Quality of life in women with a human papillomavirus-positive screening test, cervical neoplasia, or cervical cancer in Latin America

Purpose

Human papillomavirus (HPV) infection and HPV-associated diseases impact health-related quality of life (HRQOL). We aimed to measure HRQOL in women with HPV-positive test results, cervical intraepithelial neoplasia (CIN), or cervical cancer in Latin America.

Methods

We enrolled women aged 18 to 75 years from Bolivia, Colombia, Honduras, Peru, and Uruguay. We used the EQ-5D-5L instrument to calculate EQ-5D index scores with country-specific sets of health preferences when available. We calculated medians and interquartile ranges (IQR) of EQ-5D index and conducted an exploratory analysis comparing HRQOL loss by diagnosis and country with a gamma regression.

Results

We present results from 1,073 participants. Median age was 43 years (IQR: 34-52). The EQ-5D index scores by diagnosis were as follows: HPV-positive test alone 0.906 (standard deviation [SD]: 0.129), CIN1: 0.891 (SD: 0.136), CIN2: 0.892 (SE: 0.124), CIN3: 0.870 (SD: 0.138), and cervical cancer: 0.737 (SD: 0.268). HRQOL was associated with age, diagnosis, and country; there was a significant decreasing trend in HRQOL with worsening health state. Women with cervical cancer had a 3.19-fold higher HRQOL loss than women with an HPV-positive test alone or CIN1. We also found significant differences in HRQOL loss across countries, after adjustment for diagnosis and sociodemographic factors.

Conclusion

HRQOL decreased with diagnosis severity, with significant differences between countries. To conduct cost-effectiveness modeling on HPV preventive interventions, obtaining accurate HRQOL estimates is essential. This process should consider the diverse local health preferences influenced by sociodemographic and cultural factors, as well as the population’s beliefs and experiences regarding health.

PLAIN ENGLISH SUMMARY

Human papillomavirus (HPV) infection can cause precancerous lesions and cervical cancer, but there is limited information about how these conditions affect women’s quality of life, especially in low- and middle-income countries where the disease burden is highest. This study aimed to measure quality of life among women with HPV-positive test results, precancerous cervical lesions, and cervical cancer in Latin America.

We included 1,073 women aged 18 to 75 years from Bolivia, Colombia, Honduras, Peru, and Uruguay. Participants completed the EQ-5D-5L, an internationally validated questionnaire used to measure health-related quality of life.

We found that quality of life worsened as disease severity progressed. Women with cervical cancer experienced a 3.19-fold greater loss in quality of life compared with women who had an HPV-positive test result or mild precancerous lesions (CIN1). We also found important differences between countries.

These findings provide locally relevant quality-of-life estimates that can be used in future economic evaluations to help identify the most efficient strategies for preventing and treating cervical cancer and precancerous lesions in Latin America.