OBJECTIVES

: The aim of the study is to evaluate cost-effectiveness of scaling up services for routine cervical cancer screening with smear test and HPV vaccine initiation for girls aged 12 from Social security and Ministry of Health perspective.

METHODS

: This is a model based cost-effectiveness study. We generated a state-transition markov model with the help of literature which defines the natural course of the HPV infection. The model starts from the age of 12 and runs till 85 years of age in a women cohort . Model involves different health states such as; healthy, HPV infection, CIN 1,CIN 2, CIN 3, Cancer states 1 to 4) and the annual transition probabilities between cycles were obtained from literature. We evaluated 3 scenarios: 1.scaling up routine screening programme, 2.HPV vaccination 3. Both scaling up the routine screening programme and initiating HPV vaccination. Costs are presented as Turkish Lira(TL) and effectiveness as quality adjusted life years (QALY). We run the model 1000 times for probabilistic analyses. Data was analysed using Treeage 2009 programme.

RESULTS

: Compared to the assumption that existing screening rates will continue, the incremental cost-effectiveness ratio is calculated as 1072 TL / QALY for doubling the cervical smear screening rates, which was the most cost effective option. The addition of HPV vaccine to the existing screening program was dominated to other interventions The doubling of existing screening rates + 2-dose HPV vaccination strategy had an incremental cost-effectiveness ratio of 26014 TL / QALY, which was cost-effective.

CONCLUSIONS

: Increasing screening rates of cervical smear by two-folds and increasing screening rates+ 2 doses of HPV vaccination strategies were cost-effective. It is anticipated that the scaling-up the screening program in combination with initiating HPV vaccination programme will have a positive impact in terms of cost-effectivenes in Turkey.