Clinical trial to implementation: Cost and effectiveness considerations for scaling up cervical cancer screening in low- and middle-income countries
Cervical cancer is preventable and early diagnosis is possible using low-cost technologies. Despite the strong evidence base for cervical cancer screening programs, their implementation has been slow in limited-resource countries where the cancer burden is high. In this study we provide a framework for systematically evaluating costs and effectiveness in order to translate clinical study findings to guide implementation of screening programs to maximize benefits in the real-world setting. Comparing the total cost of screening can be misleading, as the resources expended on specific program activities can have direct impact across multiple dimensions including access, quality, and adherence to care; these dimensions, in turn, can affect both overall health care cost and program effectiveness. Therefore, it is important to use activity-based costs and detailed performance indicators to evaluate both screening trials and pilot studies to ensure that large-scale implementation projects are designed and optimally resourced to achieve targeted program effectiveness and outcomes.