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Abstract

Background: Cervical cancer is a leading cause of mortality among women in low- and middle-income countries (LMICs). Early detection through screening is key to cervical cancer prevention. HPV DNA testing (community-based self-sampling and facility-based provider sampling) has recently been recommended by WHO as the primary screening in LMIC in a “screen, triage and treat” approach. A lack of economic evidence considering the intervention cost and the value of health gain leads to insufficient public funds allocated for healthcare.

Objectives of this systematic review: 1) To summarize and compare the incremental resource use, implementation cost, and incremental cost-effectiveness of adopting different algorithms using HPV DNA primary tests followed by triage tests in LMICs. 2) To summarize and compare the resource use, implementation cost and cost-effectiveness of two sample collection methods (community-based self-sampling and facility-based provider-sampling) of the HPV-based primary screening as part of the screen-triage-treat approach for cervical cancer screening in LMICs. 3) To summarize and compare the resource use, implementation cost, and cost-effectiveness of different “Screen-triage-treat" methods in general population versus high-risk HIV-positive women. 4) To describe the methodological considerations applied in the economic evaluation studies (outcome, measures, analytical viewpoint, time horizon, discount rate, decision models) and assess the quality of economic evidence using standard CHEERS and Drummond checklists

Method: A systematic review will be performed following Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) using literature from multiple databases including PubMed, Embase, Web of Science, CEA registry, NHS Economic Evaluation Database, Health Economic Evaluation Database (HEED), CINAHL, EconLit, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and Cochrane Library as well as grey literature from other sources. Details of search strategies, eligibility criteria and process for study screening, study selection, quality assessment, data extraction and analysis are described in the attachment.