Budget Impact Analysis of the Implementation of Organized Population-Based Cervical Cancer Screening With HPV Self-Sampling in Catalonia: A Comparison of Multiple Scenarios

OBJECTIVES: Catalonia (northeast Spain) is transitioning to an organized population-based cervical cancer screening program, integrating human papillomavirus (HPV) testing as the primary screening method alongside self-sampling. Assessing the budgetary implications is crucial for informed decision-making at this stage of the process. This study aimed to assess the budget impact of different program scenarios on the Catalan health system.

METHODS: An economic model was developed to estimate direct medical costs for a baseline screening scenario and various alternative scenarios. These scenarios differed in terms of target population, invitation and self-sampling methods, diagnostic procedures, and organization of screening offices. We estimated the total annual program cost and per category, as well as the cost-per-invited and per-screened woman. Direct medical and programmatic costs were calculated based on resource usage and unitary costs from ongoing regional pilot implementation studies. Assumptions regarding population representation and screening participation rates were made. Sensitivity analysis were conducted to assess economic impacts.

RESULTS: The annual program cost for the baseline scenario was €13,057,399, ranging from €11,643,232 to €15,145,312, depending on the alternative scenario. Testing accounted for 63.5% of the costs (38.9% for screening, 6.8% for triage, and 17.8% for follow-up and diagnosis), with variations across scenarios. The scenario that achieved the lowest overall cost implied a centralized organization of screening offices. Likewise, incorporating an expanded target population (25-70y) alongside a centralized screening office resulted in the lowest cost-per-invited and per-screened woman (€30.3 and €66.2, respectively), screening an additional 17,275 women compared to the baseline scenario.

CONCLUSIONS: Our study examines the economic impact of various population-based organized screening scenarios through self-sampling in Catalonia. This analysis supports the development of an optimal strategy aiding evidence-based decision-making and resource allocation alongside other economic analyses.