Cervical cancer prevention in Morocco: a model-based cost-effectiveness analysis

Figures & data

Figure 1. Estimated impact on cervical cancer incidence for different strategies.

Figure 2. One-way sensitivity analysis for vaccination followed by screening with VIA performed every 3 years.

Table 1. Baseline assumptions and direct medical costs indexed at year 2018.

Variable	Value	Range of values used in the sensitivity analysis
Baseline assumptions
VIA screening coverage	10%	5–70%
Sensititvity of VIA test	69%	30–80%
Sensititvity of colposcopy	95%
Vaccination coverage	70%	30–100%
Vaccine protection against HPV 16/18	90%
Duration of HPV 16/18 protection	Lifelong
Direct medical costs (US$2018)
Screening test (VIA)	36.7	18.35–73.4
Diagnostic
Coloposcopy	36.6
Biopsy	27.1
CIN treatment
Procedure of CIN1	63.7
Procedure of CIN2/3	136.7
Cancer treatment
Stage I & II	1,026.9
Stage III	2,083.9
Stage IV	1,508.5
HPV vaccine cost per dose
Vaccine	10.0	5.0–35.0
Administration	5.0

Table 2. Discounted life expectancy (LE), discounted total lifetime cost per woman, and incremental cost-effectiveness ratio for evaluated strategies.

Strategy	Discounted cost per woman (US$)	Discounted LE	ICER (US$/YLS)
A. VIA screening alone by frequency at 10% coverage
No intervention	3.49569	54.95990
20y-VIA screening (once-in-a-lifetime)	2.48417	54.97585	CS
10y-VIA screening (twice-in-a-lifetime)	3.76766	54.97547	Dominated
5y-VIA screening (four times-in-a-lifetime)	6.97354	54.97526	Dominated
3y-VIA screening (seven times-in-a-lifetime)	11.70498	54.97480	Dominated
B. Vaccination alone at 70% coverage
No intervention	3.49569	54.95990
Vaccination (girls 14 years old)	22.36102	54.97630	1,150
C. VIA screening at 10% coverage and vaccination at 70% coverage
No intervention	3.49569	54.95990
3y-VIA screening (seven times-in-a lifetime)	11.70498	54.97480	551
Vaccination (girls 14 years old)	22.36102	54.97630	Dominated
Vaccination + 3y-VIA screening (seven times-in-a-lifetime)	32.06297	54.98196	2,843
D. VIA screening and vaccination, both at 70% coverage
No intervention	3.49569	54.95990
3y-VIA screening (seven times-in-a-lifetime)	73.61780	54.97157	Dominated
Vaccination (girls 14 years old)	22.36102	54.97630	1,150
Vaccination + 3y-VIA screening (seven times-in-a-lifetime)	95.05145	54.98143	14,170