A comparison of the cost-effectiveness of HPV (self-sampling and health care provider sampling) versus VIA for cervical cancer screening in India.

Cervical cancer ranks as the fourth most common cancer in women globally and the second most prevalent in India. Preventive measures, such as HPV vaccination and various screening methods, are essential. Despite these strategies, the economic burden of cervical cancer remains significant due to its long-term nature and treatment costs. This study evaluates the cost-effectiveness of three screening approaches-VIA, HPV physician sampling, and HPV self-sampling-for women aged 30-65. A Markov-based cost-utility analysis with a lifetime horizon and one-year cycle length was conducted. Model parameters were sourced from peer-reviewed literature, national cancer registries, and health economic studies. Deterministic and probabilistic sensitivity analyses were performed to ensure the robustness of the results. Health Provider HPV sampling yielded the highest Quality-Adjusted Life Years (QALYs) at 5.97 (three years) and 4.28 (five years), compared to VIA's 4.01 (three years) and 2.9 (five years), and HPV self-sampling's 4.71 (three years) and 3.41 (five years). Over 30 cycles for 100,000 women, healthcare provider sampling achieved a maximum QALY gain of 13.40. Compared to other methods, it offered a gain of 2.94 QALYs at an incremental cost of 19,409 INR. While VIA screening is cost-saving, it provides reduced health benefits. HPV healthcare provider sampling is more cost-effective in terms of QALYs gained despite higher screening costs. A policy analysis is necessary to achieve 70 % cervical cancer screening coverage in India, focusing on current HPV screening strategies and identifying areas for improvement.