Cost-Effectiveness of Human Papillomavirus (HPV) Testing for Cervical Cancer Screening: A Systematic Literature Review

Abstract

Background: Cervical cancer remains an important cause of morbidity and mortality, particularly in low- and middle-income countries (LMICs). HPV-based screening is recommended because of its higher sensitivity than conventional screening; however, evidence on the economic value of HPV screening strategies remains heterogeneous. This systematic review synthesized evidence on the clinical and economic effectiveness of HPV-based cervical cancer screening strategies.

Methods: A systematic review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD420261442108). PubMed, Scopus, SpringerLink, RIS HTA, and NICE were searched for studies published from 2015 to 2026. Twenty-two studies met the eligibility criteria. Findings were synthesized narratively because heterogeneity in economic models, costing methods, outcome measures, and willingness-to-pay thresholds precluded meta-analysis.

Results: Twenty-one studies (95.5%) concluded that HPV-based screening was cost-effective, highly cost-effective, cost-saving, or dominant compared with conventional approaches, while one study (4.5%) reported that it was not cost-effective in its specific context. Primary HPV testing, HPV self-sampling, and strategies incorporating genotyping or risk-based triage improved detection of cervical intraepithelial neoplasia and reduced cervical cancer incidence and mortality. ICERs varied considerably across countries and strategies, from cost-saving to values below willingness-to-pay thresholds. HPV self-sampling was economically favorable in settings with low screening coverage, whereas primary HPV testing with genotyping or risk-based triage was more efficient in health systems with established infrastructure.

Conclusion: HPV-based screening provides clinical and economic value compared with conventional approaches. Implementation should be tailored to local health system capacity, healthcare costs, screening coverage, and population characteristics to maximize health benefits and efficiency.