HPV TESTING VERSUS VISUAL INSPECTION WITH ACETIC ACID FOR CERVICAL CANCER SCREENING IN MOROCCO . A COST-UTILITY ANALYSIS BASED ON A MARKOV MODEL
Author(s)
Chakib Boukhalfa chakib, Professeur.
Ecole national de santé publique, Rabat, Morocco.
Ecole national de santé publique, Rabat, Morocco.
OBJECTIVES: To evaluate the cost-utility of HPV-based screening compared with visual inspection with acetic acid (VIA) for cervical cancer screening within the Moroccan healthcare system.
METHODS: A cost-utility analysis was conducted using a Markov model simulating the natural history of HPV infection and its progression to cervical cancer over a 47-year time horizon. The model included multiple health states : healthy, HPV infection, precancerous lesions (CIN1, CIN2, CIN3), invasive cancer, post-treatment, and death. Two screening strategies were compared: VIA and HPV testing. The analysis was performed from a societal perspective, incorporating direct medical costs, direct non-medical costs, and indirect costs related to productivity loss, including screening, diagnosis, treatment, and follow-up. Health outcomes were expressed in quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) was used to compare strategies. Sensitivity analyses were conducted to assess the robustness of the results.
RESULTS: Model simulations indicate that HPV-based screening detects a greater number of precancerous lesions than VIA due to its higher diagnostic sensitivity, although specificity is slightly lower. This improved detection leads to a reduced risk of progression to invasive cancer in the simulated cohort. Despite higher initial screening costs, the HPV strategy generates additional QALYs and reduces the overall burden of cervical cancer. HPV screening generated higher QALYs (24.20 vs 23.90) and lower costs (USD 4,180 vs USD 4,600), resulting in an incremental gain of 0.30 QALYs and cost savings of USD 421 per woman. that HPV screening was a dominant strategy. Sensitivity analyses confirm the robustness of these findings across variations in key model parameters.
CONCLUSIONS: HPV-based screening appears to be a dominant strategy in Morocco, yielding both gains in QALYs and reductions in overall costs. Despite higher upfront investments, the long-term savings, particularly through reductions in invasive cancer incidence and mortality, strongly support its progressive integration into the national screening program.
METHODS: A cost-utility analysis was conducted using a Markov model simulating the natural history of HPV infection and its progression to cervical cancer over a 47-year time horizon. The model included multiple health states : healthy, HPV infection, precancerous lesions (CIN1, CIN2, CIN3), invasive cancer, post-treatment, and death. Two screening strategies were compared: VIA and HPV testing. The analysis was performed from a societal perspective, incorporating direct medical costs, direct non-medical costs, and indirect costs related to productivity loss, including screening, diagnosis, treatment, and follow-up. Health outcomes were expressed in quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) was used to compare strategies. Sensitivity analyses were conducted to assess the robustness of the results.
RESULTS: Model simulations indicate that HPV-based screening detects a greater number of precancerous lesions than VIA due to its higher diagnostic sensitivity, although specificity is slightly lower. This improved detection leads to a reduced risk of progression to invasive cancer in the simulated cohort. Despite higher initial screening costs, the HPV strategy generates additional QALYs and reduces the overall burden of cervical cancer. HPV screening generated higher QALYs (24.20 vs 23.90) and lower costs (USD 4,180 vs USD 4,600), resulting in an incremental gain of 0.30 QALYs and cost savings of USD 421 per woman. that HPV screening was a dominant strategy. Sensitivity analyses confirm the robustness of these findings across variations in key model parameters.
CONCLUSIONS: HPV-based screening appears to be a dominant strategy in Morocco, yielding both gains in QALYs and reductions in overall costs. Despite higher upfront investments, the long-term savings, particularly through reductions in invasive cancer incidence and mortality, strongly support its progressive integration into the national screening program.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE521
Topic
Economic Evaluation, Health Policy & Regulatory, Health Technology Assessment
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Work & Home Productivity - Indirect Costs
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology, Reproductive & Sexual Health