Screening for cervical cancer in India: How much will it cost? A trial based analysis of the cost per case detected
Open accessAbstract
The cost and cost effectiveness of screening previously unscreened women by VIA, cytology or HPV testing was investigated within a large cluster randomised trial involving 131,178 women in rural India. All resources involved in implementation, training, management, recruitment, screening and diagnosis were identified and costed. We estimated the total costs and detection rates for each cluster and used these data to calculate an average cluster cost and detection rate for each screening approach. These estimates were combined to estimate a cost per case of cervical intraepithelial neoplasia grade 2/3 or invasive cancer (CIN 2/3+) detected. The average total costs per 1,000 women eligible for screening were US$3,917, US$6,609 and US$11,779 with VIA, cytology and HPV respectively. The cost of detecting a case of CIN2/3+ using VIA was $522 (95% CI $429–$652). Our results suggest that more CIN2/3+ cases would be detected in the same population if cytology were used instead of VIA and each additional case would cost US$1065 (95% CI $713–$2175). Delivering cervical cancer screening is potentially expensive in a low‐income country although costs might be lower outside a trial setting. We found screening with VIA to be the least expensive option, but it also detected fewer cases of CIN2/3+ than other methods; its long‐term cost‐effectiveness will depend on the long‐term benefits of early detection. Cytology was more effective at detecting cases than VIA but was also more expensive. Our findings indicate that HPV may not be a cost effective screening strategy in India at current consumable prices. © 2005 Wiley‐Liss, Inc.
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The cost per woman screened using different methods estimated in this study are very similar in terms of extent and pattern to a previous study conducted by Legood et al in 2005.
“The cost per women screened using different methods estimated by us are very similar in terms of the extent and pattern to a previous study conducted by Legood et al in 2005 (S1 File of S6 Table). [44–46]”
From Cost effectiveness of strategies for cervical cancer prevention in India (2020) · cites this paper as [44]
The Costs section reports the pattern across methods: VIA was least expensive, followed by cytology, then HPV. But its reported totals are per 1,000 women eligible for screening, not per woman screened. The source therefore supports the comparison of methods’ cost pattern, but not the claimed similarity in per-woman-screened costs. (LLM, conf=0.82)
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- Authors
- Legood, R., Gray, A. M., Mahé, C., Wolstenholme, J., Jayant, K., Nene, B. M., Shastri, S. S., Malvi, S. G., Muwonge, R., Budukh, A. M., & Sankaranarayanan, R.
- Affiliations
- University of Oxford (GB)
- Tata Memorial Hospital (IN)
- Centre international de recherche sur le cancer (FR)
- Corresponding author
- Legood, Rosa
- ORCID
- Venue
- International Journal of Cancer
- Publisher
- Wiley
- Published
- 2005-07-07
- Volume
- 117
- Issue
- 6
- Pages
- 981-987
- ISSN
- 0020-7136 (ISSN-L)
- 1097-0215
- OpenAlex
- W2068199759
- Cited by
- 71
- References
- 10
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 3 · 2023: 1 · 2022: 4 · 2021: 4 · 2020: 4 · 2017: 3 · 2016: 2 · 2015: 5 · 2014: 1 · 2013: 6 · 2012: 6
- FWCI
- 3.36
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- International Journal of Cancer (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- cervical cancer screening, cost per case detected, visual inspection with acetic acid, Pap smear cytology, HPV testing, cervical intraepithelial neoplasia, cost-effectiveness, rural women, low-income countries, India
- MeSH terms
- Adult, Biopsy, Uterine Cervical Dysplasia, Uterine Cervical Neoplasms, Cervix Uteri, Colposcopy, Cost-Benefit Analysis, Costs and Cost Analysis, Cytodiagnosis, Female, Humans, India, Laboratories, Mass Screening, Middle Aged, Rural Population, Papillomaviridae
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