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Costs and Cost Effectiveness of Three Approaches for Cervical Cancer Screening among HIV-Positive Women in Johannesburg, South Africa

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  • Naomi Lince-Deroche
  • Jane Phiri
  • Pam Michelow
  • Jennifer S Smith
  • Cindy Firnhaber

Abstract

Background: South Africa has high rates of HIV and HPV and high incidence and mortality from cervical cancer. However, cervical cancer is largely preventable when early screening and treatment are available. We estimate the costs and cost-effectiveness of conventional cytology (Pap), visual inspection with acetic acid (VIA) and HPV DNA testing for detecting cases of CIN2+ among HIV-infected women currently taking antiretroviral treatment at a public HIV clinic in Johannesburg, South Africa. Methods: Method effectiveness was derived from a validation study completed at the clinic. Costs were estimated from the provider perspective using micro-costing between June 2013-April 2014. Capital costs were annualized using a discount rate of 3%. Two different service volume scenarios were considered. Threshold analysis was used to explore the potential for reducing the cost of HPV DNA testing. Results: VIA was least costly in both scenarios. In the higher volume scenario, the average cost per procedure was US$ 3.67 for VIA, US$ 8.17 for Pap and US$ 54.34 for HPV DNA. Colposcopic biopsies cost on average US$ 67.71 per procedure. VIA was least sensitive but most cost-effective at US$ 17.05 per true CIN2+ case detected. The cost per case detected for Pap testing was US$ 130.63 using a conventional definition for positive results and US$ 187.52 using a more conservative definition. HPV DNA testing was US$ 320.09 per case detected. Colposcopic biopsy costs largely drove the total and per case costs. A 71% reduction in HPV DNA screening costs would make it competitive with the conservative Pap definition. Conclusions: Women need access to services which meet their needs and address the burden of cervical dysplasia and cancer in this region. Although most cost-effective, VIA may require more frequent screening due to low sensitivity, an important consideration for an HIV-positive population with increased risk for disease progression.

Suggested Citation

  • Naomi Lince-Deroche & Jane Phiri & Pam Michelow & Jennifer S Smith & Cindy Firnhaber, 2015. "Costs and Cost Effectiveness of Three Approaches for Cervical Cancer Screening among HIV-Positive Women in Johannesburg, South Africa," PLOS ONE, Public Library of Science, vol. 10(11), pages 1-16, November.
    • Handle: RePEc:plo:pone00:0141969
    DOI: 10.1371/journal.pone.0141969
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    References listed on IDEAS

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    1. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
    2. Don Husereau & Michael Drummond & Stavros Petrou & Chris Carswell & David Moher & Dan Greenberg & Federico Augustovski & Andrew Briggs & Josephine Mauskopf & Elizabeth Loder, 2013. "Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(3), pages 367-372, June.
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    1. Coshiwe Matildah Makunyane, 2020. "The Perceptions of Professional Nurses Regarding the Performance of Cervical Cancer Screening, in Makhuduthamaga Sub-district, Sekhukhune District, Limpopo Province, South Africa," Global Journal of Health Science, Canadian Center of Science and Education, vol. 12(13), pages 152-152, December.
    2. Angela Devine & Alice Vahanian & Bernard Sawadogo & Souleymane Zan & Fadima Yaya Bocoum & Helen Kelly & Clare Gilham & Nicolas Nagot & Jason J Ong & Rosa Legood & Nicolas Meda & Alec Miners & Philippe, 2021. "Costs and cost-effectiveness of cervical cancer screening strategies in women living with HIV in Burkina Faso: The HPV in Africa Research Partnership (HARP) study," PLOS ONE, Public Library of Science, vol. 16(3), pages 1-16, March.
    3. Angela Devine & Alice Vahanian & Bernard Sawadogo & Souleymane Zan & Fadima Yaya Bocoum & Helen Kelly & Clare Gilham & Nicolas Nagot & Jason Ong & Rosa Legood & Nicolas Meda & Alec Miners & Philippe M, 2021. "Costs and cost-effectiveness of cervical cancer screening strategies in women living with HIV in Burkina Faso: The HPV in Africa Research Partnership (HARP) study," Post-Print hal-03554345, HAL.
    4. Naomi Lince-Deroche & Craig van Rensburg & Jaqueline Roseleur & Busola Sanusi & Jane Phiri & Pam Michelow & Jennifer S Smith & Cindy Firnhaber, 2018. "Costs and cost-effectiveness of LEEP versus cryotherapy for treating cervical dysplasia among HIV-positive women in Johannesburg, South Africa," PLOS ONE, Public Library of Science, vol. 13(10), pages 1-13, October.
    5. Elisabeth L Vodicka & Michael H Chung & Marita R Zimmermann & Rose J Kosgei & Fan Lee & Nelly R Mugo & Timothy C Okech & Samah R Sakr & Andy Stergachis & Louis P Garrison Jr. & Joseph B Babigumira, 2019. "Estimating the costs of HIV clinic integrated versus non-integrated treatment of pre-cancerous cervical lesions and costs of cervical cancer treatment in Kenya," PLOS ONE, Public Library of Science, vol. 14(6), pages 1-17, June.

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