COST-UTILITY ANALYSIS OF CERVICAL CANCER SCREENING STRATEGIES IN THAILAND...
Author(s)
Jetnipat Jirajitkarun, MD1, Jen Sothornwit, MD2, Luxzup Wattanasukchai, MSc, MD3.
1Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, 2Department of obstetrics and gynecology, Faculty of Medicine, KhonKaen University, Khon Kaen, Thailand, 3Clinical epidemiology unity, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
1Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, 2Department of obstetrics and gynecology, Faculty of Medicine, KhonKaen University, Khon Kaen, Thailand, 3Clinical epidemiology unity, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
OBJECTIVES: Cervical cancer remains a significant public health burden in Thailand, where screening coverage is hindered by accessibility barriers and patient acceptability. Non-invasive methods, such as urine-based human papillomavirus (HPV) testing, may overcome these challenges. This study evaluated the cost-utility of various cervical cancer screening strategies within the Thai healthcare system.
METHODS: A decision tree and Markov model was developed to assess the cost-utility of eight screening strategies (conventional cytology, liquid-based cytology, clinician-collected HPV DNA, combination of Pap smear and HPV DNA, combination of LBC and HPV DNA, self-collected HPV DNA, urine-based HPV and visual inspection with acetic acid testing) for a hypothetical cohort of Thai women aged 25-65 years over a lifetime horizon. Analysis was conducted from a societal perspective. Model parameters were derived from hospital records, market surveys, and published literature. Costs were reported in 2024 Thai Baht (THB) (US$1 = ฿35.29). Uncertainty was evaluated through deterministic, probabilistic, and scenario analyses.
RESULTS: Urine-based testing was the least costly strategy (4,391 THB), while clinician-collected HPV DNA testing yielded the highest health benefits (19.9920 QALYs). The incremental cost-effectiveness ratio (ICER) for clinician-collected HPV DNA testing compared to urine-based testing was 660,614 THB per QALY, significantly exceeding Thailand’s willingness-to-pay threshold of 160,000 THB/QALY. All other strategies were dominated. At the national threshold, urine-based testing demonstrated an 87% probability of being cost-effective. Scenario analysis indicated that initiating screening at age 25 is also cost-effective, with ICERs remaining below the national threshold.
CONCLUSIONS: Urine-based HPV testing is a cost-effective, user-friendly strategy to enhance screening strategy to enhance screening coverage among underserved populations in Thailand. While clinician-collected HPV DNA test remains the most effective modality, its higher costs limit its efficiency relative to the national threshold. Integrating urine-based sampling into national policy could optimize resource allocation and improve public health outcomes in the post-vaccination era.
METHODS: A decision tree and Markov model was developed to assess the cost-utility of eight screening strategies (conventional cytology, liquid-based cytology, clinician-collected HPV DNA, combination of Pap smear and HPV DNA, combination of LBC and HPV DNA, self-collected HPV DNA, urine-based HPV and visual inspection with acetic acid testing) for a hypothetical cohort of Thai women aged 25-65 years over a lifetime horizon. Analysis was conducted from a societal perspective. Model parameters were derived from hospital records, market surveys, and published literature. Costs were reported in 2024 Thai Baht (THB) (US$1 = ฿35.29). Uncertainty was evaluated through deterministic, probabilistic, and scenario analyses.
RESULTS: Urine-based testing was the least costly strategy (4,391 THB), while clinician-collected HPV DNA testing yielded the highest health benefits (19.9920 QALYs). The incremental cost-effectiveness ratio (ICER) for clinician-collected HPV DNA testing compared to urine-based testing was 660,614 THB per QALY, significantly exceeding Thailand’s willingness-to-pay threshold of 160,000 THB/QALY. All other strategies were dominated. At the national threshold, urine-based testing demonstrated an 87% probability of being cost-effective. Scenario analysis indicated that initiating screening at age 25 is also cost-effective, with ICERs remaining below the national threshold.
CONCLUSIONS: Urine-based HPV testing is a cost-effective, user-friendly strategy to enhance screening strategy to enhance screening coverage among underserved populations in Thailand. While clinician-collected HPV DNA test remains the most effective modality, its higher costs limit its efficiency relative to the national threshold. Integrating urine-based sampling into national policy could optimize resource allocation and improve public health outcomes in the post-vaccination era.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EE56
Topic
Economic Evaluation
Disease
SDC: Oncology, SDC: Reproductive & Sexual Health