© 2002 by Oxford University Press
Journal of the National Cancer Institute, Vol. 94, No. 19, 1469-1483,
October 2, 2002
© 2002 Oxford University Press
ARTICLE |
Costs and Benefits of Different Strategies to Screen for Cervical Cancer in Less-Developed Countries
Affiliations of authors: J. S. Mandelblatt, W. F. Lawrence, J. King, B. Yi, Departments of Oncology and Medicine, Georgetown University Medical Center, and the Outcomes Core and Cancer Control Program, Lombardi Cancer Center, Washington, DC; L. Gaffikin, P. Ringers, Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO) Corporation, Baltimore, MD; K. K. Limpahayom, Royal Thai College of Obstetricians and Gynaecologists, Bangkok, Thailand; P. Lumbiganon, Department of Obstetrics and Gynecology, Khon Kaen University, Khon Kaen, Thailand; S. Warakamin, JHPIEGO Corporation and Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore; P. D. Blumenthal, Family Planning and Population Division, Department of Health, Ministry of Public Health, Thailand.
Correspondence to: Jeanne Mandelblatt, M.D., M.P.H., Georgetown University School of Medicine, Lombardi Cancer Center, 2233 Wisconsin Ave., NW, Suite 317, Washington, DC 20007 (e-mail: mandelbj{at}gunet.georgetown.edu).
Background: About 80% of cervical cancers occur in less-developed countries. This disproportionate burden of cervical cancer in such countries is due mainly to the lack of well-organized screening programs. Several cervical cancer screening strategies have been proposed as more cost-effective than cytology screening. We compared the costs and benefits of different strategies and their effectiveness in saving lives in a less-developed country. Methods: We used a population-based simulation model to evaluate the incremental societal costs and benefits in Thailand of seven screening techniques, including visual inspection of the cervix after applying acetic acid (VIA), human papillomavirus (HPV) testing, Pap smear, and combinations of screening tests, and examined the discounted costs per year of life saved (LYS). Results: Compared with no (i.e., not well-organized) screening, all strategies saved lives, at costs ranging from $121 to $6720 per LYS, and reduced mortality, by up to 58%. Comparing each strategy with the next least expensive alternative, VIA performed at 5-year intervals in women of ages 35–55 with immediate treatment if abnormalities are found was the least expensive option and saved the greatest number of lives, with a cost of $517 per LYS. HPV screening resulted in similar costs and benefits, if the test cost is $5 and if 90% of women undergo follow-up after an abnormal screen. Cytology (Pap smear) was a reasonable alternative if sensitivity exceeds 80% and if 90% of women undergo follow-up. Compared with no screening, use of a combination of Pap smear and HPV testing at 5-year intervals in women of ages 20–70 could achieve greater than 90% reduction in cervical cancer mortality at a cost of $1683 per LYS, and VIA could achieve 83% reduction at $524 per LYS. Conclusions: Well-organized screening programs can reduce cervical cancer mortality in less-developed countries at low costs. These cost-effectiveness data can enhance decision-making about optimal policies for a given setting.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  J. H. Wang, V. B. Sheppard, M. D. Schwartz, W. Liang, and J. S. Mandelblatt Disparities in Cervical Cancer Screening between Asian American and Non-Hispanic White Women Cancer Epidemiol. Biomarkers Prev., August 1, 2008; 17(8): 1968 - 1973. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Mangclaviraj, S. J Kerr, S. Chaithongwongwatthana, J. Ananworanich, B. Hirschel, S. Emery, D. A Cooper, P. Chotnopparatpattara, K. Ruxrungtham, and P. Phanuphak Nadir CD4 count and monthly income predict cervical squamous cell abnormalities in HIV-positive women in a resource-limited setting Int J STD AIDS, August 1, 2008; 19(8): 529 - 532. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. A Reyes-Ortiz, L. F Velez, M. E Camacho, K. J Ottenbacher, and K. S Markides Health insurance and cervical cancer screening among older women in Latin American and Caribbean cities Int. J. Epidemiol., August 1, 2008; 37(4): 870 - 878. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. P. Marasinghe and A.A.W. Amarasinghe Controlling cervical cancer Can. Med. Assoc. J., February 27, 2007; 176(5): 658 - 659. [Full Text] [PDF]
|
|
|
|
 |
|
 K. Aklimunnessa, M. Mori, M. M. H. Khan, F. Sakauchi, T. Kubo, Y. Fujino, S. Suzuki, S. Tokudome, A. Tamakoshi, and for the JACC Study Group Effectiveness of Cervical Cancer Screening Over Cervical Cancer Mortality Among Japanese Women Jpn. J. Clin. Oncol., August 1, 2006; 36(8): 511 - 518. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. J. Goldie, L. Gaffikin, J. D. Goldhaber-Fiebert, A. Gordillo-Tobar, C. Levin, C. Mahe, T. C. Wright, and the Alliance for Cervical Cancer Prevention Cost W Cost-Effectiveness of Cervical-Cancer Screening in Five Developing Countries N. Engl. J. Med., November 17, 2005; 353(20): 2158 - 2168. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Denny, L. Kuhn, M. De Souza, A. E. Pollack, W. Dupree, and T. C. Wright Jr Screen-and-Treat Approaches for Cervical Cancer Prevention in Low-Resource Settings: A Randomized Controlled Trial JAMA, November 2, 2005; 294(17): 2173 - 2181. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Boer, S. Plevritis, and L. Clarke Diversity of model approaches for breast cancer screening: a review of model assumptions by The Cancer Intervention and Surveillance Network (CISNET) Breast Cancer Groups Statistical Methods in Medical Research, December 1, 2004; 13(6): 525 - 538. [Abstract] [PDF]
|
|
|
|
 |
|
 T.-C. Yen, L.-C. See, T.-C. Chang, K.-G. Huang, K.-K. Ng, S. G. Tang, Y.-C. Chang, S. Hsueh, C.-S. Tsai, J.-H. Hong, et al. Defining the Priority of Using 18F-FDG PET for Recurrent Cervical Cancer J. Nucl. Med., October 1, 2004; 45(10): 1632 - 1639. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. C. Wright Jr. Chapter 10: Cervical Cancer Screening Using Visualization Techniques J Natl Cancer Inst Monographs, June 1, 2003; 2003(31): 66 - 71. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. J. Goldie Chapter 15: Public Health Policy and Cost-Effectiveness Analysis J Natl Cancer Inst Monographs, June 1, 2003; 2003(31): 102 - 110. [Abstract] [Full Text] [PDF]
|
|