3%	WHO-CHOICE cost-effectiveness analysis guideline.

We assumed the test performance for HSIL are equivalent for CIN2+.

Costs were collected in PGK currency and converted to US$, using exchange rate of PGK1=US$0.3, 17 October 2019, Commonwealth Bank, Australia)

*The Toliman et al study reported test performance of PoC HPV self-collected testing and VIA testing for HSIL.

†Costs were estimated from service provider’s perspective, considering direct medical costs that associated with each screening, diagnostic tests or treatment procedures.

‡Including costs of test and test delivery.

ASR, age-standardised rate; CIN, cervical intraepithelial neoplasia; FIGO, International Federation of Gynaecology and Obstetrics; GDP, gross domestic product; HSIL, high-grade squamous intraepithelial lesions; PNG, Papua New Guinea; PoC, point-of-care; S&T, screen and treat; VIA, visual inspection with acetic acid.