Cervical Cancer in Low-Income Settings: Costs, Cost-Effectiveness, and Budget Impact of Integrating Screening and Treatment into Existing Health Systems in East Africa
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Cervical cancer is one of the most frequently occurring cancers among women in sub-Saharan Africa (SSA). While preventable if detected early, many women experience challenges accessing life-saving screening and treatment due to health systems inefficiencies, costs, perceptions of screening, and time required to seek care. Integration of cervical cancer screening into existing public health programs, such as screening women as they enter the health system for HIV treatment or bring their children to obtain routine immunizations, may increase screening coverage rates at low marginal costs. This dissertation aimed to evaluate the potential costs, cost-effectiveness, and budget impact of integrating cervical cancer screening into a routine childhood immunization clinic in Uganda and an HIV-treatment facility in Kenya. First, using primary facility-level data, a model-based analysis was conducted to estimate the individual level-costs of treatment for pre-cancerous lesions, cervical cancer, and cervical cancer palliative care in Kenya. Second, a Markov model was developed to assess the potential costeffectiveness of integrating screening programs into an HIV treatment clinic in Kenya and a routine childhood immunization clinic in Uganda. Third, a budget impact model estimated the size of the target population and potential uptake of screening, as well as the impact on the current health system, of each integration strategy. Study findings indicate that integrating cervical cancer screening into existing health systems in East Africa is likely to be cost-saving or cost-effective in terms of cost-per life year saved, compared to current strategies of nonintegrated screening. These findings provide decision-makers in Kenya, Uganda, and other similar LMICs with information on the costs and cost-effectiveness of innovative methods for increasing access to life-saving cervical cancer screening and treatment interventions.