Costing Cervical Cancer Screening and Treatment Pathways: Case Studies in Bangladesh and Uganda

Cervical cancer is a major public health challenge in low- and middle-income countries, where access to effective screening and treatment is limited. However, cost data to inform the implementation of cervical cancer screening are often unavailable. This study estimated the costs of cervical cancer screening and treatment pathway components in Uganda and Bangladesh of both existing visual inspection with acetic acid strategies and the World Health Organization-recommended high-risk human papillomavirus testing approaches.

A mixed-methods costing study was conducted using data collected from multiple healthcare facilities to estimate cost of screening, including screening tests, triage, diagnosis, and the treatment of both precancerous lesions and cervical cancer. Depending on data availability, both micro and gross costing approaches were used from a top-down perspective. Costs are reported in 2022 international dollars (I$).

Screening and treatment costs varied by procedure and country. In both countries, the cost per screening test was higher for high-risk human papillomavirus self-testing (Uganda, I$51.77; Bangladesh, I$66.24) than for visual inspection-with-acetic-acid-based screening (Uganda, to I$20.27; Bangladesh, I$18.41). Ablative treatment for precancerous lesions cost I$29.43 in Uganda and I$37.24 in Bangladesh, whereas cancer treatment costs were substantially higher, with gross estimates exceeding I$700 for chemotherapy and radiotherapy in Uganda.

This study provides context-specific cost estimates for cervical cancer screening and treatment in 2 low- and middle-income countries that can support early-stage planning and policy decisions. The findings highlight the need for local data collection to strengthen future economic evaluations.