Cost-effectiveness of cervical cancer screening methods in low- and middle-income countries: a systematic review: cervical cancer in LMICs
Cost-effectiveness of cervical cancer screening methods in low- and middle-income countries: a systematic review: cervical cancer in LMICs
The incidence of cervical cancer in low‐ and middle‐income countries (LMICs) is five times higher than that observed in high‐income countries (HICs). This discrepancy is largely attributed to the implementation of cytology‐based screening programmes in HICs. However, due to reduced health system infrastructure requirements, HPV testing (self‐ and provider‐collected) and visual inspection with acetic acid (VIA) have been proposed as alternatives that may be better suited to LMICs. Knowing the relative value of different screening options can inform policy and the development of sustainable prevention programs. We searched MEDLINE and EMBASE for English language publications detailing model‐based cost‐effectiveness analyses of cervical cancer screening methods in LMICs from 2000 to 2016. The main outcome of interest was the incremental cost‐effectiveness ratio (ICER). Quantitative data were extracted to compare commonly evaluated screening methods and a descriptive review was conducted for each included study. Of the initial 152 articles reviewed, 19 met inclusion criteria. Generally, cytology‐based screening was shown to be the least effective and most costly screening method. Whether provider‐collected HPV testing or VIA was the more efficient alternative depended on the cost of the HPV test, loss to follow‐up and VIA test performance. Self‐collected HPV testing was cost‐effective when it yielded population coverage gains over other screening methods. We conclude that HPV testing and VIA are more cost‐effective screening methods than cytology in LMICs. Policy makers should consider HPV testing with self‐collection of samples if it yields gains in population coverage.
437-446
Mezei, Alex K.
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Armstrong, Heather L.
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Pedersen, Heather N.
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Campos, Nicole G.
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Mitchell, Sheona M.
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Sekikubo, Musa
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Byamugisha, Josaphat K.
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Kim, Jane J.
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Bryan, Stirling
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Ogilvie, Gina S.
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1 August 2017
Mezei, Alex K.
7512e5f2-87da-4f92-ae94-09e22db3073f
Armstrong, Heather L.
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Pedersen, Heather N.
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Campos, Nicole G.
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Mitchell, Sheona M.
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Sekikubo, Musa
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Byamugisha, Josaphat K.
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Kim, Jane J.
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Bryan, Stirling
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Ogilvie, Gina S.
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Mezei, Alex K., Armstrong, Heather L., Pedersen, Heather N., Campos, Nicole G., Mitchell, Sheona M., Sekikubo, Musa, Byamugisha, Josaphat K., Kim, Jane J., Bryan, Stirling and Ogilvie, Gina S.
(2017)
Cost-effectiveness of cervical cancer screening methods in low- and middle-income countries: a systematic review: cervical cancer in LMICs.
International Journal of Cancer, 141 (3), .
(doi:10.1002/ijc.30695).
Abstract
The incidence of cervical cancer in low‐ and middle‐income countries (LMICs) is five times higher than that observed in high‐income countries (HICs). This discrepancy is largely attributed to the implementation of cytology‐based screening programmes in HICs. However, due to reduced health system infrastructure requirements, HPV testing (self‐ and provider‐collected) and visual inspection with acetic acid (VIA) have been proposed as alternatives that may be better suited to LMICs. Knowing the relative value of different screening options can inform policy and the development of sustainable prevention programs. We searched MEDLINE and EMBASE for English language publications detailing model‐based cost‐effectiveness analyses of cervical cancer screening methods in LMICs from 2000 to 2016. The main outcome of interest was the incremental cost‐effectiveness ratio (ICER). Quantitative data were extracted to compare commonly evaluated screening methods and a descriptive review was conducted for each included study. Of the initial 152 articles reviewed, 19 met inclusion criteria. Generally, cytology‐based screening was shown to be the least effective and most costly screening method. Whether provider‐collected HPV testing or VIA was the more efficient alternative depended on the cost of the HPV test, loss to follow‐up and VIA test performance. Self‐collected HPV testing was cost‐effective when it yielded population coverage gains over other screening methods. We conclude that HPV testing and VIA are more cost‐effective screening methods than cytology in LMICs. Policy makers should consider HPV testing with self‐collection of samples if it yields gains in population coverage.
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Accepted/In Press date: 8 February 2017
e-pub ahead of print date: 15 March 2017
Published date: 1 August 2017
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Local EPrints ID: 430211
URI: http://eprints.soton.ac.uk/id/eprint/430211
ISSN: 0020-7136
PURE UUID: d56648ad-dc8a-4603-b8c3-a5a160d6a360
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Date deposited: 16 Apr 2019 16:30
Last modified: 16 Mar 2024 04:40
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Contributors
Author:
Alex K. Mezei
Author:
Heather N. Pedersen
Author:
Nicole G. Campos
Author:
Sheona M. Mitchell
Author:
Musa Sekikubo
Author:
Josaphat K. Byamugisha
Author:
Jane J. Kim
Author:
Stirling Bryan
Author:
Gina S. Ogilvie
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