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Purpose: To assess the cost-effectiveness of alternative cervical cancer screening programs in five regions of the world where organized cytology screening has thus far not been sustainable. Methods: We calibrated a series of computer-based models that simulate the natural history of cervical cancer to country-specific data from South Africa, Kenya, Thailand, India and Peru. Outcomes include lifetime risk of cancer, years of life saved (YLS), and lifetime costs (international dollars). Strategies differ by initial test - visual inspection with acetic acid (VIA), cervical cytology, and HPV DNA testing (Hybrid Capture II); target age; number of clinic visits; and follow-up protocols. Micro-costing methods were used to assess direct medical, time and programmatic costs. Assumptions were made in collective format with representation from each member of the Alliance for Cervical Cancer Prevention. Results: In all 5 countries, lifetime cancer risk was reduced by 25-35% with a single lifetime screen (followed by cryotherapy for women with positive results) using either 1-visit VIA or 2-visit HPV, targeted between 35 and 40 years. Although cost components differed considerably between countries, a single-lifetime strategy was identified in each that would cost less than $500 per YLS. Results were most sensitive to targeted screening age (which varied with HIV prevalence), strategy-specific loss to follow-up, and the relative programmatic costs (administration, quality control, training) associated with VIA, HPV, and cytology. Conclusions: Using country-specific data in South Africa, Kenya, Thailand, India and Peru, cervical cancer screening strategies were identified that would be effective, feasible, and cost-effective.
See more of Oral Concurrent Session B - Screening in Chronic Disease
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)