A Micro-costing Study of Community-Based Primary HPV Self-Sampling and Triage Test for Cervical Cancer Screening in Rural Cambodia.

BACKGROUND

Community-based human papillomavirus (HPV) self-sampling can expand cervical cancer screening coverage in rural settings, but local programmatic cost evidence is limited.

METHODS

We conducted an activity-based micro-costing study from the healthcare system perspective to estimate start-up (January 2022-February 2023) and implementation (March-December 2023) costs of a community-based HPV self-sampling screen-triage approach in Siem Reap Province, Cambodia. Resource use and unit costs were measured using direct observation, semi-structured interviews with program staff, and review of budgets and financial reports. All costs were converted to 2024 US dollars.

RESULTS

Between January 2022 and December 2023, 7524 women were screened; 359 (4.77%) tested HPV-positive and 312 of 359 (86.91%) completed triage during the study period. Total programmatic cost was US$204,507.14, yielding an average cost of US$27.18 per woman screened and US$569.66 per HPV-positive case identified. Laboratory testing was the largest cost component (55.01% of total programmatic cost), followed by the community-based self-sampling activity (31.12%). Estimated incremental unit costs for triage options were US$3.69 for visual inspection of cervix with acetic acid (VIA), US$16.42 for partial HPV genotyping (types 16 and 18), and US$32.92 for colposcopy per woman receiving the respective triage test.

CONCLUSIONS

Community-based HPV self-sampling can be delivered at moderate programmatic cost in rural Cambodia, with overall costs driven primarily by laboratory testing and community-based screening delivery. These findings provide inputs for budgeting and planning scale-up of HPV screening from a healthcare system perspective in Cambodia.