Screening for cervical cancer in India: How much will it cost? A trial based analysis of the cost per case detected

Abstract

The cost and cost effectiveness of screening previously unscreened women by VIA, cytology or HPV testing was investigated within a large cluster randomised trial involving 131,178 women in rural India. All resources involved in implementation, training, management, recruitment, screening and diagnosis were identified and costed. We estimated the total costs and detection rates for each cluster and used these data to calculate an average cluster cost and detection rate for each screening approach. These estimates were combined to estimate a cost per case of cervical intraepithelial neoplasia grade 2/3 or invasive cancer (CIN 2/31) detected. The average total costs per 1,000 women eligible for screening were US$3,917, US$6,609 and US$11,779 with VIA, cytology and HPV respectively. The cost of detecting a case of CIN2/31 using VIA was $522 (95% CI $429-$652). Our results suggest that more CIN2/31 cases would be detected in the same population if cytology were used instead of VIA and each additional case would cost US$1065 (95% CI $713-$2175). Delivering cervical cancer screening is potentially expensive in a low-income country although costs might be lower outside a trial setting. We found screening with VIA to be the least expensive option, but it also detected fewer cases of CIN2/31 than other methods; its long-term cost-effectiveness will depend on the long-term benefits of early detection. Cytology was more effective at detecting cases than VIA but was also more expensive. Our findings indicate that HPV may not be a cost effective screening strategy in India at current consumable prices. ' 2005 Wiley-Liss, Inc.Key words: costs; VIA; cytology; HPV; cervical cancer Each year cervical cancer affects 407,000 women and kills around 210,000 worldwide, the vast majority of whom live in developing countries. 1 In developed countries cytology-based screening programmes have led to significant reductions in cervical cancer incidence. 2 Cytology-based screening programmes in low and middle-income countries have been less successful. 3,4 Given the extremely limited health care resources available in low and middle-income countries, policy makers require estimates of the effectiveness and the costs of alternative prevention programmes. Ideally policy decisions should be based on the longterm effectiveness and cost effectiveness of cervical cancer screening. However, currently there is little data from trials on the long-term effects of alternative cervical cancer screening strategies. In our article, we only report short-term cost effectiveness results for alternative screening strategies and define effectiveness in terms of cases detected.The number of cases detected at screening depends on the quality of the overall screening process, including monitoring, quality control, proactive recruitment and follow-up strategies and not simply on the screening test alone. Consequently information is required not only on the costs of alternative tests but also on the costs of implementing (such as training and infrastructure) and r...

Knowledge, Awareness and Prevention of Cervical Cancer among Women Attending a Tertiary Care Hospital in Puducherry, India

“…This is probably because the primary health care facilities are often over burdened and under resourced [21]. Due to limited resources VIA is being offered to women for screening between 30-69 years of age even though cytology is considered a better screening tool [22]. Also the high incidence of cervical cancer can be reduced with introduction of national HPV vaccination programme but for the high cost of the vaccines which is not feasible in our country without external help [23].…”

Assessing the gain in diagnostic performance when two visual inspection methods are combined for cervical cancer prevention

“…The implicit choice of the ratio of the number of additional FPs one is prepared to accept for each additional TP depends on the added cost of the extra tests and the utilities for treating a person without the disease. Legood et al 19 estimated the percentage of the total cost attributable to each item in screening with the VIA test. On the assumption that screening using VILI alone would cost about the same, the estimated total additional cost (per 1000 women) of testing with combined testing was about international $4100 ($23,702.68-$19,585.00) versus either of the single tests.…”

Costo-efectividad de la detección del virus del papiloma humano en los programas de tamización de cáncer de cuello uterino

“…La detección de VPH tiene el potencial de incrementar los beneficios en salud a un costo razonable comparado con las políticas actuales de tamización en esos cuatro países europeos. Legood (18), 2005 India El costo promedio por cada 1.000 mujeres elegibles para tamizar fue de US$ 4.611, US$7.780 y US$ 13.866 para la inspección visual, citología y detección de VPH. La detección de VPH puede no ser una estrategia costo-efectiva en India a los precios actuales, dado que es similar a la citología en cuanto a casos detectados pero a un costo mucho mayor.…”