Cost-Effectiveness Of Different Cervical Screening Strategies In I. R. Iran: A Middle-Income Country With A Low Incidence Rate Of Cervical Cancer

Azin NAHVIJOU, , Iran
DAROUDI R. 2 , TAHMASEBI M. 1 , AMOUZEGAR HASHEMI F. 1 , REZAEI HEMAMI M. 3 , AKBARI SARI A. 2 , BARATI MARENANI H. 4 , ZENDEHDEL K. 5

1 Cancer Research Center of the Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
3 Institute of Health & Wellbeing Health Economics & Health Technology Assessment University of Glasgow, Scotland, UK
4 Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
5 Cancer Model Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
6

Objective: Invasive cervical cancer (ICC) is the fourth most common cancer among women worldwide. Cervical screening programs have reduced the incidence and mortality rates of ICC. We studied the cost-effectiveness of different cervical screening strategies in the Islamic Republic of Iran, a Muslim country with a low incidence rate of ICC.
Methods: We constructed an 11-state Markov model, in which the parameters included regression and progression probabilities, test characteristics, costs, and utilities; these were extracted from primary data and the literature. Our strategies included Pap smear screening and human papillomavirus (HPV) DNA testing plus Pap smear triaging with different starting ages and screening intervals. Model outcomes included lifetime costs, life years gained, quality-adjusted life years (QALY), and incremental cost-effectiveness ratios (ICERs). One-way sensitivity analysis was performed to examine the stability of the results.
Results: We found that the prevented mortalities for the 11 strategies compared with no screening varied from 26% to 64%. The most cost-effective strategy was HPV screening, starting at age 35 years and repeated every 10 years. The ICER of this strategy was $8,875 per QALY compared with no screening. We found that screening at 5-year intervals was also cost-effective based on GDP per capita in Iran.
Conclusion: We recommend organized cervical screening with HPV DNA testing for women in Iran, beginning at age 35 and repeated every 10 or 5 years. The results of this study could be generalized to other countries with low incidence rates of cervical cancer.
Keywords: Cervical cancer, human papillomavirus, cost-effectiveness, screening, Iran