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Purpose: To estimate direct medical, direct non-medical, and patient time costs for several cervical cancer screening and treatment modalities in India, Kenya, Peru, South Africa, and Thailand, using limited primary data.
Method(s): Direct medical costs for several cervical screening modalities including specimen transport and laboratory services, diagnostic work-up, pre-cancer treatment, and cancer care were estimated based on literature reviews, national health system and civil service data, hospital charge sheets, primary micro-costing studies, World Bank and World Health Organization data, simplified spatial models, and laboratory productivity models. Direct non-medical costs for patient time and transport were estimated, accounting for inadequate rural transport and women’s larger role in informal or unpaid labor, using primary survey data as well as World Bank and International Labour Organization data. A set of standardizing assumptions was developed in consultation with clinical experts and program sites in each country. All cost estimates were standardized to year 2000 international dollars using purchasing power parity conversion factors.
Results: Three screening modalities with different resource requirements for level of provider training, test kits, equipment, laboratory facilities were assessed. Location of service delivery was accounted for by country which led to differences in transport cost and time for patients receiving care as well as transport of laboratory specimens. Our results demonstrate that patient time and transport costs in countries with inadequate infrastructure and rural populations can equal or supersede the direct medical costs of screening. Other factors impacting total costs such as recurrent programmatic costs to maintain quality and efficiency as well as the potentially non-linear implications of population coverage levels were also explored. We produced ranges of plausible cost estimates for each country which when compared to study results and estimates from other sources had a high degree of concordance, providing general face validity.
Conclusions: Our cost estimation methodologies rely primarily on publicly available international dataset inputs and required only a small number of country-specific inputs. These methods, as applied to cervical cancer screening in five different regions of the world, provide one approach for conducting cost-effectiveness analyses when primary data are limited and/or incomplete or programs have not yet been implemented.
See more of Oral Concurrent Session A - Cost Effective Analysis: Methods
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)