Cost effectiveness analysis of cervical cancer screening methods at family guidance association, Addis Ababa,Ethiopia 2017
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2018-10
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Abstract
Background: Cervical cancer is one of the most widespread and second leading cause of
gynecological related mortality worldwide. In developing countries, the number of deaths and
morbidities from the disease has been on the rise. Cervical cancer is usually detected in advanced
stages in these countries due to the lack of effective preventive mechanisms. In Ethiopia only 1%
of age eligible women receive effective screening for cervical cancer. Although organized
cervical cancer screening has been proven to be effective in saving significant number of lives in
developed world, there are a number of barriers to expand them into developing world such as
competing health care needs, limited human and financial resources, poorly developed health
care services, gender related barriers, political instability and widespread poverty.
Objectives: To evaluate the cost-effectiveness of cervical cancer screening methods, Addis
Ababa, Ethiopia.
Methods: Institutional based cross sectional study design was used. The cost was from societal
perspective. Sample size was determined using singe population mean formula and systematic
random sampling techniques was used to include women for the interview and also the cost from
provider perspective were collected from the three clinics. Full economics evaluation was done
using Markova model to construct and simulate the natural history of HPV-induced cervical
dysplasia to compare cost and effectiveness of Papanicolaou, Visual Inspection of cervix with
Acetic acid and Human Papilloma virus Deoxyribonucleic Acid test. A micro-costing approach
was used to measure and aggregate the cost of all resources used to provide cervical cancer
screening at individual level. Cost-effectiveness analysis was used to determine the incremental
cost-effectiveness ratio.
Results: Cost of VIA, PAP and HPV DNA test from societal perspective was found to be
$14.23, $ 20.51and $19.06 respectively. Among the three screening strategies, Pap smear was
not cost effective at any given willingness to pay threshold. VIA and HPV DNA test was cost
effective at incremental cost effectiveness ratio $ 268.10 per disability adjusted life year averted.
Conclusion: Cervical cancer screening using VIA and HPV DNA test are cost-effective
strategies.
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Cervical cancer