The road to cervical cancer elimination in Malaysia: Evaluation of the impact and cost-effectiveness of HPV screening with self-collection and digital registry support.

Keane, Adam; Ng, Chiu Wan; Simms, Kate T; Nguyen, Diep; Woo, Yin Ling; Saville, Marion; Canfell, Karen

The WHO has launched a global strategy to eliminate cervical cancer through the scale-up of human papillomavirus (HPV) vaccination, cervical screening, and cervical cancer treatment. Malaysia has achieved high coverage HPV vaccination since 2010, but coverage of the existing cytology-based program remains low. Pilot studies found HPV self-sampling was acceptable and effective, with high follow-up rates when a digital registry was used, and recently the Malaysian Government announced plans for a national HPV-based screening program. We therefore evaluated the impact of primary HPV screening with self-collection in Malaysia in the context of Malaysia's existing vaccination program. We used the "Policy1-Cervix" modelling platform to assess health outcomes, cost-effectiveness, resource use and cervical cancer elimination timing (the year when cervical cancer rates reach 4 cases per 100 000 women) of self-collected HPV testing. Based on available data, we assumed a digital registry could increase compliance with follow-up from 50-75% to 90%. We found that the current vaccination program would prevent 27 000-32 200 cervical cancer cases and 11 700-14 000 deaths by 2070. HPV testing with a digital registry was cost-effective (CER = $US6,953-7549 < $US11,373[<1xGDP per-capita]) and could prevent an additional 15 900-17 800 cases and 9700-10 600 deaths by 2070, expediting national elimination by 11-20 years, to 2055-2059. If HPV screening were implemented without a digital registry, there would be 1800-4900 fewer deaths averted by 2070 and the program would be less cost-effective. These results underline the importance of HPV testing as a key elimination pillar in Malaysia. This article is protected by copyright. All rights reserved.