Methods: We calibrated a computer-based model that simulates the natural history of cervical cancer to country-specific data from a high-risk region of China on age-specific prevalence of HPV, precancerous lesions, and age-specific incidence of cancer. Strategies differ by initial test, number of clinic visits required, target age, and screening frequency (1x, 2x, and 3x per lifetime). Screening tests included cervical cytology, HPV testing with Hybrid Capture II (5-7 hours for processing), and the newly developed rapid HPV Test (1-2 hours for processing). Clinical data were from the literature and assumptions about culturally acceptable attributes of strategies (e.g., the need for a diagnostic confirmation test following positive screening test results) were made in collaboration with an expert panel of physicians in China. Direct medical, time and programmatic costs were expressed in 2002 International Dollars (I$). Model outcomes include lifetime risk of cancer, years of life saved (YLS), lifetime costs, and incremental cost-effectiveness ratios ($I per YLS).

Results: In the absence of screening discounted per-woman lifetime costs were $60 and LE was 27.62 years. The most effective strategy was two-visit rapid HPV testing three times per lifetime (at ages 35, 40, 45) which reduced lifetime cancer risk by 51% and cost $880/YLS. The least effective strategy was to screen once in a lifetime with cytology (17% reduction, $380/YLS), next best was to screen using the rapid HPV test once in a lifetime (29% reduction, $420/YLS), and next best was the rapid HPV test twice in a lifetime (43% reduction, $540 per YLS). For all screening frequencies, rapid HPV testing dominated use of Hybrid Capture II. Results were most sensitive to loss to follow-up, number of clinic visits required, sensitivity and cost of the HPV rapid test.

Conclusions: Public health interventions with cost-effectiveness ratios less than the per capita GDP ($4,460 in China) are considered very cost-effective. Using this criterion, cervical cancer screening three times per lifetime, using a rapid HPV test, should be strongly considered.