Abstract
ObjectiveThis study evaluated the potential cost-effectiveness of cervical cancer screening in HIV treatment clinics in Nairobi, Kenya.MethodsA Markov model was used to project health outcomes and costs of cervical cancer screening and cryotherapy at an HIV clinic in Kenya using cryotherapy without screening, visual inspection with acetic acid (VIA), Papanicolaou smear (Pap), and testing for human papillomavirus (HPV). Direct and indirect medical and non-medical costs were examined from societal and clinic perspectives.ResultsCosts of cryotherapy, VIA, Pap, and HPV for women with CD4 200–500 cells/mL were $99, $196, $219, and $223 from a societal perspective and $19, $94, $124, and $113 from a clinic perspective, with 17.3, 17.1, 17.1, and 17.1 years of life expectancy, respectively. Women at higher CD4 counts (>500 cells/mL) given cryotherapy VIA, Pap, and HPV resulted in better life expectancies (19.9+ years) and lower cost (societal: $49, $99, $115, and $102; clinic: $13, $51, $71, and $56). VIA was less expensive than HPV unless HPV screening could be reduced to a single visit.ConclusionsPreventative cryotherapy was the least expensive strategy and resulted in highest projected life expectancy, while VIA was most cost-effective unless HPV could be reduced to a single visit.
Highlights
Cancer is a growing cause of mortality worldwide, and cervical cancer is one of the leading causes of cancer death in sub-Saharan Africa (SSA) [1]
Cervical cancer screening has been offered at the Hope Center since 2005 with over 7000 HIV-infected women having been screened to date [22]
In 2009, we conducted a cross-sectional study of cervical cancer screening with 498 HIV-infected women at the Hope Center to compare visual inspection with acetic acid (VIA), Papanicolaou smear (Pap) smear, and human papillomavirus (HPV) (Cervex brush with PreservCyt media) against the gold colposcopy-directed biopsy [7]
Summary
Cancer is a growing cause of mortality worldwide, and cervical cancer is one of the leading causes of cancer death in sub-Saharan Africa (SSA) [1]. In addition to the cancer burden, more than 10 million women are infected with HIV and are at greater risk for cervical cancer and early mortality, making early detection and prevention critical for this already vulnerable population [4, 5]. Reducing cervical cancer among HIV-infected women is a primary focus of the Pink Ribbon Red Ribbon Initiative, a joint public–private international program launched in 2011 supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) [6]. The initiative promotes integrating cervical cancer screening and treatment into HIV treatment clinics in sub-Saharan Africa [6]. Understanding the cost-effectiveness of each cervical cancer screening method in an integrated context is essential to meeting the goals of the Initiative and to sustaining cervical cancer screening programs during a period of decreasing PEPFAR funding [6]
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