Costs and Benefits of Different Strategies to Screen for Cervical Cancer in Less-Developed Countries

Mandelblatt, Jeanne S.; Lawrence, William; Gaffikin, Lynne; Limpahayom, Khunying Kobchitt; Lumbiganon, Pisake; Warakamin, Suwanna; King, Jason; Yi, Bin; Ringers, Patricia; Blumenthal, Paul D.

doi:10.1093/jnci/94.19.1469

Cited by 166 publications

(139 citation statements)

References 86 publications

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“…Mandelblatt et al in Thailand modeled three strategies including; VIA, HPV DNA testing, and Pap smears and concluded that VIA with immediate treatment for women aged 35-55 years was the most cost-effective strategy (Mandelblatt et al, 2002a). Sroczynski et al conducted a study in Germany and reported that HPV DNA testing alone every two years starting at age 30 was the most costeffective strategy.…”

Section: Comparison Of Starting Age Of Screeningmentioning

confidence: 99%

“…Four articles in four high income countries (Goldie et al, 2001;2004;Mandelblatt et al, 2002a;Bistoletti et al, 2008;Burger et al, 2012;de Kok et al, 2012), nine middle income countries from seven articles Andres-Gamboa et al, 2008;Vijayaraghavan et al, 2009;Chow et al, 2010;Levin et al, 2010) and 1 article in low income countries suggested starting age after age 30 (Table 1).…”

Section: Comparison Of Starting Age Of Screeningmentioning

confidence: 99%

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A Systematic Review of Economic Aspects of Cervical Cancer Screening Strategies Worldwide: Discrepancy between Economic Analysis and Policymaking

Nahvijou

Hadji

Ahmad

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: Organized cervical screening has decreased the incidence of cervical cancer. However, screening strategies vary in different countries. Objectives: We performed a systematic review to evaluate the economic aspects of different screening methods. Materials and Methods: We searched databases and then data were abstracted from each study. We evaluated articles based on different types of screening tests as well as screening age and intervals, and using incremental cost effectiveness ratio via calculating quality adjusted life years (QALY), or life years gained (LYG) per cost. We compared the incremental cost-effectiveness ratio (ICER) of each study using GDP per capita. Furthermore, we compared national guidelines with recommendations of costeffectiveness studies in different countries. Results: A total of 21 articles met our criteria, of which 19 studies showed that HPV DNA testing, 13 suggested an age of 30 years or more, and 10 papers concluded that at least a 5-year or longer interval were the most cost-effective strategies. In some countries, the national guidelines did not match the recommendations of the cost-effectiveness studies. Conclusions: HPV testing, starting at age 30 years or older and repeated at 5-year or longer intervals, is the most cost-effective strategy in any setting. Closer collaboration with health economists is required during guideline development.

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Section: Comparison Of Starting Age Of Screeningmentioning

confidence: 99%

Section: Comparison Of Starting Age Of Screeningmentioning

confidence: 99%

A Systematic Review of Economic Aspects of Cervical Cancer Screening Strategies Worldwide: Discrepancy between Economic Analysis and Policymaking

Nahvijou

Hadji

Ahmad

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…Because VIA requires less infrastructure, training, equipment, and specialized personnel than other cervical cancer screening methods, it is well suited to low resource settings. A series of studies has demonstrated its effectiveness (Megevand et al, 1996;Belinson et al, 1999; University of Zimbabwe and Jhpiego, 1999;Mandelblatt et al, 2002;Goldie et al, 2005;Sankaranarayanan et al, 2005Almonte et al, 2007), and over 40 low-income countries have introduced VIA on either a national or pilot-study basis (CCA, 2012).…”

Section: Introductionmentioning

confidence: 99%

Influencing Women's Actions on Cervical Cancer Screening and Treatment in Karawang District, Indonesia

Kim

Ati²,

Kols

et al. 2012

Asian Pacific Journal of Cancer Prevention

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Introduction: The impact of cervical cancer prevention programs depends on persuading women to go for screening and, if needed, treatment. As part of an evaluation of a pilot project in Indonesia, qualitative research was conducted to explore the factors that influence women's decisions regarding screening and treatment and to generate practical recommendations to increase service coverage and reduce loss to follow up. Methods: Research was conducted at 7 of the 17 public health centers in Karawang District that implemented the pilot project. Interviews and focus group discussions were held with 20 women, 20 husbands, 10 doctors, 18 midwives, 3 district health officials, and 16 advocacy team members. Results: Free services and mobile outreach events encouraged women to go for screening, along with promotional efforts by community health workers, advocacy teams, and the mass media. Knowledge and perceptions were the most important barriers to screening: women were not aware of cervical cancer risks, did not know the disease was treatable, and were fatalistic. Factors facilitating treatment were social support from husbands, relatives, and friends and the encouragement and role modeling of health workers. Barriers to prompt treatment included limited access to services and the requirement for husband's consent for cryotherapy. Conclusion: As cervical cancer prevention services are scaled up throughout Indonesia, the findings suggest three strategies to expand screening coverage and ensure prompt treatment: strengthening community mobilization and advocacy activities, modifying the service delivery model to encourage a single visit approach to screening and treatment, and working to gain men's support.

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“…46 By contrast, studies using liquid based cytology and HPV DNA testing have reported costs from 121 USD to 184,000 USD per life year saved or per quality-adjusted life-year (QALY). [11][12][13][14][15][16][17][18][19][20][21][22] Possible reasons for discrepancies include the fact that we did not include screening of young women in our model, the setting with organized screening, the setting with midwives (who have lower salaries than doctors) for taking smears, population-based real-life input data and analysis using a probabilistic state transition model.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5] Several studies have evaluated the economic impact of cervical screening with and without HPV testing, but have reported variable results. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Possible reasons for discrepancies include different modeling methodologies, use of surrogate endpoints and use of input data based on clinical studies that may not have been representative of the population as a whole. However, most modeling studies have consistently found similar reductions of the cumulative lifetime risk of invasive cervical cancer as a result of cytology and HPV DNA screening.…”

mentioning

confidence: 99%

Cost‐effectiveness of primary cytology and HPV DNA cervical screening

Bistoletti

Sennfält

Dillner

2007

Intl Journal of Cancer

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Because cost-effectiveness of different cervical cytology screening strategies with and without human papillomavirus (HPV) DNA testing is unclear, we used a Markov model to estimate life expectancy and health care cost per woman during the remaining lifetime for 4 screening strategies: (i) cervical cytology screening at age 32, 35, 38, 41, 44, 47, 50, 55 and 60, (ii) same strategy with addition of testing for HPV DNA persistence at age 32, (iii) screening with combined cytology and testing for HPV DNA persistence at age 32, 41 and 50, iv) no screening. Input data were derived from population-based screening registries, health-service costs and from a population-based HPV screening trial. Impact of parameter uncertainty was addressed using probabilistic multivariate sensitivity analysis. Cytology screening between 32 and 60 years of age in 3-5 year intervals increased life expectancy and life-time costs were reduced from 533 to 248 US Dollars per woman compared to no screening. Addition of HPV DNA testing, at age 32 increased costs from 248 to 284 US Dollars without benefit on life expectancy. Screening with both cytology and HPV DNA testing, at ages 32, 41 and 50 reduced costs from 248 to 210 US Dollars with slightly increased life expectancy. In conclusion, population-based, organized cervical cytology screening between ages 32 to 60 is highly cost-efficient for cervical cancer prevention. If screening intervals are increased to at least 9 years, combined cytology and HPV DNA screening appeared to be still more effective and less costly. ' 2007 Wiley-Liss, Inc.Key words: Markov model; health economics; cervical cancer; organized screening Human Papillomavirus (HPV) DNA testing has been accepted as an adjunct to cytology for primary cervical screening in women over 30 years of age. 1,2 The combination of HPV testing and cervical cytology is more sensitive in detecting cervical intraepithelial neoplasia (CIN) lesions with risk for progression to invasive cancer than either method alone, with extremely high negative predictive values. [3][4][5] Several studies have evaluated the economic impact of cervical screening with and without HPV testing, but have reported variable results. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Possible reasons for discrepancies include different modeling methodologies, use of surrogate endpoints and use of input data based on clinical studies that may not have been representative of the population as a whole. However, most modeling studies have consistently found similar reductions of the cumulative lifetime risk of invasive cervical cancer as a result of cytology and HPV DNA screening. 6,11,12,19,[23][24][25] State transition models are used in more than 85% of all costeffectiveness analyses and several cervical cancer state transition models have been reported previously. 26,27 The long-term effects and cost of cytology and HPV screening cannot be captured in clinical trials, where all studies have used surrogate endpoints, such as CIN grade 2 or 3 (CIN2-3). ...

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Costs and Benefits of Different Strategies to Screen for Cervical Cancer in Less-Developed Countries

Abstract: Well-organized screening programs can reduce cervical cancer mortality in less-developed countries at low costs. These cost-effectiveness data can enhance decision-making about optimal policies for a given setting.

Cited by 166 publications

References 86 publications

A Systematic Review of Economic Aspects of Cervical Cancer Screening Strategies Worldwide: Discrepancy between Economic Analysis and Policymaking

A Systematic Review of Economic Aspects of Cervical Cancer Screening Strategies Worldwide: Discrepancy between Economic Analysis and Policymaking

Influencing Women's Actions on Cervical Cancer Screening and Treatment in Karawang District, Indonesia

Cost‐effectiveness of primary cytology and HPV DNA cervical screening

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