Background: Persistent Human Papillomavirus (HPV)-infection can cause cervical cancer through a gradual process of 10-15 years, indicating that cervical cancer is suitable for secondary prevention in terms of screening. Currently, Norwegian health authorities are considering alternative triage strategies in the Norwegian Cervical Cancer Screening Program in attempt to improve the effectiveness of the program. In the absence of a formal consequence analysis, our objectives were to enumerate the number of detected precancerous lesions (so-called CIN2+) and the resource use required of alternative screening strategies. Methods: We developed a probabilistic decision tree simulation model to estimate age-stratified (ages 25-33 and 34-69) outcomes of different screening algorithms. The model uses epidemiologic data from the Cancer Registry of Norway and follows a cohort of women attending primary screening through one screening round (i.e., 3 years), allowing for loss-to-follow-up and spontaneous regression of CIN2+. We compared the current Norwegian strategy entailing primary cytology with co-testing (HPV and cytology) for delayed triage of atypical and low-grade cytology results, with nine alternative strategies involving reflex HPV testing of women with low-grade and/or inadequate cytology results, and various triage strategies according to the co-test result. Primary outcomes were CIN2+ detected, total costs, total number of tests and consultations, and number of colposcopies/biopsies performed. In addition, we calculated the incremental cost-effectiveness ratio (ICER) and harm-benefit ratio (IHBR) for each strategy compared with the next most costly/harmful strategy, defined as the additional cost, and the additional colposcopies required, per additional CIN2+ detected, respectively. Results: Among 100,000 women, the current Norwegian guidelines would detect 1,325 and 473 CIN2+ for ages 25-33 and 34-69, respectively. For the alternative strategies, these outcomes ranged from 1,365 to 1,725 and 462 to 525. For all ages, four strategies gave more value (i.e., CIN2+ detection) for money in terms of ICERs than the current strategy. For ages 25-33, five strategies provided more value for use of colposcopies than the current strategy, while for ages 34-69, the current strategy was among the four strategies that yielded most value for use of colposcopies, in terms of IHBRs. Across the alternative strategies for ages 25-33 and 34-69, respectively, the ICERs ranged from NOK7,729-68,059 and NOK16,544-180,483, while the IHBRs ranged from 3.75-12.22 and 0.67-28.93 colposcopies. Conclusions: There is a potential for improving the current screening algorithm, in terms of both effectiveness and cost-effectiveness, by adding reflex HPV testing in primary screening. A larger number of precancers can be detected with fewer resources. Even more resources may be justified depending on society s willingness to pay costs and accept harms in terms of unnecessary colposcopies. Ultimately, the differential effectiveness of the alternative algorithms in terms of preventing invasive cancer will depend on the extent to which precancerous lesions regress or progress into cancer.