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Is a point-of-care HPV screening programme cost-effective for Samoa?

The availability of new technology for cervical cancer screening potentially opens up opportunities to initiate a national screening programme for Samoa. However, whether a screening programme is cost-effective and what form it should take are important considerations for Samoa’s health care providers. We used a computer simulation, called a Markov model with data for Samoa to simulate whether a point-of-care cervical cancer screening programme would be cost-effective.

Cervical cancer’s impact on Samoa is significant. The disease is the most common cancer for women aged 15-44, and Samoa’s estimated incidence is the sixth highest out of 26 Asia-Pacific countries. Current technical constraints mean Samoa cannot operate a national cervical cancer screening programme; and, at the time of writing, the population is unvaccinated against the disease-causing agent, the Human Papillomavirus (HPV). Cervical cancer is easily prevented if pre-cancers are detected and treated early.

The Markov model we used is based on the natural history of cervical cancer progression. The model’s predictive capability was tested against Samoan 2012 ICO cervical cancer data. The simulation performed cost-utility analysis for eight screening scenarios and compared them to ‘no screening’. Comparisons were based on cost and health outcomes represented in quality-adjusted life years (QALYs), a measure combining quantity and quality of life, to show the relative effectiveness, including the ‘value for money’, of the eight screening scenarios. Sensitivity analyses were carried out to test the model’s robustness.

The Markov model showed that a point-of-care cervical screening programme would be cost-effective for Samoa. Our finding is based on the assumption that only 50% of eligible woman would participate in the screening programme. Under these conditions, the most effective screening scenario is 5-yearly HPV testing for women 30-59 years, which was predicted to reduce cervical cancer incidence by 41% and contribute an additional 12 QALYs per 1000 women to Samoa. Disease incidence reduces further if a higher percentage of the population participates in the screening programme.

One issue highlighted by our work is the lack of specific information about cervical cancer in Samoa. This information will be needed if useful tools to support Samoa’s health care decision-makers are to be developed further.

A poster describing this work was presented at the International Papilloma Virus Conference, Sydney, 2018. A manuscript giving further detail of the model and our findings is currently under review.

This research was carried out by Vivienne Rijnberg for her Masters of Economics, University of Otago, under the supervision of Prof Paul Hansen, Prof Alec Ekeroma and Dr Jo-Ann Stanton.

Click here to see the published work.