| Institution: | 1.Department of Pharmacy,University of Washington,Seattle,USA;2.Department of Global Health,University of Washington,Seattle,USA;3.Chandaria School of Business, United States International University-Africa,Nairobi,Kenya;4.Department of Obstetrics and Gynecology,Kenyatta National Hospital,Nairobi,Kenya;5.Coptic Hospital, Coptic Hope Center,Nairobi,Kenya;6.Department of Medicine,University of Washington,Seattle,USA;7.Department of Epidemiology,University of Washington,Seattle,USA |
| Abstract: | ObjectiveThis study evaluated the potential cost-effectiveness of cervical cancer screening in HIV treatment clinics in Nairobi, Kenya.MethodsA Markov model was used to project health outcomes and costs of cervical cancer screening and cryotherapy at an HIV clinic in Kenya using cryotherapy without screening, visual inspection with acetic acid (VIA), Papanicolaou smear (Pap), and testing for human papillomavirus (HPV). Direct and indirect medical and non-medical costs were examined from societal and clinic perspectives.ResultsCosts of cryotherapy, VIA, Pap, and HPV for women with CD4 200–500 cells/mL were $99, $196, $219, and $223 from a societal perspective and $19, $94, $124, and $113 from a clinic perspective, with 17.3, 17.1, 17.1, and 17.1 years of life expectancy, respectively. Women at higher CD4 counts (>500 cells/mL) given cryotherapy VIA, Pap, and HPV resulted in better life expectancies (19.9+ years) and lower cost (societal: $49, $99, $115, and $102; clinic: $13, $51, $71, and $56). VIA was less expensive than HPV unless HPV screening could be reduced to a single visit.ConclusionsPreventative cryotherapy was the least expensive strategy and resulted in highest projected life expectancy, while VIA was most cost-effective unless HPV could be reduced to a single visit. |
