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

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 and Philippe Mayaud
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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 de Ouagadougou = University of Ouagadougou, CRIS - Centre de Recherche Internationale pour la Sante - UJZK - Université Joseph Ki-Zerbo de Ouagadougou = University of Ouagadougou
Souleymane Zan: CHUYO - Centre Hospitalier Universitaire Yalgado Ouédraogo [Ouagadougou, Burkina Faso]
Fadima Yaya Bocoum: UJZK - Université Joseph Ki-Zerbo de Ouagadougou = University of Ouagadougou
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 de Ouagadougou = University of Ouagadougou
Alec Miners: LSHTM - London School of Hygiene and Tropical Medicine
Philippe Mayaud: LSHTM - London School of Hygiene and Tropical Medicine

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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. $

Date: 2021-03-25
New Economics Papers: this item is included in nep-dem
Note: View the original document on HAL open archive server: https://hal.umontpellier.fr/hal-03554345v1
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Published in PLoS ONE, 2021, 16 (3), pp.e0248832. ⟨10.1371/journal.pone.0248832⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-03554345

DOI: 10.1371/journal.pone.0248832

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