Cervical cancer screening by co-testing method for Vietnamese women 25 to 55 years old: A Cost – Effectiveness Analysis

Objective: “Cervical cancer screening by co-testing method for Vietnamese women 25 to 55 years old: a cost – effectiveness analysis”, two objectives were set as follows: (1) To conduct literature review on cost-effectiveness analysis of concurrent cervical cytology and HPV testing (co-testing) for screening cervical cancer for women worldwide to find research-based data for modeling analysis. (2) To analyze cost-effectiveness of screening cervical cancer by concurrent HPV testing and cervical cytology (co-testing) compared with cervical cytology alone for women 25 to 55 years old in Vietnam.

Methods: The study applied cost-effectiveness analysis method using Markov modelling to analyze efficiency of the co-testing method in CC screening for Vietnamese women from 25 to 55 years old.

Finding: CC screening by 3 times consecutive co-testing was not cost-effective compared to CC screening by 5 times cytology. In the DSA, the researcher found out that the ICER was the most sensitive of the transition probability from HPV hr(-) state to HPV hr(+) state, the prevalence of HPV hr in general women population and the number of CC screening times. This research proposed an age interval from 25 to 55 years for cervical cancer screening while national guidelines from other countries target women from 21 to 65 or even 79 years in their screening programs. The research did not consider effects from HPV vaccination on the transition probabilities of the Markov model. The 21 transition probabilities that  used in the Markov model, only one assumption about the lower and upper ranges are made.

Conclusions: The 3 times consecutive CC screening by the co-testing method is dominated by 5 times consecutive CC screening by the cytology method. Although the co-testing method proves being cost-effective in the second scenario under the DSA, saving ranges from 16 to 64 USD for 1 QALY gained be a considerable offer for both healthcare decision makers and users. In addition, 3 times consecutive CC screening by co-testing significantly increase referral cases and unnecessary treatment of healthy women.

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