SCREENING, PREVENTION, AND TREATMENT OF CERVICAL CANCER - A GLOBAL AND REGIONAL GENERALIZED COST-EFFECTIVENESS ANALYSIS
Author(s)
Gary M Ginsberg, DrPH, MSc(Econ), Director, Medical Technology Assessment Sector1, Tessa Tan-Torres Edeger, MD, Director2, Jeremy A Lauer, MSc, Senior Scientist2, Cecilia Sepulveda, MD, Director21Formerly WHO, Geneva 27, Switzerland; 2 WHO, Geneva 27, Switzerland
Objective: The paper calculates regional generalized cost-effectiveness estimates of screening, prevention, treatment and combined interventions for cervical cancer. Methods: Standardised WHO-CHOICE methodology was used. A cervical cancer model was employed to provide estimates of screening, vaccination and treatment effectiveness. Intervention effectiveness was determined via a population state-transition model (PopMod) that simulates the evolution of a sub-regional population accounting for births, deaths and disease epidemiology. Economic costs of procedures and treatment were estimated, including programme overhead and training costs. Results: In regions characterised by high income, low mortality and high existing treatment coverage, the addition of any screening programme to the current high treatment levels is very cost effective. However, based on projections of the future price per dose (representing the economic costs of the vaccination excluding monopolistic rents and vaccine development cost) vaccination is the most cost-effective intervention. In regions characterized by low income, low mortality and existing treatment coverage around 50%, expanding treatment with or without combining it with screening appears to be cost effective or very cost-effective. Abandoning treatment in favour of screening in a no-treatment scenario would not be cost effective. Vaccination is usually the most cost-effective intervention, however in some regions one-off PAP or VIA screening at age 40 are more cost-effective than other interventions though less effective overall. In regions characterised by low income, high mortality and low treatment levels, expanding treatment with or without adding screening would be very cost-effective. One-off PAP or VIA screening at age 40 are more cost-effective than other interventions though less effective overall. Conclusion: From a cost-effectiveness perspective, consideration should be given to implementing vaccination (depending on cost per dose) and screening programmes on a worldwide basis to reduce the burden of disease from cervical cancer. Treatment should also be increased where coverage is low.
Conference/Value in Health Info
2008-05, ISPOR 2008, Toronto, Ontario, Canada
Value in Health, Vol. 11, No. 3 (May/June 2008)
Code
PCN29
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Oncology, Reproductive and Sexual Health