The cost-effectiveness of human papillomavirus self-collection among cervical cancer screening non-attenders in El Salvador

Nicole G. Campos, Karla Alfaro, Mauricio Maza, Stephen Sy, Mario Melendez, Rachel Masch, Montserrat Soler, Gabriel Conzuelo-Rodriguez, Julia C. Gage, Todd A. Alonzo, Philip E. Castle, Juan C. Felix, Miriam Cremer, Jane J. Kim

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Cervical cancer screening with human papillomavirus (HPV) DNA testing has been incorporated into El Salvador's national guidelines. The feasibility of home-based HPV self-collection among women who do not attend screening at the clinic (i.e., non-attenders) has been demonstrated, but cost-effectiveness has not been evaluated. Using cost and compliance data from El Salvador, we informed a mathematical microsimulation model of HPV infection and cervical carcinogenesis to conduct a cost-effectiveness analysis from the societal perspective. We estimated the reduction in cervical cancer risk, lifetime cost per woman (2017 US$), life expectancy, and incremental cost-effectiveness ratio (ICER, 2017 US$ per year of life saved [YLS]) of a program with home-based self-collection of HPV (facilitated by health promoters) for the 18% of women reluctant to screen at the clinic. The model was calibrated to epidemiologic data from El Salvador. We evaluated health and economic outcomes of the self-collection intervention for women aged 30 to 59 years, alone and in concert with clinic-based HPV provider-collection. Home-based self-collection of HPV was projected to reduce population cervical cancer risk by 14% and cost $1210 per YLS compared to no screening. An integrated program reaching 99% coverage with both provider- and home-based self-collection of HPV reduced cancer risk by 74% (compared to no screening), and cost $1210 per YLS compared to provider-collection alone. Self-collection facilitated by health promoters is a cost-effective strategy for increasing screening uptake in El Salvador.

Original languageEnglish (US)
Article number105931
JournalPreventive Medicine
StatePublished - Feb 2020


  • Cancer screening
  • Cost-effectiveness analysis
  • Decision analysis
  • El Salvador
  • HPV DNA tests
  • HPV self-collection
  • Human papillomavirus (HPV)
  • Mathematical model
  • Uterine cervical neoplasms

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health


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