Pricing of HPV tests in Italian tender-based settings

Abstract

Background and aim

Human papillomavirus (HPV) testing has been recommended by the WHO as the first choice method in cervical cancer screening. So far, only a limited number of countries have implemented primary HPV testing, partly because of the assumed high costs of HPV testing. We assessed tender-based prices of HPV testing in Italy, where programmatic HPV-based screening has been implemented at the regional level.

Materials and methods

Procurement notices and awards, published between 2014 and December 2021, were retrieved from the European online platform for public procurement. The unit price per HPV test was calculated as the ratio of the contract award price and contract volume. The association between the unit price and contract volume, calendar year, number of offers, region’s per capita gross domestic product and population density was assessed by linear regression. Fractional polynomials were used to describe the association between the unit price and contract volume.

Results

We retrieved data from 29 procurement procedures. The median unit price per HPV test was €10.75, ranging from €4.30 to €204.80. The unit price was not higher than €5 for 6 out of 11 contract awards with a volume of at least 100,000 tests. After discarding two low-volume contracts with very high contract prices (€182.40 and €204.80), volume explained 86.5% of the variation in unit price. The unit price was not associated with other variables.

Conclusions

The Italian experience showed that the tender-based unit price of an HPV test is very low when procured at high volume, indicating that there is no reason for countries to further delay the implementation of HPV-based screening because of prohibitively high HPV testing costs.

PLAIN LANGUAGE SUMMARY

Health authorities purchase healthcare goods and services in bulk through a procedure called tendering that drives the price down as a result of price competition. A contract is made between the health authority and the supplier for a fixed price (i.e. tender-based price) for a certain amount of goods (i.e. contract volume) and a certain period. HPV testing for cervical cancer screening is subject to tendering and tender-based prices are important to inform about the costs associated with cervical screening. We collected public tender documents for HPV testing in Italian regions and calculated tender-based unit prices per HPV test. We found tender-based unit prices ranging from €4.30 and €204.80, with low prices for contracts with large volumes. In particular, the unit price per HPV test was not higher than €5 for the majority of contracts with a volume of at least 100,000 tests. This shows that the implementation of HPV-based screening does not lead to prohibitively high costs and may even lead to cost savings. Health authorities might collaborate in order to contract large volumes of HPV tests. Transparency around the prices of HPV testing as provided by this study is important to support health authorities when organizing a tender for the purchase of HPV tests.

Keywords:

• HPV
• test
• price
• tender
• procurement
• screening

JEL CLASSIFICATION codes:

• H51
• H5
• H
• I00
• I
• I18
• I1

Transparency

Declaration of funding

This work was supported by the European Union’s Horizon 2020 research and innovation program (RISCC, grant agreement number 847845). The funders had no role in the identification, design, conduct, reporting, and interpretation of the analysis.

Declaration of financial/other relationships

FI and JB had financial support from the European Union’s Horizon 2020 research and innovation program (RISCC, grant agreement number 847845) for the submitted work. No other relationships or activities that could appear to have influenced the submitted work.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

FI and JB conceived and designed the study, FI collected the data, FI and JB conducted the analysis, drafted and revised the manuscript.

Acknowledgements

We would like to thank the people responsible for the procurement procedures who very kindly helped us retrieving information on the contract agreements.

Data availability statement

This study is based on procurement notices and awards publicly available on the European tender platform TED (ted.europa.eu)¹⁹. TED procurement publication numbers can be found on the Supplementary Appendix (Supplementary Table 1).