Average estimated procedure costs for each scenario (USD 2013), cost ranges for sensitivity analysis.

<p>*Range represents 25% lower and higher than base case. These boundaries were used for the sensitivity analysis.</p><p>**The Study Statistics estimates were also explored in the sensitivity analysis.</p><p>Average estimated procedure costs for each scenario (USD 2013), cost ranges for sensitivity analysis.</p

Comparison of screening methods: True cases of CIN2+ detected by cost per case.

<p>NB: The line represents the cost-effectiveness threshold, or frontier. All interventions or combinations of interventions along this line are more cost effective than intervention or combination of interventions left of the line.</p

Incremental cost-effectiveness analysis (Functional Limit scenario).

<p>ICER = Incremental cost-effectiveness ratio, colpo. = colposcopic biopsy</p><p>*For initial screen plus colposcopic biopsy when indicated. Excludes colposcopic biopsy for VIA because not clinically relevant.</p><p>**HPV DNA screening was dominated by Pap 2 in that it offered fewer cases for a higher total cost.</p><p>***Pap 1 was dominated by Pap 2 in that the marginal cost of identifying cases was higher than with Pap 2.</p><p>Incremental cost-effectiveness analysis (Functional Limit scenario).</p

Resources utilized to provide screening services.

<p>PHC nurse = Primary health care nurse</p><p>*Training for the nurses is as follows: Staff nurse, 2 years; Professional nurse, 4 years; PHC nurse, 6 years.</p><p>Resources utilized to provide screening services.</p

Validation study design for detection of CIN in HIV-positive women.

<p>In the validation study, which preceded the study presented here, all women were screened with all methods. After screening and diagnosis all women were followed up using study guidelines and local standards of care.</p

Threshold analysis comparing the costs of HPV DNA testing to actual and hypothetical Pap screening (Functional Limit scenario).

<p>* Note that this method is not currently allowed under existing guidelines, but was presented as a hypothetical alternative in the validation study.</p><p>** For initial screen plus colposcopic biopsy when indicated. Excludes colposcopic biopsy for VIA because not clinically relevant.</p><p>Threshold analysis comparing the costs of HPV DNA testing to actual and hypothetical Pap screening (Functional Limit scenario).</p

Strategies for cost-effectiveness analysis comparing cervical screening methods.

<p>Colpo. = colposcopic biopsy, LSIL = low grade squamous intraepithelial lesions, ASCUS = atypical squamous cells of undetermined significance, ASC-H = atypical squamous cells cannot rule out high grade lesion, HSIL = high grade squamous intraepithelial lesions, SCC = Squamous cell carcinoma</p

Screening outcomes, costs for screening analytic cohort for CIN 2+ (Functional Limit scenario).

<p>CI = Confidence interval, TP = True positive, FP = False positive, FN = False negative, Colpo. = colposcopic biopsy</p><p>*All costs are presented with a range of 25% higher and lower.</p><p>**Considers the colposcopic biopsy costs for true positives plus false positives. Not clinically relevant for VIA.</p><p>***For initial screen plus colposcopic biopsy when indicated. Excludes colposcopic biopsy for VIA because not clinically relevant.</p><p>Screening outcomes, costs for screening analytic cohort for CIN 2+ (Functional Limit scenario).</p

Caseload scenarios: Total procedures possible per day per study nurse or doctor.

<p>*Average number of procedures done in the clinic during the study timeframe (i.e. average per nurse/doctor per day).</p><p>**Calculated using the reported time required per procedure plus time required for daily, weekly and monthly activities directly required by each service. It assumes 8 hours of productive time per work day.</p><p>Caseload scenarios: Total procedures possible per day per study nurse or doctor.</p

Sensitivity of cumulative cervical cancer mortality to model parameters.

<p>A. Sensitivity to the relative effect of HAART in reducing HIV-mortality. B. Sensitivity to the progression rate of precancerous lesions. C. Sensitivity to cervical cancer mortality rate. The values on the x-axis refer to the ratio of each parameter compared to its value in the base model. (NHNS: No HAART No Screening; HNS: HAART but No Screening; HSHI: HAART and one screen at HAART initiation; HS35: HAART and one screen at age 35).</p