OBJECTIVES: The aim of this study was to evaluate the strategies for China public cervical cancer screening and make recommendations on selecting the optimal strategy by comparing the screening effectiveness and disease management costs of different strategies.

METHODS: A Markov cohort model was developed to simulate 2 cycles of cervical cancer screening in women aged from 30 to 65 in population of 1,000,000. The costs and effectiveness of different strategies were calculated from the perspective of China’s healthcare system. Five strategies were compared, including cytology only primary screening, cytology primary screening with reflex to CINtec PLUS, HPV primary screening with reflex to cytology, HPV 16/18 genotyping primary screening with reflex to cytology, and HPV 16/18 genotyping primary screening with reflex to CINtec PLUS.

RESULTS: In the cytology primary screening strategy groups, more CIN2+ cases could be detected at less cost per case of CIN2+ detected when using CINtec PLUS as reflex, which will also decrease annual incidence and mortalities of cervical cancers. In the HPV primary screening strategy groups, introducing HPV 16/18 genotyping will help identify more CIN2+ cases at less cost per case of CIN2+ detected, and further reduce the annual incidence and mortalities of cervical cancers. And HPV 16/18 genotyping with reflex to CINtec PLUS screening strategy can find the most CIN2+ cases at the least cost per case of CIN2+ detected and deliver the least annual incidence and mortalities of cervical cancers.

CONCLUSIONS: In general, compared with the cytology primary screening strategy, the HPV primary screening strategy can prolong screening interval, which will cause small decline of total annual cost and meanwhile substantially improve screening effectiveness. HPV 16/18 genotyping with reflex to CINtec PLUS screening strategy is the optimal strategy with the best screening effectiveness if the total budget is affordable.