The cost-saving impact of human papillomavirus self-sampling for cervical cancer screening in women workers at the manufacturing sector in Ciudad Juárez, Chihuahua, Mexico

Cervical cancer is the second leading cause of cancer-related death among women in Mexico, accounting for approximately 4,500 deaths annually. The Mexican Social Security Institute (IMSS), which provides mandatory social security and healthcare for formal-sector workers, currently relies on conventional cervical cytology for early detection. To explore alternatives, a workplace-based pilot program introducing human papillomavirus (HPV) self-sampling was implemented. This study compares the effectiveness and feasibility of HPV self-sampling with the existing cytology program, aiming to inform future screening strategies. A prospective analysis of the cost-saving impact was conducted from the IMSS institutional financing perspective, including healthcare program costs and IMSS-financed disability leave and pension payments. A two-module Markov model separately simulated clinical pathways for detection, diagnosis, and treatment under each screening strategy, and the natural progression of HPV infection and cervical intraepithelial neoplasia. Model inputs were derived from the HPV self-sampling pilot and complementary literature. Costs are reported in 2024 USD and both costs and outcomes are discounted at 3% annually. Both programs were evaluated by simulating a cohort of 100,000 women over a 10 year period. The HPV self-sampling strategy was less costly and more effective than cytology. In the modeled cohort, HPV screening prevented 812 cervical cancer cases at a total cost of 39.7 million USD, resulting in a cost of 48,896 USD per cancer case prevented. In contrast, the cytology program prevented 651 cases at a cost of 99.9 million USD, yielding 153,559 USD per case prevented. HPV self-sampling demonstrated a 61% increase in the detection of high-grade cervical lesions and was less costly and more effective than cytology. The reduction in disability leaves and associated social security expenditures further amplifies its economic value for an institution like IMSS. These findings highlight the potential benefits of increasing screening coverage and implementing workplace-based HPV screening.