OBJECTIVES: Previously we have shown that primary HPV screening with dual-stain cytology triage reduced the incidence of cervical cancer 36 % and the mortality by 40 %. Our objective is to determine the cost-effectiveness of dual-stain cytology triage in the 2017 cervical cancer screening program of Belgium.

METHODS: The age group for the cervical cancer screening program is 25-65 years with a 3- years interval. Current practice is liquid based cytology (LBC) with reflex HPV testing for ASCUS. The proposed practice is primary HPV screening with reflex dual-stain cytology. The calculations are based on the honorarium of 2017. The cost calculation is based on screening, diagnostics and treatment.

RESULTS: The cost for a HPV test is 35 €, for dual-stain cytology is 60 € and for LBC is 28,41 €. The transition from the current practice to the proposed practice will lead to an increase in costs the first three years (4.1 M €, 4.7 M € and 4.7 M €) and a decrease in the fourth (14.3 M €) and fifth (14.8 M €) year. Likewise screening in the 6^th, 7^th and 8^th years will have an increase of respectively 2.2 M €, 3.5 M € and 3.5 M €. The 9^th and the 10^th year there is a decrease of 13.5 M € and 14 M €.

CONCLUSIONS: Primary HPV screening program with dual-stain cytology triage can lead to a 5-years screening interval with a budget cost reduction after 5 years of almost 15 M €.