An economic appraisal of a mobile cervical cytology screening service

Cervical cytology screening is widely accepted as an important strategy in the control of cervical cancer. With increasing competition for health resources the need for information on the cost-effectiveness of different screening programmes has become critical. This paper describes the cost of screening via a mobile clinic, and compares the cost-effectiveness of screening via a mobile clinic with that of screening at established clinics.

Data were obtained from work studies, review of clinic and health authority records and key informant interviews. In addition to describing the actual cost of the project over the first year, a projection is made of the cost of operating the mobile clinic under non-research conditions. Sensitivity analysis is used to adjust for differences in yield and follow-up in comparing the cost-effectiveness in each setting.

The cost of the project over 1 year was R185,795. The projected cost of running such a project under non-research conditions for 1 year is R291,858. The cost-effectiveness of screening at the mobile clinic was 57% less than that of screening at the established clinics. Sensitivity analysis indicated that for any given yield and follow-up rate, the projected cost-effectiveness of screening at the mobile clinic is 15-28% less than for the established clinics.

These findings raise questions about the appropriateness of using mobile clinics in areas where there are established health services.