Table 2.
Results of the studies included in the systematic review.
| Author (Year) | Compared tracking strategies | Effective Measures | Types of costs | Currency (year) | Cost-effectiveness combined result | Exchange into international dollar (2019) | Cost-effectiveness threshold | Sensitivity analysis | Parameters Analyzed |
|---|---|---|---|---|---|---|---|---|---|
| Andrés-Gamboa | No tracking/ Conventional cytology/ DNA-HPV test | Years of life saved | Direct medical costs | US Dollar (2006) | USD44/ YSL | Int$77.42 | USD 3,200 | Without Information | Performance and costs of screening tests, diagnosis, and treatment costs for HSIL |
| Beal (2014) | Conventional cytology compared to: HR-HPV plus Conventional cytology; HR-HPV plus molecular screening; Co-testing | Number of missed cases of CIN 2, CIN 3 or cervical cancer avoided | Direct medical and non-medical costs | USD (2013) | ICER: HR-HPV plus Conventional Cytology USD 108.99; HR-HPV plus molecular screening USD 819; Co-testing USD-537 | HR-HPV plus Conventional Cytology: Int$197.23 HR-HPV plus Molecular Screening: Int$1,482.03 Co-testing: Int $971.74 | Willingness-to-pay 0 to 3,000 USD | Probability/ Monte Carlo Simulation | ‒ |
| Caetano (2006) | Conventional cytology/ Cytology in liquid medium/ CH-HPV test/ CH-HPV with self collection/ Conventional cytology with CH-HPV/ Cytology in liquid medium with CH-HPV | Number of detected cases of precursor lesions with a high degree of malignancy or cervical cancer | Direct medical costs | Brazilian Real BRL (2005) | BRL 1,404.36/ detected case of cancer or high-grade precursor lesion | Int$1,309.68 | Without Information | Univariate Deterministics | Costs of Compared Strategies |
| Campos (2015) | HPV-DNA testing (provider-collected [cervical] and self-collected [vaginal] sampling), Visual inspection with acetic acid (VIA)/ Conventional cytology Screening strategies included several scenarios, varying both age at onset and frequency throughout life: 1x in life (25, 30, 35, 40, 45 or 50 years); 2x in life (25 and 35; 30 and 40 or 35 and 45 years); 3x in life (25, 35 and 45 years; 30, 35 and 40 years; 35, 40 and 45 years; or 30, 40 and 50 years) |
Years of life saved | Direct medical costs | International Dollar Int $ (2011) | DNA-HPV test (cervical sampling) India: 1 × ICER in life (40 years: Int$330/YLS; 45 years: Int$190/YLS); 2 × in life (35 and 45 years: Int$390/YLS); 3 × in life (30, 35 and 40 years: Int$1,600/YLS; 30, 40 and 50 years: Int$580/YLS) | India: 1 × in life (40 years Int$402.53; 45 years Int$231.76); 2 × in life (35 and 45 years Int$475.72); 3 × in life (30, 35 and 40 years Int$1,951.68; 30, 40 and 50 years Int$707.49) | Int$ 5,240 GDP per capita in India | Probability/ Monte Carlo Simulation | Prevalence of age-specific high-risk HPV and age-specific incidence of cancer |
| Nicaragua: ICER 2 × in life (30 and 40 years: Int$50/YLS); 3 × in life (30, 35 and 40 years: Int$ 180/YLS, 25, 35 and 45 years: Int$ 1200/YLS) | Nicaragua: 2 × in life (30 and 40 years Int$58.27); 3 × in life (30, 35 and 40 years Int$209.77; 25, 35 and 45 years Int$1,398.45) | Int$ 4,220 GDP per capita in Nicaragua | |||||||
| Uganda: ICER 1 × in life (35 years: Int$ 160/YLS; 40 years: I $120/YLS); 2 × in life (30 and 40 years: Int$210/YLS); 3 × in life (30, 40 and 50 years: Int$350/YLS) | Uganda: 1 × in life (35 years Int$166.32; 40 years Int$124.74); 2 × in life (30 and 40 years Int$ 218.29); 3 × in life (30, 40 and 50 years Int$ 2,165.77) | Int$1,370 GDP per capita in Uganda | |||||||
| Campos (2017) | Conventional cytology w/3 years, with referral for colposcopy if ASCUS or worse result/ DNA-HPV test w/5 years, with referral for cryotherapy for HPV-positive eligible/ DNA-HPV test w/5 years, with referral for screening with visual inspection with acetic acid (VIA) for HPV-positive/ DNA-HPV test w/5 years, with referral to conventional cytology for HPV-positive | Years of life saved | Direct medical and non-medical costs | US Dollar U$ (2015) | USD320/ YLS | Int$ 969.36 | USD 2,090 GDP per capita | Univariate Deterministics | Test performance, colposcopy performance, screening coverage, visit compliance, eligibility for cryotherapy after a positive screening and screening test, treatment effectiveness, discount rate, and costs |
| Flores (2011) | No screening/ Conventional cytology/ Self-collection DNA-HPV test/ DNA-HPV test administered by the doctor/ DNA-HPV test administered by the doctor plus Conventional cytology | Number of detected cases of high grade, cervical intraepithelial neoplasm or cervical cancer | Direct medical costs | US Dollar U$ (2008) | USD 9,352.00/ case detected | Int$ 21,581.07 | Without Information | Univariate Deterministics | Performance and costs of screening tests and treatment costs |
| Goldie (2005) | Strategies vary according to the number of clinic visits, frequency of screening, and specific ages. | Years of life saved | Direct costs (medical and non-medical) and programme costs | International Dollar Int$ (2000) | Lifetime tracking (1, 2, 3 times, respectively) | India: 3 × in life Int$37.58, Kenya: 2 × in life Int$197.22; 3 × in life Int$ 310.24 Peru: 1 × in life Int$ 5.47; 2 × in life Int$ 16.31; 3 × in life Int$41.24 South Africa: 1 × in life Int$5.30; 2x in life Int$ 12.40; 3 × in life Int$ 27.89 Thailand: 1 × in life Int$ 3.44; 2 × in life Int$6.26; 3 × in life Int$ 13.29 | Int$2,330 GDP per capita in IndiaI | Univariate Deterministics | Costs associated with invasive cancer treatment and target age of screening, while the choice between strategies was sensitive to test characteristics and screening costs. |
| Costs/ YLS | Int$1,005 GDP per capita in Kenya | ||||||||
| India = D; D; 24.32 | |||||||||
| Kenya = D; 70.15; 110.35 | Int$4,747 GDP per capita in Peru | ||||||||
| Turkey = 3.2; 9.54; 24.12 | |||||||||
| South Africa = 4.92; 11.52; 25.91 | Int$9,486 GDP per capita in South Africa | ||||||||
| Thailand = 2.67; 4.86; 10.32 | |||||||||
| Int$6,373 GDP per capita in Thailand | |||||||||
| Gutiérrez-Delgado (2008) | Strategies include 10 scenarios: 3 with screening by conventional Cytology, DNA-HPV Test (CH) or combined; and 7 with HPV vaccine | Years of life saved | Direct medical costs | Mexican Peso Mex$ (2006) | Conventional cytology by the Program, 80% coverage = ICER: Mex$16,678/YLS | Conventional cytology by the Program, 80% coverage: Int$3,078.93 | Mex$ 88,688 GDP per capita | Univariate Deterministics | The frequency and cost of tracking for the HC-HPV test and the discount rate |
| DNA-HPV w/3 years, 80% coverage = ICER: Mex$ 21,914/ YLS | DNA-HPV with 3 years, 80% coverage: Int$ 4,045.55 | ||||||||
| Levin (2010) | Conventional cytology/ DNA-HPV test (CH-HPV, Rapid HPV test) | Years of life saved, Number of cancer cases avoided | Direct costs (medical and non-medical) and programme costs | US Dollar U$ (2005) | $50/ YLS for a single lifetime screening using county-level HPV DNA rapid testing compared to no screening. | DNA-HPV rapid test 1 × in life: Int$ 140.65 2 × in life: Int$ 225.04 3 × in life: 421.95 | USD 1,702GDP per capita | Univariate Deterministics | Costs associated with invasive cancer, treatment of precancerous lesions, and screening test costs. |
| The strategies varied according to age, screening frequency, number of clinic visits (1, 2 or 3) and service delivery configuration (city, county or national) | $80 and $150/ YLS two or three times in a lifetime, with the same strategy, respectively | ||||||||
| Mandelblatt (2002) | Strategies include 7 scenarios: 3 with screening per test: Conventional Cytology, VIA Test??, DNA-HPV Test and Combined Tests | Years of life saved | Direct medical and non-medical costs | US Dollar U$ (2000) | Incremental ratio ($/YL) | Variation from Int$ 621.47 to Int$ 34,514.67 | Without Information | Probability/ Monte Carlo Simulation | Individual parameters: sensitivity and test cost, prevalence rates; and parameter combinations: two- or three-way sensitivity analysis at reasonable intervals to examine the robustness of model results |
| All strategies saved lives, at costs ranging from $121 to $6,720/ YLS | |||||||||
| Nahvijou (2014) | Conventional cytology/ DNA-HPV test with conventional cytology | Not applicablea | Direct medical costs | International Dollar Int$ (2010) | Total cost/woman: Conventional cytology = $36.1; DNA-HPV Test USD 174.0 | Conventional cytology: Int$ 18.84 DNA-HPV Test: Int$ 90.81 | per capita GDP of the country | Without Information | Without Information |
| Nahvijou (2016) | 11 screening strategies compared to no screening, varying both age at onset for Conventional cytology (21, 30, 35 years), for DNA-HPV Test (30, 35 years) and the interval between tests for Conventional cytology (3, 5, 10 years) for DNA-HPV Test (5, 10 years) | Life Years Saved, Quality Adjusted Life Years (QALY) | Direct medical costs | International Dollar Int$ (2013) | ICER $8,875/QALY compared to no tracking | Int$ 23,281.74 | USD 6,631 GDP per capita | Univariate Deterministics | Performance and Costs of Tracking Tests |
| Tantitamit (2015) | Women Population with ASCUS results: Repeat conventional cytology/ Screening with DNA-HPV test/ Immediate colposcopy | Number of CIN 2+ cases detected | Direct medical costs | Thai Baht ₿ (2013) | Health system: ICER = 56,048 THB/ additional case of CIN 2+ detected | Health system: Int$ 4.62 | USD 6,168.30 GDP per capita | Univariate Deterministics | Tracking Strategies Costs |
| Patient: ICER = 62,712 THB/ additional case of CIN 2+ detected | Patient: Int$ 5.17 | ||||||||
| Termrungruanglert (2017) | DNA-HPV test with 16/18 genotyping, with referral for colposcopy if positive or return to routine screening within 5 years/ HR-HPV test w/5 years, colposcopy for women with positive result/ Conventional cytology, followed by colposcopy if the result is ASCUS or worse | Number of detected cases of CIN 2, CIN 3 and cervical cancer per 100,000 women | Direct medical costs | Thai Baht ₿ (2016) | ICER test DNA-HPV with 16/18 genotyping: −360.810 THB (dominated) | DNA-HPV test with 16/18 genotyping: Int$-29.51HR-HPV test: Int$ 3,358.97 | USD 5,904.20 GDP per capita | Univariate Deterministics | Prevalence of HPV infection in strategies 1 and 2, sensitivity of conventional cytology in strategy 3, discount rate and costs of all screening tools |
| HR-HPV test: 41,075.1 THB/ Case detected | Conventional cytology: Int$ -941.39 | ||||||||
| Conventional cytology: −11,511.8 THB (dominated) | |||||||||
| Termrungruanglert (2019) | DNA-HPV test/double staining with 16/18 genotyping/ Conventional cytology | Number of pre-invasive and invasive cervical cancer cases identified quality-adjusted life years (QALY) | Direct medical costs | US Dollar U$ (2018) | ICER = USD1,395/QALY earned | Int$ 3,672.46 | USD5,901 GDP per capita | Univariate Deterministics | Tracking Strategies Costs |
ASCUS, Atypical Squamous Cells of Undetermined Meaning; HSIL, High-grade squamous intraepithelial lesion; HR-HPV, High-risk HPV test; CH-HPV, Hybrid Capture for HPV; YLS, Years of life saved; CER, cost-effectiveness ratio; ICER, Incremental cost-effectiveness ratio; D, Dominant.
a
This is a cost-minimization study.