Cost-effectiveness of screening for and early diagnosis of breast and gynecological cancers in low-income countries
Screening and diagnosis provided for breast and gynecological cancers in the low-resource setting should be based not only on cost-effectiveness but also on affordability to ensure that large-scale implementation is possible. Over the past two decades, with the growing importance of economic evaluations in informing health care planning, a large number of cost-effectiveness assessments have been published for high-income countries, but these studies unfortunately have limited generalizability to low- or even middle-income countries. Only a few studies have been published on cost-effectiveness of screening in the resource-limited setting for breast and cervical cancer. In general, these studies support the use of clinical breast exams for breast cancer screening and the use of visual inspection with acetic acid or human papillomavirus (HPV) DNA testing for cervical cancer screening. HPV vaccination of adolescent girls can also be cost-effective, but the cost of both HPV vaccination and HPV DNA testing has to be quite low to make them affordable in the low-resource setting. No study to date has directly addressed the cost-effectiveness of providing integrated cancer screening, that is, combining breast and cervical cancer screening along with diagnostic evaluation for other gynecological cancers into a single visit. Integrating cancer screening services for women can potentially result in lower costs due to efficiencies for both the provider and the patient. On the provider side, synergies can reduce health care costs as a person is seen once for several screening tests and not multiple times. For the patient, a single trip is efficient and can reduce transportation and child care costs. Targeted screening trials and cost-effectiveness modeling are urgently needed to fully understand the impact of packaging screening for multiple cancers on the overall cost and effectiveness in the low-income setting.