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Table 1 Base case parameters and sensitivity analysis parameters used in modeling cervical cancer in HIV-infected women

From: Cost-effectiveness of cervical cancer screening and preventative cryotherapy at an HIV treatment clinic in Kenya

  Base case   One-way sensitivity analysis CD4 scenario sensitivity analyses Source
CD4 200–500   Min–max CD4 ≤ 200 CD4 > 500
Start age 38   30–46 N/A N/A [7]
Initial prevalence of cancer and pre-cancerous lesions 0.22   0.18–0.27 0.33 0.12 [7]
Initial prevalence
 Among cancer/pre-cancerous lesions
  Low grade lesions 0   N/A N/A N/A [12, 23]
  High grade lesions 0.952   0.762–1 N/A 1
  Local cancer 0.020   0.016–0.024 N/A 0
  Regional cancer 0.024   0.019–0.029 N/A 0
  Distant cancer 0.004   0.003–0.005 N/A 0
 Among normal
  Low grade lesions 0.098   0.078–0.118 0.169 0.025 [23]
  Normal 0.902   0.722–1 0.832 0.975
Loss-to-follow-up probability
 2-visit 0.32   0–0.4 N/A N/A [29, 52]
 3-visit 0.48   0.3–0.6 N/A N/A [29, 52]
Standardized mortality ratio for treated HIV-infected patients compared to HIV negative 1.77   1.42–2.12 2.54 1 [53]
Untreated cancer parameter
 Cancer mortality probability (monthly)
  Local 0.004   0.003–0.005 N/A N/A [24]
  Regional 0.021   0.017–0.025 N/A N/A
  Distant 0.063   0.051–0.076 N/A N/A
 Progression probability (monthly)
  Normal to low grade lesions 0.001   0.000–0.002 N/A 0.000 [23, 24]
  Low grade to high grade lesions 0.003   0.002–0.004 N/A 0.001
  High grade lesions to local invasive cancer 0.002   0.001–0.003 N/A 0.002
  Local to regional invasive cancer 0.003   0.002–0.004 N/A N/A
  Regional to distant invasive cancer 0.003   0.002–0.004 N/A N/A
 Regression probability (monthly)
  Low grade lesions to normal 0.003   0.002–0.004 N/A N/A [24]
  High grade to low grade lesions 0.000   0.000–0.001 N/A N/A
  High grade lesions to normal 0.000   0.000–0.001 N/A N/A
Treated cancer parameters
 Treatment effectiveness (mortality, progression, lesion regression) 0.9   0.7–1 N/A N/A [11]
 Treated cancer cure probability (monthly) 0.15   0.12–0.18 N/A N/A [12]
 Side effect probability (monthly) 0.01   0.00–0.02 N/A N/A [13]
 Probability side effect is Major 0.16   0.13–0.20 N/A N/A
Sensitivity [7]
 Pap 0.74   0.59–0.89 0.76 0.61
 VIA 0.61   0.49–0.73 0.76 0.52
 HPV 0.81   0.65–0.97 0.92 0.83
 VIA + HPV 0.58   0.46–0.70 N/A N/A
 VIA + Pap 0.51   0.41–0.61 N/A N/A
 HPV + Pap 0.63   0.50–0.76 N/A N/A
Specificity [7]
 Pap 0.98   0.78–1 0.93 0.98
 VIA 0.63   0.50–0.76 0.62 0.73
 HPV 0.55   0.44–0.66 0.46 0.62
 VIA + HPV 0.84   0.67–1 N/A N/A
 VIA + Pap 0.99   0.79–1 N/A N/A
 HPV + Pap 0.99   0.79–1 N/A N/A
  1. min minimum, max maximum, Pap Papanicolaou smear, HPV DNA testing for Human Papilloma Virus, VIA visual inspection of the cervix with acetic acid, LEEP loop electrosurgical excision procedure, N/A not applicable
Costs (2014 USD) Societal perspective  Clinic perspective     
Screening [31]
 PAP $39 $24 $31–$47 N/A N/A
 VIA $18 $10 $14–$22 N/A N/A
 HPV (CareHPV) $32 $18 $26–$38 N/A N/A
Treatment
 Cryotherapy $48 $12 $38–$58 N/A N/A
 Colposcopy $160 $109 $128–$192 N/A N/A
 LEEP $86 $20 $69–$103 N/A N/A
Side effects
 Major $974 $847 $779–$1169 N/A N/A
 Minor $203 $178 $162–$244 N/A N/A
Cancer care
 Local $1135 $112 $908–$1362 N/A N/A
 Regional $6447 $149 $5158–$7736 N/A N/A
 Distant $5107 $144 $4086–$6128 N/A N/A
 Palliative care $196 $145 $157–$235 N/A N/A  
  1. min minimum, max maximum, Pap Papanicolaou smear, HPV DNA testing for Human Papilloma Virus, VIA visual inspection of the cervix with acetic acid, LEEP loop electrosurgical excision procedure, N/A not applicable