PCN17 - Economic Evaluation of the Change from An Opportunistic Cervical Screening Program to an Organized Screening in Catalonia, Spain

Abstract

Cervical cancer (CC) screening in Catalonia is opportunistic with a protocol that recommends a cytology every 3 years for women aged 25-65 years. However, evidence on the use of HPV testing as primary screening indicates that it is at least as effective as cytology, but with a greater protective effect allowing prolonged intervals of 5 years for HPV-negative women. In addition, well-organized screening programs have proven to be more effective and efficient than opportunists. The objective is to assess the cost-effectiveness and health expenditure in Catalonia of the current opportunistic screening and a hypothetical organized screening based on primary HPV testing every 5 years. Using a calibrated mathematical model to simulate the natural history of CC, we performed a cost-effectiveness and budget impact analysis. The model includes all processes and expenses derived from screening, follow-up and treatment of cases, as well as organizational expenses. Outcomes include QALYs, reduction of CC incidence and clinical procedures, total direct medical and non-medical costs (MDC & NMDC), and annual and per woman costs. The analysis was carried out from a societal perspective, with costs indexed at year 2016 and a discount rate of 3%. Sensitivity analysis was performed. An organized HPV screening would cost 13,940 €/QALY compared to non-intervention and current screening would be dominated. At the same coverage, organized HPV screening is always less expensive than the current screening. Assuming 40% coverage in the NHS in Catalonia, current screening would cost 17.8€ million annually (MDC 14.6€ and NMDC 3.2€) and an organized screening with HPV 12.2€ million annually (MDC 10.2€, NMDC 1.7€ and organization 0.3€). The same economic resources currently used in cytology-based opportunistic screening every 3 years with 40% coverage could be more efficiently utilized by covering more women (~70%) through screening with HPV testing every 5 years.