Cost of community-based human papillomavirus self-sampling in Peru: a micro-costing study

Abstract

Background: Cost is an essential component of economic evaluations and a determinant of implementation feasibility of human papillomavirus (HPV) self-sampling programmes. Yet, reliable evidence that can be used in low-income and middle-income countries, where cervical cancer burden is highest, remains scarce. Here, we estimate the total and unit costs associated with the Hope Project, a community-based HPV self-sampling social entrepreneurship programme in the peri-urban area of Lima, Peru. Methods: We conducted a micro-costing analysis from the programme perspective to determine the unit costs of: (1) recruitment and training of community leaders (known as Hope Ladies); and (2) Hope Ladies distributing HPV self-sampling kits (named careHPV) in their communities. A procedural manual was used to identify the programme's activities. A structured questionnaire was administered, and in-depth interviews were conducted with three programme administrators to estimate the resource use for each activity and time associated with intervention delivery. Laboratory materials (disposable and durable) and equipment were also costed. We obtained unit costs for each input previously identified from programme budgets and expenditure reports from Nov 1, 2018, to Dec 30, 2019. Findings: The annual cost per community leader recruited and trained was US$86·21 (2019 USD); cost per HPV self-sampling kit distributed was $39·44. The cost per HPV-positive woman identified was $328·54; and the cost per woman who received the intervention was $49·38. Personnel and laboratory costs represented 47% and 28% of programmatic costs, respectively. During the study period (Nov 1, 2018, to Dec 30, 2019), the programme recruited and trained 62 Hope Ladies, who distributed 4882 HPV self-sampling kits to women in their communities. Of the screened women, 586 (12%) tested positive for HPV. Interpretation: Community-based HPV self-sampling appears to be a feasible way to improve cervical cancer screening coverage. These findings can be used as the basis for economic evaluations, such as a cost-effectiveness analysis, or to model the scaling of the intervention. Funding: Thomas Francis Jr Fellowship.