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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

Author

Listed:
  • 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 Mayaud
  • on behalf of the HARP Consortium

Abstract

Introduction: This study estimated the costs and incremental cost per case detected of screening strategies for high-grade cervical intraepithelial neoplasia (CIN2+) in women living with HIV (WLHIV) attending HIV clinics in Burkina Faso. Methods: The direct healthcare provider costs of screening tests (visual inspection with acetic acid (VIA), VIA combined visual inspection with Lugol’s iodine (VIA/VILI), cytology and a rapid HPV DNA test (careHPV)) and confirmatory tests (colposcopy, directed biopsy and systematic four-quadrant (4Q) biopsy) were collected alongside the HPV in Africa Research Partnership (HARP) study. A model was developed for a hypothetical cohort of 1000 WLHIV using data on CIN2+ prevalence and the sensitivity of the screening tests. Costs are reported in USD (2019). Results: The study enrolled 554 WLHIV with median age 36 years (inter-quartile range, 31–41) and CIN2+ prevalence of 5.8%. The average cost per screening test ranged from US$3.2 for VIA to US$24.8 for cytology. Compared to VIA alone, the incremental cost per CIN2+ case detected was US$48 for VIA/VILI and US$814 for careHPV. Despite higher costs, careHPV was more sensitive for CIN2+ cases detected compared to VIA/VILI (97% and 56%, respectively). The cost of colposcopy was US$6.6 per person while directed biopsy was US$33.0 and 4Q biopsy was US$48.0. Conclusion: Depending on the willingness to pay for the detection of a case of cervical cancer, decision makers in Burkina Faso can consider a variety of cervical cancer screening strategies for WLHIV. While careHPV is more costly, it has the potential to be cost-effective depending on the willingness to pay threshold. Future research should explore the lifetime costs and benefits of cervical cancer screening to enable comparisons with interventions for other diseases.

Suggested Citation

  • 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.
    • Handle: RePEc:plo:pone00:0248832
    DOI: 10.1371/journal.pone.0248832
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    References listed on IDEAS

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    1. 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," PharmacoEconomics, Springer, vol. 31(5), pages 361-367, May.
    2. 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.
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