 |
|
Policy Analysis of Cervical Cancer Screening Strategies in Low-Resource Settings
Clinical Benefits and Cost-effectiveness
Sue J. Goldie, MD,MPH;
Louise Kuhn, PhD;
Lynette Denny, MMED(O&G),FCOG(SA);
Amy Pollack, MD;
Thomas C. Wright, MD
JAMA. 2001;285:3107-3115.
Context Cervical cancer is a leading cause of cancer-related death among women in developing countries. In such low-resource settings, cytology-based screening is difficult to implement, and less complex strategies may offer additional options.
Objective To assess the cost-effectiveness of several cervical cancer screening strategies using population-specific data.
Design and Setting Cost-effectiveness analysis using a mathematical model and a hypothetical cohort of previously unscreened 30-year-old black South African women. Screening tests included direct visual inspection (DVI) of the cervix, cytologic methods, and testing for high-risk types of human papillomavirus (HPV) DNA. Strategies differed by number of clinical visits, screening frequency, and response to a positive test result. Data sources included a South African screening study, national surveys and fee schedules, and published literature.
Main Outcome Measures Years of life saved (YLS), lifetime costs in US dollars, and incremental cost-effectiveness ratios (cost per YLS).
Results When analyzing all strategies performed as a single lifetime screen at age 35 years compared with no screening, HPV testing followed by treatment of screen-positive women at a second visit, cost $39/YLS (27% cancer incidence reduction); DVI, coupled with immediate treatment of screen-positive women at the first visit was next most effective (26% cancer incidence reduction) and was cost saving; cytology, followed by treatment of screen-positive women at a second visit was least effective (19% cancer incidence reduction) at a cost of $81/YLS. For any given screening frequency, when strategies were compared incrementally, HPV DNA testing generally was more effective but also more costly than DVI, and always was more effective and less costly than cytology. When comparing all strategies simultaneously across screening frequencies, DVI was the nondominated strategy up to a frequency of every 3 years (incremental cost-effectiveness ratio, $460/YLS), and HPV testing every 3 years (incremental cost-effectiveness ratio, $11 500/YLS) was the most effective strategy.
Conclusion Cervical cancer screening strategies that incorporate DVI or HPV DNA testing and eliminate colposcopy may offer attractive alternatives to cytology-based screening programs in low-resource settings.
Author Affiliations: From the Department of Health Policy and Management Harvard School of Public Health, Boston, Mass (Dr Goldie); Department of Obstetrics and Gynecology, University of Cape Town, South Africa (Dr Denny); Gertrude H. Sergievsky Center, College of Physicians and Surgeons, and Division of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY (Dr Kuhn); EngenderHealth, New York, NY, (Dr Pollack); Department of Pathology, College of Physicians and Surgeons of Columbia University, New York, NY, (Dr Wright).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED LETTERS
Policy Analysis of Cervical Cancer Screening Strategies in Low-Resource Settings: Clinical Benefits and Cost-effectiveness
Sue J. Goldie, Louise Kuhn, Lynette Denny, Amy Pollack, and Thomas C. Wright
JAMA. 2001;285(24):3107-3115.
ABSTRACT
| FULL TEXT
Cervical Cancer Screening in Developing Countries
Eric J. Suba, Stephen S. Raab, Sue J. Goldie, Louise Kuhn, Lynette Denny, Amy Pollack, and Thomas C. Wright
JAMA. 2001;286(24):3079-3081.
EXTRACT
| FULL TEXT
RELATED ARTICLE
June 27, 2001
JAMA. 2001;285(24):3197-3198.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
DNA Ploidy Cytometry Testing for Cervical Cancer Screening in China (DNACIC Trial): a Prospective Randomized, Controlled Trial
Tong et al.
Clin. Cancer Res. 2009;15:6438-6445.
ABSTRACT
| FULL TEXT
Multiparameter Calibration of a Natural History Model of Cervical Cancer
Kim et al.
Am J Epidemiol 2007;166:137-150.
ABSTRACT
| FULL TEXT
Quadrivalent Vaccine against Human Papillomavirus to Prevent High-Grade Cervical Lesions
The FUTURE II Study Group
NEJM 2007;356:1915-1927.
ABSTRACT
| FULL TEXT
The German Cervical Cancer Screening Model: development and validation of a decision-analytic model for cervical cancer screening in Germany
Siebert et al.
Eur J Public Health 2006;16:185-192.
ABSTRACT
| FULL TEXT
Cost-Effectiveness of Cervical-Cancer Screening in Five Developing Countries
Goldie et al.
NEJM 2005;353:2158-2168.
ABSTRACT
| FULL TEXT
Screen-and-Treat Approaches for Cervical Cancer Prevention in Low-Resource Settings: A Randomized Controlled Trial
Denny et al.
JAMA 2005;294:2173-2181.
ABSTRACT
| FULL TEXT
Cervical Cancer Prevention: Making Programs More Appropriate and Pragmatic
Blumenthal and Gaffikin
JAMA 2005;294:2225-2228.
FULL TEXT
Cost-effectiveness of Human Papillomavirus DNA Testing in the United Kingdom, The Netherlands, France, and Italy
Kim et al.
JNCI J Natl Cancer Inst 2005;97:888-895.
ABSTRACT
| FULL TEXT
Diagnostic accuracy of self collected vaginal specimens for human papillomavirus compared to clinician collected human papillomavirus specimens: a meta-analysis
Ogilvie et al.
Sex. Transm. Infect. 2005;81:207-212.
ABSTRACT
| FULL TEXT
Options for Handling Missing Data in the Health Utilities Index Mark 3
Naeim et al.
Med Decis Making 2005;25:186-198.
ABSTRACT
Cost-effectiveness of Whole-Body CT Screening
Beinfeld et al.
Radiology 2005;234:415-422.
ABSTRACT
| FULL TEXT
Evaluation of Breast Cancer Risk Assessment Techniques: A Cost-effectiveness Analysis
Ozanne and Esserman
Cancer Epidemiol. Biomarkers Prev. 2004;13:2043-2052.
ABSTRACT
| FULL TEXT
The Cost-Effectiveness of Screening Programs Using Single and Multiple Birth Cohort Simulations: A Comparison Using a Model of Cervical Cancer
Dewilde and Anderson
Med Decis Making 2004;24:486-492.
ABSTRACT
Defining the Priority of Using 18F-FDG PET for Recurrent Cervical Cancer
Yen et al.
JNM 2004;45:1632-1639.
ABSTRACT
| FULL TEXT
Primary cervical cancer screening by self-sampling of human papillomavirus DNA in internal medicine outpatient clinics
Dannecker et al.
Ann Oncol 2004;15:863-869.
ABSTRACT
| FULL TEXT
Projected Clinical Benefits and Cost-effectiveness of a Human Papillomavirus 16/18 Vaccine
Goldie et al.
JNCI J Natl Cancer Inst 2004;96:604-615.
ABSTRACT
| FULL TEXT
A Comparison of Single and Combined Visual, Cytologic, and Virologic Tests as Screening Strategies in a Region at High Risk of Cervical Cancer
Ferreccio et al.
Cancer Epidemiol. Biomarkers Prev. 2003;12:815-823.
ABSTRACT
| FULL TEXT
Comparison between Prototype Hybrid Capture 3 and Hybrid Capture 2 Human Papillomavirus DNA Assays for Detection of High-Grade Cervical Intraepithelial Neoplasia and Cancer
Castle et al.
J. Clin. Microbiol. 2003;41:4022-4030.
ABSTRACT
| FULL TEXT
Potential Health and Economic Impact of Adding a Human Papillomavirus Vaccine to Screening Programs
Kulasingam and Myers
JAMA 2003;290:781-789.
ABSTRACT
| FULL TEXT
Chapter 10: Cervical Cancer Screening Using Visualization Techniques
Wright
J Natl Cancer Inst Monogr 2003;2003:66-71.
ABSTRACT
| FULL TEXT
Chapter 15: Public Health Policy and Cost-Effectiveness Analysis
Goldie
J Natl Cancer Inst Monogr 2003;2003:102-110.
ABSTRACT
| FULL TEXT
Cervical Cancer Screening: From the Papanicolaou Smear to the Vaccine Era
Crum et al.
JCO 2003;21:224s-230.
ABSTRACT
| FULL TEXT
Cervical Cancer: Disparities in Screening, Treatment, and Survival
Garner
Cancer Epidemiol. Biomarkers Prev. 2003;12:242s-247s.
FULL TEXT
The Beginning of the End for Cervical Cancer?
Crum
NEJM 2002;347:1703-1705.
FULL TEXT
Costs and Benefits of Different Strategies to Screen for Cervical Cancer in Less-Developed Countries
Mandelblatt et al.
JNCI J Natl Cancer Inst 2002;94:1469-1483.
ABSTRACT
| FULL TEXT
Assessing the Sensitivity of Decision-Analytic Results to Unobserved Markers of Risk: Defining the Effects of Heterogeneity Bias
Kuntz and Goldie
Med Decis Making 2002;22:218-227.
ABSTRACT
Cost-effectiveness of Alternative Triage Strategies for Atypical Squamous Cells of Undetermined Significance
Kim et al.
JAMA 2002;287:2382-2390.
ABSTRACT
| FULL TEXT
The causal relation between human papillomavirus and cervical cancer
Bosch et al.
J. Clin. Pathol. 2002;55:244-265.
ABSTRACT
| FULL TEXT
Cervical Cancer Screening in Developing Countries
Suba et al.
JAMA 2001;286:3079-3081.
FULL TEXT
|
