A Micro-costing Study of Community-Based Primary HPV Self-Sampling and Triage Test for Cervical Cancer Screening in Rural Cambodia.

backgroundCommunity-based human papillomavirus (HPV) self-sampling can expand cervical cancer screening coverage in rural settings, but local programmatic cost evidence is limited.

methodsWe conducted an activity-based micro-costing study from the healthcare system perspective to estimate start-up (January 2022-February 2023) and implementation (March-December 2023) costs of a community-based HPV self-sampling screen-triage approach in Siem Reap Province, Cambodia. Resource use and unit costs were measured using direct observation, semi-structured interviews with program staff, and review of budgets and financial reports. All costs were converted to 2024 US dollars.

resultsBetween January 2022 and December 2023, 7524 women were screened; 359 (4.77%) tested HPV-positive and 312 of 359 (86.91%) completed triage during the study period. Total programmatic cost was US$204,507.14, yielding an average cost of US$27.18 per woman screened and US$569.66 per HPV-positive case identified. Laboratory testing was the largest cost component (55.01% of total programmatic cost), followed by the community-based self-sampling activity (31.12%). Estimated incremental unit costs for triage options were US$3.69 for visual inspection of cervix with acetic acid (VIA), US$16.42 for partial HPV genotyping (types 16 and 18), and US$32.92 for colposcopy per woman receiving the respective triage test.

conclusionsCommunity-based HPV self-sampling can be delivered at moderate programmatic cost in rural Cambodia, with overall costs driven primarily by laboratory testing and community-based screening delivery. These findings provide inputs for budgeting and planning scale-up of HPV screening from a healthcare system perspective in Cambodia.