Economic consequences of the implementation of primary DNA-HPV genotype testing in Bulgaria

Abstract

There is a global call for action for cervical cancer elimination as a public health problem—WHO Strategy 90-70-90. One of the strategic pillars, alongside vaccination, is cervical cancer screening. This aims to assess the economic consequences and cost-effectiveness of primary DNA-HPV testing for cervical cancer screening in Bulgaria. Combined cost-effectiveness (CEA) and cost-benefit (CBA) analysis was performed to evaluate the net benefit of the HPV genotype testing program among women aged 30–54 in Bulgaria and to compare its cost-effectiveness with the current practice. ICER was presented separately for only direct costs and direct + indirect costs. The CBA analysis for the age group 30-54 shows that the benefit/cost ratio of DNA-HPV primary screening is 1.03 and the net present benefit accounts for 373,023 euro thus making the program beneficial for the healthcare system. CEA shows that HPV screening is cost-effective over the current practice of PAP testing with ICER 1634 euro/LYG when considering only direct costs and—8020 euro/LYG for direct and indirect costs. The ICER in terms of the sensitivity rate of the testing methods is 1316 euros. The LYG earned with the HPV testing account for 4989 for the observed women. Primary hrHPVDNA-based screening is an important scientific and clinical advance since it offers better reassurance of low cancer risk compared to cytology-only screening conducted at the same interval. Primary hrHPV screening can be considered as a dominant alternative to current cytology-based cervical cancer screening approaches including cytology alone and contesting and providing better benefit.

Keywords:

• Economic impact
• HPV screening
• benefit
• life years gained

Acknowledgments

The results presented in the manuscript have been reported as a poster abstract at ISPOR Europe 2022, 6–9 November; Available from: https://www.ispor.org/conferences-education/conferences/past-conferences/ispor-europe-2022/program/program/session/euro2022-3564/121563

Author contributions

MD and ZM performed the research. MD and ZM drafted the manuscript and prepared calculations. MP analyzed and interpreted the final data. MP and GP critically reviewed the paper and prepared the final manuscript. All authors have provided valuable contributions to the manuscript, and read, and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The raw data supporting the conclusions of this article is available upon request from the corresponding author.

Additional information

Funding

This study was funded by the European Union-Next Generation EU, through the National Recovery and Resilience Plan of the Republic of Bulgaria, Project No. BG-RRP-2.004-0004-C01.