Background: Low- and middle-income countries bear a disproportionate burden of cervical cancer morbidity and mortality. To accelerate secondary prevention efforts aligned with the global Cervical Cancer Elimination Initiative, the SUCCESS project, supported by Unitaid, introduced HPV-testing and thermal ablation (HPV-TA) in Burkina Faso, Côte d’Ivoire, Guatemala, and Philippines from 2019-2023. A key component of the project was to enhance local costing capacity to inform the development of national cervical cancer control plans.

Objectives: To update and refine the WHO-C4P cervical cancer costing model and deploy it in planning and promoting programmatic transition to HPV-testing and thermal ablation. 

Methods: The WHO-C4P model enables five-year projections of incremental capital and recurrent costs and resource utilization in screening and treatment through bottom-up, ingredients-based costing. The existing model was updated to reflect new WHO guidelines for cervical cancer screening and treatment, incorporating algorithms with HPV-TA. Default templates details quantities of equipment and supplies for each procedure, based on accepted Standard Operating Procedures. Prices were obtained from Unicef catalogues and public sources. Nominal wages for relevant providers and facility costs were obtained from WHO sources. In each country, a local consultant worked with the ministry of health to conduct a comprehensive months-long micro-costing study to customize the model, including verifying or replacing default unit quantities and prices, confirming relevant demographic/epidemiological information, confirming numbers/types of facilities, and obtaining target screening rates. A 3-day workshop was then held with key stakeholders in national cancer control planning and management to validate assumptions and costs and to use the C4P model to generate 2-3 scenarios of varying intensities of screening and treatment scale-up, with particular focus on HPV-TA, including specification of laboratory resources, supplies and level.

Results: The Philippine projections for 2025-2029 serves as an exemplar. The cost of HPV-testing (includes processing; in 2024 USD) was $36/procedure compared to VIA at $0.35/procedure. Thermal ablation cost $0.38 and LEEP, $44.82. In a scenario with a modest increase of screening, up to 2.5% by 2029 and where 100% of new screening was through HPV-testing, 410,000 more HPV-screens would be made, accompanied by 29,000 more VIA-screens. The incremental cost would be $15 million for screening and precancer treatment, $950,000 for equipment procurement, and $8.7 million for training and other support activities – totalling $25 million. In a faster rate of scale-up to 20% by 2029, the total cost would be $60 million. This represents a more complex implementation that is necessarily constrained by facility/lab capacity: for the general population, 30% HPV-testing and 70% VIA for 30-49 year-olds and 100% cytology for 50-65 year-olds. For all age-eligible women living with HIV, 100% HPV-testing would be done.

Conclusions: The revised C4P model provided realistic and country-specific costs and resource utilization, legitimized by collaborative data collection and co-development of scenarios aligned with aims of ministries of health. Estimates may be used to support economic evaluation, estimate resource implications of alternative screening strategies, and budgeting or fund-raising when planning for cervical cancer elimination. Costing is a transferable skill to other health system policy-making.