Implications for practice and research

• In the absence of vaccination, primary screening using human papillomavirus (HPV) DNA testing for cervical cancer prevention is potentially cost-effective.

• Costs associated with HPV testing must be kept low, particularly when background prevalence of HPV in the population is high.

• Screening primarily with cytology was preferred when cytology costs were low, despite lower sensitivity and specificity.

• For the same number of quality-adjusted life year's (QALY) gained, fewer lifetime HPV tests were required as a primary screening test (five vs eight for cytology); however, cytology remained the cheaper option.

• There is ‘no one size fits all’ situation and each country should assess several factors when deciding on cervical cancer screening, including laboratory infrastructure and accessibility to effective treatment.

• Establishing country-specific estimates for factors, …