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Cost-effectiveness of cervical-cancer screening in five developing countries
Sue J Goldie1, Lynne Gaffikin, Jeremy D Goldhaber-Fiebert
1Department of Health Policy and Management, Harvard School of Public Health, Boston, USA. sue_goldie@harvard.edu
The New England Journal of Medicine
|November 18, 2005
Summary
Single-visit cervical cancer screening using visual inspection or HPV DNA testing is cost-effective in developing countries. These strategies significantly reduce cancer risk with fewer visits compared to traditional methods.
Area of Science:
- Public Health
- Oncology
- Health Economics
Background:
- Conventional cervical cancer screening (cytology) is often impractical in developing countries due to multiple visit requirements.
- Resource-poor settings face significant challenges in implementing effective cervical cancer prevention programs.
Purpose of the Study:
- To assess the cost-effectiveness of various cervical cancer screening strategies in developing countries.
- To identify optimal screening approaches balancing effectiveness, cost, and feasibility.
Main Methods:
- Computer-based models were used to evaluate screening strategies in India, Kenya, Peru, South Africa, and Thailand.
- Data on cancer incidence, mortality, and screening/treatment effectiveness were synthesized from primary sources and literature.
- Cost-effectiveness was analyzed based on screening test type, target age/frequency, number of visits, and outcomes like lifetime cancer risk and cost per year of life saved.
Main Results:
- Fewer visits correlated with improved follow-up and treatment, enhancing cost-effectiveness.
- One or two-visit strategies using visual inspection or HPV DNA testing reduced lifetime cancer risk by 25-36% at <$500 per year of life saved.
- Two screenings (ages 35 and 40) further reduced risk by 40%, achieving cost-effectiveness below national per capita GDP.
Conclusions:
- Cervical cancer screening with visual inspection or HPV DNA testing in one or two visits offers a cost-effective alternative.
- These strategies are suitable for resource-poor settings, overcoming limitations of traditional multi-visit cytology programs.
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