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Table 1 Baseline values for model variablesa

From: Estimating the value of point-of-care HPV testing in three low- and middle-income countries: a modeling study

Variable [Reference] India Nicaragua Uganda
Population coverage of screening program 100% 100% 100%
Loss to follow-up per visitb 10-70% 10-70% 10-70%
Proportion of eligible women receiving immediate cryotherapy following positive careHPV resultb 100% 100% 100%
careHPV (cervical specimen) sensitivity/specificity for CIN2+ [15] 90% / 95% 78% / 89% 89% / 82%
Test sensitivity/specificity for CIN1+, colposcopyc 50% / 96% 95% / 68% 95% / 51%
Eligibility for cryotherapy [22]
 No lesion or CIN1 100% 100% 100%
 CIN2 85% 85% 85%
 CIN3 75% 75% 75%
 Cancer 10% 10% 10%
Effectiveness of cryotherapy [22, 30,31,32] 92% 92% 92%
Effectiveness of cryotherapy/LEEP following colposcopy [22, 31] 96% 96% 96%
Direct medical costs by procedure [14, 15]d
careHPV (cervical specimen)e 9.24 15.61 8.78
 Colposcopyf 9.86 15.25 7.08
 Colposcopy and biopsyf 30.06 39.48 32.90
 Cryotherapy 38.13 33.04 13.49
 LEEP NA 133.64 139.54
 Cytology (follow-up post-treatment)g 15.15 13.71 12.25
Direct non-medical costsd
 Transportation (round-trip, clinic) [22, 33, 34] 0.08 0.69 4.46
 Transportation (round-trip, secondary facility) [22, 33, 34] 15.29 2.75 10.87
 Women’s time (per hour) [35] 1.14 1.41 0.68
Treatment of local cancer (FIGO stages 1a-2a)[22, 33, 34]d,h 1821 3322 888
Treatment of regional/distant cancer (FIGO stages ≥2b)[22, 33, 34]d,h 2652 4268 1176
  1. aCIN: cervical intraepithelial neoplasia; FIGO: International Federation of Gynecology and Obstetrics; LEEP: loop electrosurgical excision procedure. Further details on unit cost assumptions are available in Additional file 1
  2. bLoss to follow-up is defined as the proportion of women who do not return for each subsequent clinical encounter, relative to the previous visit. For the 2-visit screen-and-treat strategy, this applied to the results/cryotherapy visit, as well as subsequent visits for diagnostic confirmation and treatment among women who are ineligible for cryotherapy in a screen-and-treat approach. For the 1-visit screen-and-treat strategy, loss to follow-up only applied to diagnostic confirmation and treatment visits among women who are ineligible for immediate cryotherapy. All women who received a positive careHPV result and presented to the clinic and were deemed eligible were assumed to receive immediate cryotherapy
  3. cTest performance characteristics of colposcopy in the START-UP demonstration projects were derived from the worst diagnosis of the local pathologist relative to the worst diagnosis by a quality control pathologist (gold standard); we applied the treatment threshold of CIN1+, although this was not the treatment threshold in START-UP. To derive test performance of colposcopy, we excluded histological classifications that were inadequate or with a histological classification other than negative, CIN1, CIN2, CIN3, or cancer. Because CIN1 is not a true underlying health state in the model, performance of colposcopy in the model is based on the underlying health states of no lesion, HPV infection, CIN2, or CIN3. For a treatment threshold of CIN1, we weighted sensitivity of colposcopy for women with HPV based on the country-specific prevalence of CIN1 among women with HPV infections in the START-UP studies
  4. dAll costs are in 2011 international dollars (I$). The location of service delivery for each procedure, as well as time spent traveling, waiting for, and receiving care by procedure and country, are presented in Additional file 1. In the START-UP study, procedures were performed at secondary or tertiary facilities, and costs may over- or under-estimate costs at primary health facilities due to differences in volume of procedures and overhead costs
  5. eThis includes the cost of the careHPV test, which was assumed to be I$5
  6. fThe proportion of colposcopies that were accompanied by a biopsy was drawn from START-UP data as follows: 93.1% (India); 95.6% (Uganda); and 99.5% (Nicaragua), in the absence of data from actual practice in low-resource settings
  7. gProtocols for follow-up after treatment varied by country, and are described in Additional file 1
  8. hAll cancer costs presented include the value of women’s time spent pursuing care and transportation to health facilities