A patient costing analysis of Lesotho's cervical cancer screening program
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Thatohatsi Sefuthi1, Cari Van Schalkwyk2, Lungiswa Nkonki1,3
1Division of Health Systems and Public Health, Global Health Department, Stellenbosch University, Stellenbosch, South Africa.
Background:
Cervical cancer is a leading cause of cancer-related mortality worldwide and disproportionately affects low- and middle-income countries. While cervical cancer elimination strategies increasingly emphasize primary HPV testing and screen-and-treat approaches, limited evidence exists on the costs incurred by patients accessing these services. Patient-incurred costs may pose barriers to accessing screen-and-treat services, particularly in resource-constrained settings such as Lesotho.
Materials And Methods:
This study estimated patient costs for cervical cancer screening and treatment at the Senkatana Cervical Cancer Center of Excellence in Lesotho. A survey was conducted among 100 women accessing cervical cancer screening services between January and November 2025. Data was collected on direct, indirect, and productivity costs incurred by patients and accompanying caregivers. Screening modalities included Visual Inspection with Acetic Acid (VIA), HPV DNA testing, and cytology (Pap smear testing), with eligible patients receiving Loop Electrosurgical Excision Procedure (LEEP) treatment. Costs were converted to international US dollars using 2024 purchasing power parity estimates. A one-way sensitivity analysis was conducted to identify patient cost drivers.
Results:
Among the 100 women interviewed, 46% were screened with Pap smear testing, 44% with HPV DNA testing, 9% with VIA, and 3% received LEEP treatment. The majority (91%) were required to return to the facility to collect results, with a mean turnaround time of 32.4 days. The mean total cost per patient per visit was $21.4 (95% CI: $ 17.42-$ 25.98.). Indirect costs accounted for the largest share at $11.05 (52%), followed by productivity costs at $9.40 (44%). Direct medical costs contributed $0.95 (4%). Extrapolated costs across the screening-to-treatment cascade were $62.3 for Pap-LEEP, $61.7 for HPV-LEEP, and $41.2 for VIA-LEEP, representing approximately 17%, 17%, and 11% of average monthly income, respectively. A one-way sensitivity analysis identified indirect medical costs as the primary cost driver, followed by productivity costs.
Conclusion:
Patient-incurred costs associated with cervical cancer screening and pre-cancer treatment are substantial. Indirect costs and productivity losses represent critical demand-side barriers that are insufficiently captured in provider-focused evaluations. Incorporating patient costs into cervical cancer screening policy, program design, and economic evaluations is essential to ensure that elimination strategies are clinically effective, accessible, and equitable.
