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Cited by 666Cervical Cancer and HPV ResearchWomen's cancer prevention and managementHealth Systems, Economic Evaluations, Quality of Life

Cost-Effectiveness of Cervical-Cancer Screening in Five Developing Countries

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Goldie, Sue J., Gaffikin, Lynne, Goldhaber-Fiebert, Jeremy D., Gordillo-Tobar, Amparo, Levin, Carol, Mahé, Cédric, Wright, Thomas C.·2005·New England Journal of Medicine
DOI 10.1056/nejmsa044278
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Abstract

BACKGROUND: Cervical-cancer screening strategies that involve the use of conventional cytology and require multiple visits have been impractical in developing countries. METHODS: We used computer-based models to assess the cost-effectiveness of a variety of cervical-cancer screening strategies in India, Kenya, Peru, South Africa, and Thailand. Primary data were combined with data from the literature to estimate age-specific incidence and mortality rates for cancer and the effectiveness of screening for and treatment of precancerous lesions. We assessed the direct medical, time, and program-related costs of strategies that differed according to screening test, targeted age and frequency, and number of clinic visits required. Single-visit strategies involved the assumption that screening and treatment could be provided in the same day. Outcomes included the lifetime risk of cancer, years of life saved, lifetime costs, and cost-effectiveness ratios (cost per year of life saved). RESULTS: The most cost-effective strategies were those that required the fewest visits, resulting in improved follow-up testing and treatment. Screening women once in their lifetime, at the age of 35 years, with a one-visit or two-visit screening strategy involving visual inspection of the cervix with acetic acid or DNA testing for human papillomavirus (HPV) in cervical cell samples, reduced the lifetime risk of cancer by approximately 25 to 36 percent, and cost less than 500 dollars per year of life saved. Relative cancer risk declined by an additional 40 percent with two screenings (at 35 and 40 years of age), resulting in a cost per year of life saved that was less than each country's per capita gross domestic product--a very cost-effective result, according to the Commission on Macroeconomics and Health. CONCLUSIONS: Cervical-cancer screening strategies incorporating visual inspection of the cervix with acetic acid or DNA testing for HPV in one or two clinical visits are cost-effective alternatives to conventional three-visit cytology-based screening programs in resource-poor settings.

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Crossref · 10.1056/nejmsa044278

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  • These less infrastructure-dependent strategies with greater follow-up are expected to be cost-effective.

    “These strategies, less dependent on existing health system infrastructure and associated with greater rates of follow-up, are also expected to be cost-effective (Goldie et al, 2005).”

    From Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India (2008) · cites this paper as Goldie et al, 2005

  • The opportunity to prevent these deaths is now inarguable with the availability of a vaccine to prevent HPV 16,18 infection, new diagnostics for HPV DNA testing, and promising secondary prevention strategies.

    “The opportunity to prevent these deaths is now inarguable with the availability of a vaccine to prevent HPV 16,18 infection, new diagnostics for HPV DNA testing, and promising secondary prevention strategies that target women after age 30 and perform screening and treatment in as few visits as possible (Goldie et al, 2005).”

    From Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India (2008) · cites this paper as Goldie et al, 2005

  • Our cost estimates were higher than what was reported by Diaz et al and Goldie et al even after adjustment of latter estimates for inflation since the year of estimation.

    “However, our cost estimates were higher than what was reported by Diaz et al and Goldie et al even after adjustment of latter estimates for inflation since the year of estimation. [47, 48].”

    From Cost effectiveness of strategies for cervical cancer prevention in India (2020) · cites this paper as [48]

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  1. Sankaranarayanan R, 2001, Bull World Health Organ, 79, 954

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Authors
Goldie, S. J., Gaffikin, L., Goldhaber-Fiebert, J. D., Gordillo-Tobar, A., Levin, C., Mahé, C., & Wright, T. C.
Affiliations
  • Harvard University (US)
  • Jhpiego (US)
  • World Health Organization Regional Office for the Americas (US)
  • Program for Appropriate Technology in Health (US)
  • Centre international de recherche sur le cancer (FR)
  • Columbia University (US)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2005-11-17
Volume
353
Issue
20
Pages
2158-2168
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmsa044278
OpenAlex
W2045116756
Semantic Scholar
1cfa53027c7a5ecdf784883cc53143c661ed7c67
Cited by
666
References
22
Citations by year
2026: 11 · 2025: 13 · 2024: 23 · 2023: 18 · 2022: 28 · 2021: 24 · 2020: 19 · 2019: 35 · 2018: 24 · 2017: 37 · 2016: 25 · 2015: 58 · 2014: 40 · 2013: 41 · 2012: 39
FWCI
28.34
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5r01ca093435-06)
  • National Cancer Institute (R01-CA93435)
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
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Keywords
cervical cancer screening, cost-effectiveness, developing countries, visual inspection with acetic acid, HPV testing, life-years saved, precancerous lesions, resource-limited settings, India, Kenya, Peru, South Africa, Thailand
MeSH terms
Adult, Uterine Cervical Neoplasms, Cost-Benefit Analysis, Developing Countries, DNA, Viral, Female, Humans, Mass Screening, Time Factors, Health Care Costs, Papillomaviridae

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