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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

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  • Angela Devine

    (Charles Darwin University [Australia], Melbourne School of Population and Global Health [Melbourne] - University of Melbourne)

  • Alice Vahanian

    (LSHTM - London School of Hygiene and Tropical Medicine)

  • Bernard Sawadogo

    (UJZK - Université Joseph Ki-Zerbo, CRIS - Centre de Recherche Internationale pour la Sante - UJZK - Université Joseph Ki-Zerbo)

  • Souleymane Zan

    (CHUYO - Centre Hospitalier Universitaire Yalgado Ouédraogo [Ouagadougou, Burkina Faso])

  • Fadima Yaya Bocoum

    (UJZK - Université Joseph Ki-Zerbo)

  • Helen Kelly

    (LSHTM - London School of Hygiene and Tropical Medicine)

  • Clare Gilham

    (LSHTM - London School of Hygiene and Tropical Medicine)

  • Nicolas Nagot

    (PCCEI - Pathogenesis and Control of Chronic and Emerging Infections - INSERM - Institut National de la Santé et de la Recherche Médicale - UM - Université de Montpellier - UA - Université des Antilles - Etablissement français du don du sang [Montpellier], EFS - Etablissement Français du Sang Provence-Alpes Côte-d'Azur et Corse, CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier])

  • Jason Ong

    (LSHTM - London School of Hygiene and Tropical Medicine, CCS - Monash Central Clinical School [Melbourne] - Faculty of Medicine, Nursing and Health Sciences - Monash university [Victoria] - Monash university)

  • Rosa Legood

    (LSHTM - London School of Hygiene and Tropical Medicine)

  • Nicolas Meda

    (CRIS - Centre de Recherche Internationale pour la Sante - UJZK - Université Joseph Ki-Zerbo)

  • Alec Miners

    (LSHTM - London School of Hygiene and Tropical Medicine)

  • Philippe Mayaud

    (LSHTM - London School of Hygiene and Tropical Medicine)

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 ( care HPV)) 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 USD3.2 for VIA to USD24.8 for cytology. Compared to VIA alone, the incremental cost per CIN2+ case detected was USD48 for VIA/VILI and USD814 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 USD48.0. 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 care HPV 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 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.
    • Handle: RePEc:hal:journl:hal-03554345
    DOI: 10.1371/journal.pone.0248832
    Note: View the original document on HAL open archive server: https://hal.umontpellier.fr/hal-03554345v1
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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," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(3), pages 367-372, June.
    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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