COST-EFFECTIVENESS ANALYSIS OF A POINT OF CARE HPV DNA TEST FOR CERVICAL CANCER SCREENING IN INDIA
Author(s)
Anuja V. R, BDS, MPH1, Sajith Kumar S, PhD1, Ankita Ahire, BDS, MPH1, Akshita Vikani, MBBS, MPH1, Narthana Venkatesh, BTech, MPH1, Bushra Shaikh, MPH1, Manju Sengar, MBBS,MD,DM1, Gauravi Ashish Mishra, MBBS, MD2, C S Pramesh, MBBS, MS, FRCS1.
1Tata Memorial Hospital, Mumbai, India, 2Centre for Cancer Epidemiology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Navi Mumbai, India.
1Tata Memorial Hospital, Mumbai, India, 2Centre for Cancer Epidemiology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Navi Mumbai, India.
OBJECTIVES: Estimate the cost-effectiveness of Point of Care HPV DNA Test (Truenat HPV HR Plus) compared with visual inspection with acetic acid (VIA) for cervical cancer screening among women aged 30-65 years in India.
METHODS: We conducted a cost-utility analysis using a decision-analytic Markov model from a health system perspective. Model inputs, including transition probabilities, utilities and costs were derived from the literature following the hierarchy of evidence. Lifetime costs and quality-adjusted life years (QALY) for both the intervention and the comparator arms were estimated, and the incremental cost-effectiveness ratio (ICER) was compared with the current willingness to pay threshold of one GDP per capita. Sensitivity, scenario and subgroup analysis were done to evaluate the robustness of the result and outcomes.
RESULTS: The intervention was cost-saving, with lower cost and higher effectiveness at the current screening coverage of 2.3% for India. It had an incremental cost of INR18,77,21,899 and an incremental QALY of 804 per 100,000 population; thus, base-case ICER was dominant. Screening frequency, VIA sensitivity and Truenat sensitivity did not alter the base case result in scenario analysis; however, when coverage exceeded 40%, the Truenat remained less costly but with fewer QALYs than VIA, and associated cost savings no longer offset the loss in QALYs.
CONCLUSIONS: The intervention was found to be a dominant strategy at current screening coverage. The findings support the integration of the POC into primary and community-based cervical cancer screening programmes in India. However, careful consideration is required while scaling up coverage beyond 40%, as the associated cost savings may no longer compensate for the reduction in the health benefits compared with VIA. This may be addressed through price negotiation and price reduction (28%) strategies to improve cost-effectiveness at higher coverage levels.
METHODS: We conducted a cost-utility analysis using a decision-analytic Markov model from a health system perspective. Model inputs, including transition probabilities, utilities and costs were derived from the literature following the hierarchy of evidence. Lifetime costs and quality-adjusted life years (QALY) for both the intervention and the comparator arms were estimated, and the incremental cost-effectiveness ratio (ICER) was compared with the current willingness to pay threshold of one GDP per capita. Sensitivity, scenario and subgroup analysis were done to evaluate the robustness of the result and outcomes.
RESULTS: The intervention was cost-saving, with lower cost and higher effectiveness at the current screening coverage of 2.3% for India. It had an incremental cost of INR18,77,21,899 and an incremental QALY of 804 per 100,000 population; thus, base-case ICER was dominant. Screening frequency, VIA sensitivity and Truenat sensitivity did not alter the base case result in scenario analysis; however, when coverage exceeded 40%, the Truenat remained less costly but with fewer QALYs than VIA, and associated cost savings no longer offset the loss in QALYs.
CONCLUSIONS: The intervention was found to be a dominant strategy at current screening coverage. The findings support the integration of the POC into primary and community-based cervical cancer screening programmes in India. However, careful consideration is required while scaling up coverage beyond 40%, as the associated cost savings may no longer compensate for the reduction in the health benefits compared with VIA. This may be addressed through price negotiation and price reduction (28%) strategies to improve cost-effectiveness at higher coverage levels.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EE53
Topic
Economic Evaluation
Disease
SDC: Oncology, SDC: Reproductive & Sexual Health