Cost-effectiveness of the screen-and-treat strategies using HPV test linked to thermal ablation for cervical cancer prevention in China: a modeling study

Table 1 Scenarios for all screen-and-treat and currently used strategies in China

Scenarios	Strategies	Screening test	Triage test	Treatment method
1	Self-HPV without triage	Self-HPV test	/	Thermal ablation^a
2	Self-HPV16/18 triage	Self-HPV test	HPV16/18 positive → thermal ablation; Other hrHPV positive → triage by colposcopy	Thermal ablation^a
3	Self-HPV7 types triage^b	Self-HPV test	HPV16/18/31/33/45/52/58 positive → thermal ablation; other hrHPV positive → triage by colposcopy	Thermal ablation^a
4	Physician-HPV without triage	Physician-HPV test	/	Thermal ablation^a
5	Physician-HPV16/18 triage	Physician-HPV test	HPV16/18 positive → thermal ablation; other hrHPV positive → triage by colposcopy	Thermal ablation^a
6	Physician-HPV7 types triage^b	Physician-HPV test	HPV16/18/31/33/45/52/58 positive → thermal ablation; other hrHPV positive → triage for colposcopy	Thermal ablation^a
7 (reference)	Physician-HPV with genotype triage	Physician-HPV test, cytology	HPV16/18 positive→ referred to colposcopy; other hrHPV positive → triage by cytology, women with ASCUS+ referred to colposcopy	LEEP
8 (reference)	Physician-HPV with cytology triage	Physician-HPV test, cytology	hrHPV positive → triage by cytology, women with ASCUS+ referred to colposcopy	LEEP

^aEligibility for thermal ablation is an assessment for women with a positive screening test under colposcopy. Women receive thermal ablation if there is no suspicion of invasive or glandular disease, and meet the following criteria: the transformation zone (TZ) is fully visible, the whole lesion is visible and it does not extend into the endocervix, or the lesion is type 1 TZ, or the lesion is type 2 TZ where the probe tip will achieve complete ablation of the SCI epithelium, i.e., where it can reach the upper limit of the TZ. Sometimes the SCJ can be seen high in the canal but a probe tip would not reach it
^bSeven types of hrHPV referred to HPV16, 18, 31, 33, 45, 52, 58
hrHPV, high risk human papillomavirus; ASCUS+, atypical squamous cells of undetermined significance or above; LEEP, loop electrosurgical excision procedure

ISSN: 1741-7015