Community-based HPV self-collection versus visual inspection with acetic acid in Uganda: a cost-effectiveness analysis of the ASPIRE trial
Background Cervical cancer is the leading cause of cancer death for women in Uganda, despite the potential for prevention through organised screening. Community-based self-collected human papillomavirus (HPV) testing has been proposed to reduce barriers to screening.Objective Our objective was to ev...
Saved in:
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2018-06-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/8/6/e020484.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1823857281958150144 |
|---|---|
| author | Joel Singer Angeli Rawat Heather Armstrong Josaphat Byamugisha Gina S Ogilvie Alex K Mezei Heather N Pedersen Stephen Sy Catherine Regan Sheona M Mitchell-Foster Musa Sekikubo Jane J Kim Nicole G Campos |
| author_facet | Joel Singer Angeli Rawat Heather Armstrong Josaphat Byamugisha Gina S Ogilvie Alex K Mezei Heather N Pedersen Stephen Sy Catherine Regan Sheona M Mitchell-Foster Musa Sekikubo Jane J Kim Nicole G Campos |
| author_sort | Joel Singer |
| collection | DOAJ |
| description | Background Cervical cancer is the leading cause of cancer death for women in Uganda, despite the potential for prevention through organised screening. Community-based self-collected human papillomavirus (HPV) testing has been proposed to reduce barriers to screening.Objective Our objective was to evaluate the cost-effectiveness of the Advances in Screening and Prevention of Reproductive Cancers (ASPIRE) trial, conducted in Kisenyi, Uganda in April 2014 (n=500). The trial compared screening uptake and compliance with follow-up in two arms: (1) community-based (ie, home or workplace) self-collected HPV testing (facilitated by community health workers) with clinic-based visual inspection with acetic acid (VIA) triage of HPV-positive women (‘HPV-VIA’) and (2) clinic-based VIA (‘VIA’). In both arms, VIA was performed at the local health unit by midwives with VIA-positive women receiving immediate treatment with cryotherapy.Design We informed a Monte Carlo simulation model of HPV infection and cervical cancer with screening uptake, compliance and retrospective cost data from the ASPIRE trial; additional cost, test performance and treatment effectiveness data were drawn from observational studies. The model was used to assess the cost-effectiveness of each arm of ASPIRE, as well as an HPV screen-and-treat strategy (‘HPV-ST’) involving community-based self-collected HPV testing followed by treatment for all HPV-positive women at the clinic.Outcome measures The primary outcomes were reductions in cervical cancer risk and incremental cost-effectiveness ratios (ICERs), expressed in dollars per year of life saved (YLS).Results HPV-ST was the most effective and cost-effective screening strategy, reducing the lifetime absolute risk of cervical cancer from 4.2% (range: 3.8%–4.7%) to 3.5% (range: 3.2%–4%), 2.8% (range: 2.4%–3.1%) and 2.4% (range: 2.1%–2.7%) with ICERs of US$130 (US$110–US$150) per YLS, US$240 (US$210–US$280) per YLS, and US$470 (US$410–US$550) per YLS when performed one, three and five times per lifetime, respectively. Findings were robust across sensitivity analyses, unless HPV costs were more than quadrupled.Conclusions Community-based self-collected HPV testing followed by treatment for HPV-positive women has the potential to be an effective and cost-effective screening strategy. |
| format | Article |
| id | doaj-art-610020d5000448ddbdc0326bc62d0a70 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2018-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-610020d5000448ddbdc0326bc62d0a702025-02-11T21:35:10ZengBMJ Publishing GroupBMJ Open2044-60552018-06-018610.1136/bmjopen-2017-020484Community-based HPV self-collection versus visual inspection with acetic acid in Uganda: a cost-effectiveness analysis of the ASPIRE trialJoel Singer0Angeli Rawat1Heather Armstrong2Josaphat Byamugisha3Gina S Ogilvie4Alex K Mezei5Heather N Pedersen6Stephen Sy7Catherine Regan8Sheona M Mitchell-Foster9Musa Sekikubo10Jane J Kim11Nicole G Campos12Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada2 Women’s Health Research Institute, British Columbia Women’s Hospital and Health Centre, Vancouver, British Columbia, Canada4 Psychology, University of Southampton, Southampton, UK5 Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda2 Women’s Health Research Institute, British Columbia Women’s Hospital and Health Centre, Vancouver, British Columbia, Canada1 Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada2 Women’s Health Research Institute, British Columbia Women’s Hospital and Health Centre, Vancouver, British Columbia, Canada3 Department of Health Policy and Management, Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA3 Department of Health Policy and Management, Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA4 Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada7 Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Kampala, UgandaCenter for Health Decision Science, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA3 Department of Health Policy and Management, Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USABackground Cervical cancer is the leading cause of cancer death for women in Uganda, despite the potential for prevention through organised screening. Community-based self-collected human papillomavirus (HPV) testing has been proposed to reduce barriers to screening.Objective Our objective was to evaluate the cost-effectiveness of the Advances in Screening and Prevention of Reproductive Cancers (ASPIRE) trial, conducted in Kisenyi, Uganda in April 2014 (n=500). The trial compared screening uptake and compliance with follow-up in two arms: (1) community-based (ie, home or workplace) self-collected HPV testing (facilitated by community health workers) with clinic-based visual inspection with acetic acid (VIA) triage of HPV-positive women (‘HPV-VIA’) and (2) clinic-based VIA (‘VIA’). In both arms, VIA was performed at the local health unit by midwives with VIA-positive women receiving immediate treatment with cryotherapy.Design We informed a Monte Carlo simulation model of HPV infection and cervical cancer with screening uptake, compliance and retrospective cost data from the ASPIRE trial; additional cost, test performance and treatment effectiveness data were drawn from observational studies. The model was used to assess the cost-effectiveness of each arm of ASPIRE, as well as an HPV screen-and-treat strategy (‘HPV-ST’) involving community-based self-collected HPV testing followed by treatment for all HPV-positive women at the clinic.Outcome measures The primary outcomes were reductions in cervical cancer risk and incremental cost-effectiveness ratios (ICERs), expressed in dollars per year of life saved (YLS).Results HPV-ST was the most effective and cost-effective screening strategy, reducing the lifetime absolute risk of cervical cancer from 4.2% (range: 3.8%–4.7%) to 3.5% (range: 3.2%–4%), 2.8% (range: 2.4%–3.1%) and 2.4% (range: 2.1%–2.7%) with ICERs of US$130 (US$110–US$150) per YLS, US$240 (US$210–US$280) per YLS, and US$470 (US$410–US$550) per YLS when performed one, three and five times per lifetime, respectively. Findings were robust across sensitivity analyses, unless HPV costs were more than quadrupled.Conclusions Community-based self-collected HPV testing followed by treatment for HPV-positive women has the potential to be an effective and cost-effective screening strategy.https://bmjopen.bmj.com/content/8/6/e020484.full |
| spellingShingle | Joel Singer Angeli Rawat Heather Armstrong Josaphat Byamugisha Gina S Ogilvie Alex K Mezei Heather N Pedersen Stephen Sy Catherine Regan Sheona M Mitchell-Foster Musa Sekikubo Jane J Kim Nicole G Campos Community-based HPV self-collection versus visual inspection with acetic acid in Uganda: a cost-effectiveness analysis of the ASPIRE trial BMJ Open |
| title | Community-based HPV self-collection versus visual inspection with acetic acid in Uganda: a cost-effectiveness analysis of the ASPIRE trial |
| title_full | Community-based HPV self-collection versus visual inspection with acetic acid in Uganda: a cost-effectiveness analysis of the ASPIRE trial |
| title_fullStr | Community-based HPV self-collection versus visual inspection with acetic acid in Uganda: a cost-effectiveness analysis of the ASPIRE trial |
| title_full_unstemmed | Community-based HPV self-collection versus visual inspection with acetic acid in Uganda: a cost-effectiveness analysis of the ASPIRE trial |
| title_short | Community-based HPV self-collection versus visual inspection with acetic acid in Uganda: a cost-effectiveness analysis of the ASPIRE trial |
| title_sort | community based hpv self collection versus visual inspection with acetic acid in uganda a cost effectiveness analysis of the aspire trial |
| url | https://bmjopen.bmj.com/content/8/6/e020484.full |
| work_keys_str_mv | AT joelsinger communitybasedhpvselfcollectionversusvisualinspectionwithaceticacidinugandaacosteffectivenessanalysisoftheaspiretrial AT angelirawat communitybasedhpvselfcollectionversusvisualinspectionwithaceticacidinugandaacosteffectivenessanalysisoftheaspiretrial AT heatherarmstrong communitybasedhpvselfcollectionversusvisualinspectionwithaceticacidinugandaacosteffectivenessanalysisoftheaspiretrial AT josaphatbyamugisha communitybasedhpvselfcollectionversusvisualinspectionwithaceticacidinugandaacosteffectivenessanalysisoftheaspiretrial AT ginasogilvie communitybasedhpvselfcollectionversusvisualinspectionwithaceticacidinugandaacosteffectivenessanalysisoftheaspiretrial AT alexkmezei communitybasedhpvselfcollectionversusvisualinspectionwithaceticacidinugandaacosteffectivenessanalysisoftheaspiretrial AT heathernpedersen communitybasedhpvselfcollectionversusvisualinspectionwithaceticacidinugandaacosteffectivenessanalysisoftheaspiretrial AT stephensy communitybasedhpvselfcollectionversusvisualinspectionwithaceticacidinugandaacosteffectivenessanalysisoftheaspiretrial AT catherineregan communitybasedhpvselfcollectionversusvisualinspectionwithaceticacidinugandaacosteffectivenessanalysisoftheaspiretrial AT sheonammitchellfoster communitybasedhpvselfcollectionversusvisualinspectionwithaceticacidinugandaacosteffectivenessanalysisoftheaspiretrial AT musasekikubo communitybasedhpvselfcollectionversusvisualinspectionwithaceticacidinugandaacosteffectivenessanalysisoftheaspiretrial AT janejkim communitybasedhpvselfcollectionversusvisualinspectionwithaceticacidinugandaacosteffectivenessanalysisoftheaspiretrial AT nicolegcampos communitybasedhpvselfcollectionversusvisualinspectionwithaceticacidinugandaacosteffectivenessanalysisoftheaspiretrial |