OBJECTIVES: There is a global call for action for Cervical Cancer elimination as a public health problem – WHO Strategy 90-70-90. One of the strategic pillars, alongside with vaccination, is cervical cancer screening. The aim of the current study is to assess the economic consequences and cost-effectiveness of HPV screening in Bulgaria.

METHODS: Combined cost-effectiveness (CEA) and cost-benefit (CBA) analysis was performed to evaluate the net benefit of HPV screening program among women aged 35-45 in Bulgaria and to compare its cost-effectiveness with the current practice of PAP testing. ICER was presented separately for only direct costs and for direct + indirect costs.

RESULTS: The results show that with the current practice of PAP testing almost 40% of the women remain under diagnosed. The CBA analysis shows that the benefit/cost ratio of HPV screening is 2.51 and the net present benefit accounts for 7746853 euro thus making the program beneficial for the healthcare system. CEA shows that HPV screening is dominant over the current practice of PAP testing with ICER -461 euro/LYG when considering only direct costs and-31421 euro/LYG for both direct and indirect costs. The LYG earned with the HPV testing account for 1461 for the observed cohort of women.

CONCLUSIONS: Primary hrHPV screening is an important scientific and clinical advance in cervical cancer screening since it offers better reassurance of low cancer risk compared to cytology-only screening conducted at the same interval. Primary hrHPV screening can be considered as dominant alternative to current cytology-based cervical cancer screening approaches including cytology alone and contesting and providing better benefit for the healthcare system and the society in Bulgaria.