Impact of New Cervical Cancer Screening Program Using Human Papillomavirus (HPV) Deoxyribonucleic Acid (DNA) Testing on Urban-Rural Disparities in Thailand: A Post-Hoc Distributional Cost-Effectiveness Analysis
Author(s)
Jeong-Yeon Cho, PharmD, PhD1, Chayanis Kositamongkol, MSc, PharmD2, Pochamana Phisalprapa, MSc, PhD, MD2, Chia Jie Tan, RPh, PhD1, Nathorn Chaiyakunapruk, PharmD, PhD1;
1University of Utah College of Pharmacy, Department of Pharmacotherapy, Salt Lake City, UT, USA, 2Mahidol University, Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
1University of Utah College of Pharmacy, Department of Pharmacotherapy, Salt Lake City, UT, USA, 2Mahidol University, Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
OBJECTIVES: Thailand recently introduced human papillomavirus (HPV) deoxyribonucleic acid (DNA) testing in 2020 and its self-sampling in 2022 as part of cervical cancer screening program, which previously consisted of Pap smear or visual inspections. This study projected the impact of this policy change on health disparities between urban and rural areas.
METHODS: We conducted a distributional cost-effectiveness analysis of cervical cancer screening program. A previously published decision model of cervical cancer screening program was adapted to simulate population-level costs and outcomes, stratified by urban and rural regions, using screening rates, population, and health-adjusted life-expectancy (HALE) from Thai nationwide administrative data and the World Health Organization. Health opportunity costs were assumed equal across the urban and rural areas. Other input parameters were obtained from local studies. We compared equally distributed equivalent (EDE) of HALE for the previous and new programs across a range of Atkinson inequality aversion indices.
RESULTS: Baseline HALE in urban women (73.61) was estimated to be 3.61 years higher than those in rural areas (69.00). Before implementing HPV DNA testing, urban areas showed a lower screening rate (31%) than rural areas (45%). After implementing the new screening program, total screening rates in both urban and rural were increased to 45% and 88%, respectively, which narrowed the HALE gap to 3.59 years, driven by early screening and treatment. The new program was dominant and consistently showed a higher EDE of HALE compared to the previous program at any level of inequality aversion among the Thai population, indicating that the new screening program is always favorable from both equity and efficiency standpoint.
CONCLUSIONS: Our findings show that the new screening program improved health equity as well as efficiency among Thai women across urban and rural areas. Our findings could help policymakers understand the quantitative equity impact of new program supporting their decision making.
METHODS: We conducted a distributional cost-effectiveness analysis of cervical cancer screening program. A previously published decision model of cervical cancer screening program was adapted to simulate population-level costs and outcomes, stratified by urban and rural regions, using screening rates, population, and health-adjusted life-expectancy (HALE) from Thai nationwide administrative data and the World Health Organization. Health opportunity costs were assumed equal across the urban and rural areas. Other input parameters were obtained from local studies. We compared equally distributed equivalent (EDE) of HALE for the previous and new programs across a range of Atkinson inequality aversion indices.
RESULTS: Baseline HALE in urban women (73.61) was estimated to be 3.61 years higher than those in rural areas (69.00). Before implementing HPV DNA testing, urban areas showed a lower screening rate (31%) than rural areas (45%). After implementing the new screening program, total screening rates in both urban and rural were increased to 45% and 88%, respectively, which narrowed the HALE gap to 3.59 years, driven by early screening and treatment. The new program was dominant and consistently showed a higher EDE of HALE compared to the previous program at any level of inequality aversion among the Thai population, indicating that the new screening program is always favorable from both equity and efficiency standpoint.
CONCLUSIONS: Our findings show that the new screening program improved health equity as well as efficiency among Thai women across urban and rural areas. Our findings could help policymakers understand the quantitative equity impact of new program supporting their decision making.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HPR112
Topic
Health Policy & Regulatory
Topic Subcategory
Health Disparities & Equity
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology, SDC: Reproductive & Sexual Health