Cost-utility analysis of primary HPV testing through home-based self-sampling in comparison to visual inspection using acetic acid for cervical cancer screening in East district, Sikkim, India, 2023
Open accessAbstract
Introduction: Primary Human Papilloma Virus (HPV) testing offers higher sensitivity and specificity over Visual Inspection using Acetic acid (VIA) in cervical cancer screening. Self-sampling is a promising strategy to boost participation and reduce disparities. However, concerns about the initial costs hinder HPV testing adoption in low and middle-income countries. This study assesses the cost-utility of home-based HPV self-sampling versus VIA for cervical cancer screening in India. Methods: A cross-sectional study was conducted in East district, Sikkim, India, comparing the costs and utility outcomes of population-based cervical cancer screening through VIA and primary HPV screening through self-sampling. Cost-related data were collected from April 2021 to March 2022 using the bottom-up micro-costing method, while utility measures were collected prospectively using the EuroQoL-5D-5L questionnaire. The utility values were converted into quality-adjusted life days (QALDs) for an 8-day period. The willingness to pay threshold (WTP) was based on per capita GDP for 2022. If the calculated Incremental Cost-Effectiveness Ratio (ICER) value is lower than the WTP threshold, it signifies that the intervention is cost-effective. Results: The study included 95 women in each group of cervical cancer screening with VIA & HPV self-sampling. For eight days, the QALD was found to be 7.977 for the VIA group and 8.0 for the HPV group. The unit cost per woman screened by VIA and HPV self-testing was ₹1,597 (US$ 19.2) and ₹1,271(US$ 15.3), respectively. The ICER was ₹-14,459 (US$ -173.6), which was much below the WTP threshold for eight QALDs, i.e. ₹ 4,193 (US$ 50.4). Conclusion: The findings support HPV self-sampling as a cost-effective alternative to VIA. This informs policymakers and healthcare providers for better resource allocation in cervical cancer screening in Sikkim.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Self-sampling is viable in bypassing socio-cultural barriers and stigma associated with pelvic exams.
“This approach serves as a tool for patient empowerment in the Indian context, bypassing the lack of autonomy often experienced in seeking clinician/nurse-led care.26,27”
From Integrating a “see-and-treat” approach with opportunistic human papilloma virus deoxyribonucleic acid (HPV DNA) based cervical cancer screening in India: a retrospective cross-sectional study (2026) · cites this paper as [27]
The Discussion (page unavailable) says home-based HPV self-sampling overcomes barriers to screening and that women prefer collecting samples at home rather than visiting a facility. It does not identify socio-cultural stigma around pelvic exams or lack of autonomy in seeking clinician-led care as barriers that self-sampling bypasses. (LLM, conf=0.82)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
HPV Screening for Cervical Cancer in Rural India
Sankaranarayanan, R., Nene, B. M., Shastri, S. S., Jayant, K., Muwonge, R., Budukh, A. M., Hingmire, S., Malvi, S. G., Thorat, R., Kothari, A., et al. (2009) · New England Journal of Medicine · doi:10.1056/nejmoa0808516 · Cited by 1,278 · see citing works
Arbyn, M., Verdoodt, F., Snijders, P. J. F., Verhoef, V. M. J., Suonio, E., Dillner, L., Minozzi, S., Bellisario, C., Banzi, R., Zhao, F.-H., et al. (2014) · The Lancet Oncology · doi:10.1016/s1470-2045(13)70570-9 · Cited by 674 · see citing works
Self-sampling for human papillomavirus (HPV) testing: a systematic review and meta-analysis
Yeh, P. T., Kennedy, C. E., Vuyst, H. D., & Narasimhan, M. (2019) · BMJ Global Health · doi:10.1136/bmjgh-2018-001351 · Cited by 328 · see citing works
Arrossi, S., Thouyaret, L., Herrero, R., Campanera, A., Magdaleno, A., Cuberli, M., Barletta, P., Laudi, R., & Orellana, L. (2015) · The Lancet Global Health · doi:10.1016/s2214-109x(14)70354-7 · Cited by 217 · see citing works
Mezei, A. K., Armstrong, H. L., Pedersen, H. N., Campos, N. G., Mitchell, S. M., Sekikubo, M., Byamugisha, J. K., Kim, J. J., Bryan, S., & Ogilvie, G. S. (2017) · International Journal of Cancer · doi:10.1002/ijc.30695 · Cited by 212 · see citing works
Gupta, S., Palmer, C., Bik, E. M., Cárdenas, J. P., Núñez, H., Kraal, L., Bird, S. W., Bowers, J., Smith, A. J., Walton, N. A., et al. (2018) · Frontiers in Public Health · doi:10.3389/fpubh.2018.00077 · Cited by 157 · see citing works
Gravitt, P. E., Paul, P., Katki, H. A., Vendantham, H., Ramakrishna, G., Mrudula, S., Basany, K., Ronnett, B. M., Vijayaraghavan, K., Shah, K. V., et al. (2010) · PLoS ONE · doi:10.1371/journal.pone.0013711 · Cited by 136 · see citing works
Jyani, G., Sharma, A., Prinja, S., Kar, S. S., Trivedi, M., Patro, B. K., Goyal, A., Purba, F. D., Finch, A. P., Rajsekar, K., et al. (2022) · Value in Health · doi:10.1016/j.jval.2021.11.1370 · Cited by 135 · see citing works
Self-citationBhatla, N., Dar, L., Patro, A. R., Kumar, P., Kriplani, A., Gulati, A., Iyer, V. K., Mathur, S. R., Sreenivas, V., Shah, K. V., et al. (2009) · Cancer Epidemiology · doi:10.1016/j.canep.2009.10.013 · Cited by 99 · see citing works
Cost effectiveness of strategies for cervical cancer prevention in India
Chauhan, A. S., Prinja, S., Srinivasan, R., Rai, B., Malliga, J., Jyani, G., Gupta, N., & Ghoshal, S. (2020) · PLOS ONE · doi:10.1371/journal.pone.0238291 · Cited by 75 · cited 3× · see citing works
“In the context of India, a single modeling study has examined the cost-effectiveness of three cervical cancer screening strategies: VIA, Pap smear, and HPV DNA [10].”
BackgroundMethodBerner, A., Connolly, D. J., Pinnell, I., Wolton, A., MacNaughton, A., Challen, C., Nambiar, K. Z., Bayliss, J., Barrett, J., & Richards, C. (2021) · British Journal of General Practice · doi:10.3399/bjgp.2020.0905 · Cited by 71 · see citing works
Legood, R., Gray, A. M., Mahé, C., Wolstenholme, J., Jayant, K., Nene, B. M., Shastri, S. S., Malvi, S. G., Muwonge, R., Budukh, A. M., et al. (2005) · International Journal of Cancer · doi:10.1002/ijc.21220 · Cited by 71 · see citing works
Ložar, T., Nagvekar, R., Rohrer, C. T., Mandishora, R. S. D., Ivanuš, U., & Fitzpatrick, M. B. (2021) · International Journal of Women s Health · doi:10.2147/ijwh.s288376 · Cited by 70 · see citing works
Gennaro, G. D., Licata, F., Trovato, A., & Bianco, A. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.1003461 · Cited by 69 · see citing works
Mezei, A., Pedersen, H., Sy, S., Regan, C., Mitchell‐Foster, S., Byamugisha, J. K., Sekikubo, M., Armstrong, H. L., Rawat, A., Singer, J., et al. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-020484 · Cited by 60 · see citing works
Sawaya, G. F., Sanstead, E. C., Alarid‐Escudero, F., Smith‐McCune, K., Gregorich, S. E., Silverberg, M. J., Leyden, W. A., Huchko, M. J., Kuppermann, M., & Kulasingam, S. (2019) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2019.0299 · Cited by 43 · see citing works
Having a Pap smear, quality of life before and after cervical screening: a questionnaire study
Korfage, I., van Ballegooijen, M., Wauben-Spaetgens, B., Looman, C., Habbema, J., & Essink‐Bot, M. (2012) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2012.03344.x · Cited by 29 · see citing works
Kilfoyle, K. A., Marais, A. C. D., Ngo, M. A., Romocki, L. S., Richman, A. R., Barclay, L. B., Brewer, N. T., Rahangdale, L., & Smith, J. S. (2018) · Journal of Lower Genital Tract Disease · doi:10.1097/lgt.0000000000000430 · Cited by 27 · see citing works
Intimate Partner Violence and Barriers to Cervical Cancer Screening
Levinson, K. L., Jernigan, A. M., Flocke, S. A., Tergas, A. I., Gunderson, C. C., Huh, W. K., Wilkinson‐Ryan, I., Lawson, P. J., Fader, A. N., & Belinson, J. L. (2015) · Journal of Lower Genital Tract Disease · doi:10.1097/lgt.0000000000000153 · Cited by 24 · see citing works
Cancer trends and disparities in India: data needs for providing equitable cancer care
Shastri, S. S. (2018) · The Lancet Oncology · doi:10.1016/s1470-2045(18)30563-1 · Cited by 11 · see citing works
Dhanasekaran, K., Tamang, T., Pradhan, S., Lhamu, R., & Hariprasad, R. (2022) · ecancermedicalscience · doi:10.3332/ecancer.2022.1492 · Cited by 11 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 1
- [4]Mpinga EK and Chastonay P. Patient satisfaction studies and the monitoring of the rightto health: Some thoughts based on a review of the literature. Glob JHealth Sci 2011; 3: 64– 7.
Cited by
Sorted by citations
Human papillomavirus infection and screening strategies
Chen, S.-H., Song, Y., Gan, N., Wang, P., Kang, Y. M., Wang, S., Zu, Y., & Peng, X.-W. (2025) · World Journal of Clinical Oncology · doi:10.5306/wjco.v16.i5.105055 · Cited by 8 · see citing works
Rakhat, A., Marat, А., Sakhipova, G., Sakko, Y., & Aimagambetova, G. N. (2026) · Sci · doi:10.3390/sci8010005 · Cited by 4 · see citing works
Tian, X., Cao, C., Wang, L., Zhang, J., Chen, Y., Tian, R., Zhou, B., Sun, L., Zhang, C., Gan, L., et al. (2026) · BMJ · doi:10.1136/bmj-2025-084831 · Cited by 3 · see citing works
Goh, S. P., Chan, J. E., & Ong, S. C. (2026) · Health Economics Review · doi:10.1186/s13561-026-00752-w · Cited by 1 · see citing works
Rao, S., Chhabra, M., Kudkuli, J., Toraskar, M., Nath, A. G., Prakash, D., Srivastava, S., Imo Singh, W., Chandrasekharan, M., Oswal, K., et al. (2026) · AJOG Global Reports · doi:10.1016/j.xagr.2026.100678
Arekal, S., Seshadri, J. G., & Thejashwini, R. N. (2026) · Indian Journal of Gynecologic Oncology · doi:10.1007/s40944-026-01121-5
Balasubramani, L., Madhivanan, P., Anand, M., Gupta, M., Kumar, P. G., Shankar, A., & Krishnan, S. S. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1906243
- Authors
- Hariprasad, R., Bagepally, B. S., Kumar, S., Pradhan, S., Gurung, D., Tamang, H., Sharma, A., & Bhatnagar, T.
- Affiliations
- National Institute of Epidemiology (IN)
- Government of Sikkim (IN)
- Jhpiego (US)
- Corresponding author
- Bagepally, Bhavani Shankara
- Bhatnagar, Tarun
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2024-08-13
- Volume
- 19
- Issue
- 8
- Pages
- e0300556
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC11321578
- OpenAlex
- W4401542814
- Cited by
- 6
- References
- 21
- Citations by year
- 2026: 5 · 2025: 1
- FWCI
- 1.83
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- medRxiv (acceptedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Keywords
- cervical cancer screening, HPV self-sampling, visual inspection with acetic acid, cost-utility analysis, cost-effectiveness, willingness-to-pay threshold, micro-costing, low- and middle-income countries, Sikkim
- MeSH terms
- Self-Testing, Adult, Uterine Cervical Neoplasms, Cost-Benefit Analysis, Cross-Sectional Studies, Female, Humans, India, Middle Aged, Self Care, Specimen Handling, Acetic Acid, Papillomaviridae, Papillomavirus Infections, Early Detection of Cancer
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
