Strategies for More Cost-Effective HrHPV Screening: A Simulation Study of Pooled Testing Based on Real-World Data in Low- and Middle-Income Countries
Author(s)
Fengming Pan, M.M.1, Marcel J. w. Greuter, PhD2, Jaap A.r. Koot, MD, MBA, DrHC3, Heather Cubie, PhD4, Naheed Nazrul, MMed5, Carolyn Nakisige, MMed6, Jogchum Beltman, MD, PhD7, Geertruida H. de Bock, PhD1, Jurjen van der Schans, PhD3.
1Department of Epidemiology, UMCG, University of Groningen, Groningen, Netherlands, 2Department of Radiology, UMCG, University of Groningen, Groningen, Netherlands, 3Unit of Global Health, Department of Health Sciences, UMCG, University of Groningen, Groningen, Netherlands, 4Global Health Academy, University of Edinburgh, Edinburgh, United Kingdom, 5Health Sector, Friendship NGO, Dhaka, Bangladesh, 6Department of Gynaecologic-Oncology, Uganda Cancer Institute, Kampala, Uganda, 7Department of Gynecology, Leiden University Medical Centre, Leiden University, Leiden, Netherlands.
1Department of Epidemiology, UMCG, University of Groningen, Groningen, Netherlands, 2Department of Radiology, UMCG, University of Groningen, Groningen, Netherlands, 3Unit of Global Health, Department of Health Sciences, UMCG, University of Groningen, Groningen, Netherlands, 4Global Health Academy, University of Edinburgh, Edinburgh, United Kingdom, 5Health Sector, Friendship NGO, Dhaka, Bangladesh, 6Department of Gynaecologic-Oncology, Uganda Cancer Institute, Kampala, Uganda, 7Department of Gynecology, Leiden University Medical Centre, Leiden University, Leiden, Netherlands.
OBJECTIVES: The World Health Organization recommends high-risk human papillomavirus (hrHPV) testing as the primary method for cervical cancer screening. Combining samples in a pool can reduce the expense associated with large numbers of commercially available tests. This study simulated the potential real-world test saving of pooled hrHPV testing in two low- and middle-income countries (LMICs).
METHODS: Two- and three-stage hrHPV pooling was simulated in Bangladesh (hrHPV prevalence 2.1%) and Uganda (hrHPV prevalence 22.5%) using real-world laboratory data. Measurements included: number of tests per stage, number of tests overall, and percentage of tests saved. Sensitivity analysis was performed to explore the impact of 1% loss of sensitivity and specificity per additional sample in a pool on the false-negative rate (FNR).
RESULTS: In Bangladesh, the two-stage strategy (eight samples per pool) and three-stage strategy saved 71.2% and 77.7% of tests compared to testing individually, respectively. In Uganda, the two-stage strategy (three samples per pool) saved 15.3% of tests compared to testing individually. Assuming loss of sensitivity and specificity due to pooling, the FNR was higher (0.012-0.134) when the hrHPV prevalence was low in the two-stage strategy.
CONCLUSIONS: Pooled hrHPV testing can reduce the number of tests used and enhance surveillance capacity in resource-limited settings. Notably, a lower prevalence of hrHPV allows for more efficient pooled testing. Despite the potential loss in sensitivity and specificity, the benefits of pooled hrHPV testing could be considerable for LMICs.
METHODS: Two- and three-stage hrHPV pooling was simulated in Bangladesh (hrHPV prevalence 2.1%) and Uganda (hrHPV prevalence 22.5%) using real-world laboratory data. Measurements included: number of tests per stage, number of tests overall, and percentage of tests saved. Sensitivity analysis was performed to explore the impact of 1% loss of sensitivity and specificity per additional sample in a pool on the false-negative rate (FNR).
RESULTS: In Bangladesh, the two-stage strategy (eight samples per pool) and three-stage strategy saved 71.2% and 77.7% of tests compared to testing individually, respectively. In Uganda, the two-stage strategy (three samples per pool) saved 15.3% of tests compared to testing individually. Assuming loss of sensitivity and specificity due to pooling, the FNR was higher (0.012-0.134) when the hrHPV prevalence was low in the two-stage strategy.
CONCLUSIONS: Pooled hrHPV testing can reduce the number of tests used and enhance surveillance capacity in resource-limited settings. Notably, a lower prevalence of hrHPV allows for more efficient pooled testing. Despite the potential loss in sensitivity and specificity, the benefits of pooled hrHPV testing could be considerable for LMICs.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE673
Topic
Economic Evaluation, Epidemiology & Public Health, Methodological & Statistical Research
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Infectious Disease (non-vaccine), No Additional Disease & Conditions/Specialized Treatment Areas, Oncology, Reproductive & Sexual Health