Table 2.
Health outcomes, costs, and incremental net monetary benefits of shifting from a 2-visit to a 1-visit approach for cervical cancer screening and treatment of precancera
| India (GDP per capita: I$5450) | Nicaragua (GDP per capita: I$4690) | Uganda (GDP per capita: I$1690) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Strategyb | Cancer incidence reduction, %c | Lifetime cost (2011 I$)d | Life expectancye | INMB (1× GDP per capita threshold)f |
Cancer incidence reduction, %c | Lifetime cost (2011 I$)d | Life expectancye | INMB (1× GDP per capita threshold)f |
Cancer incidence reduction, %c | Lifetime cost (2011 I$)d | Life expectancye | INMB (1× GDP per capita threshold)f |
| No screening | – | 8.87 (7.05-12.54) |
27.78539 (27.76486-27.79362) |
– | – | 42.67 (37.28-50.31) | 28.58210 (28.54475-28.61306) |
– | – | 12.42 (10.96-14.16) |
25.20221 (25.17432-25.22855) |
– |
| LTFU: 10% | ||||||||||||
| 2-visit | 62.0 (48.8-76.6) |
29.68 (27.25-32.02) |
27.82880 (27.82371-27.83431) |
– | 66.0 (58.9-73.6) |
53.03 (48.86-56.89) |
28.73581 (28.72337-28.74977) |
– | 67.4 (62.3-73.1) |
45.66 (43.01-47.78) |
25.33856 (25.33166-25.34855) |
– |
| 1-visit | 65.0 (51.8-79.4) |
27.32 (24.81-29.72) |
27.83081 (27.82611-27.83594) |
13 (11-16) |
68.8 (61.7-76.3) |
48.69 (44.60-52.56) |
28.74246 (28.73123-28.75554) |
36 (29-42) |
70.1 (65.0-75.9) |
37.75 (34.87-40.12) |
25.34406 (25.33770-25.35278) |
17 (15-19) |
| LTFU: 20% | ||||||||||||
| 2-visit | 58.1 (45.1-72.8) |
28.92 (26.55-31.22) |
27.82567 (27.82006-27.83160) |
– | 61.9 (54.8-69.5) |
53.51 (49.16-57.58) |
28.72533 (28.71125-28.74107) |
– | 63.2 (58.1-68.8) |
43.91 (41.45-45.79) |
25.32940 (25.32187-25.34090) |
– |
| 1-visit | 64.7 (51.4-79.1) |
27.31 (24.79-29.72) |
27.83013 (27.82534-27.83545) |
26 (21-32) |
68.2 (61.1-75.8) |
48.82 (44.72-52.74) |
28.74042 (28.72857-28.75389) |
75 (61-88) |
69.6 (64.6-75.4) |
37.70 (34.81-40.07) |
25.34217 (25.33572-25.35127) |
28 (24-31) |
| LTFU: 30% | ||||||||||||
| 2-visit | 53.5 (40.9-68.0) |
28.21 (25.91-30.45) |
27.82200 (27.81527-27.82855) |
– | 57.2 (50.2-64.5) |
54.25 (49.76-58.61) |
28.71253 (28.69672-28.73052) |
– | 58.4 (53.6-64.0) |
42.21 (39.94-43.82) |
25.31800 (25.30857-25.33155) |
– |
| 1-visit | 64.3 (50.9-78.9) |
27.31 (24.77-29.73) |
27.82940 (27.82447-27.83494) |
41 (35-54) |
67.8 (60.7-75.4) |
48.93 (44.80-52.87) |
28.73814 (28.72585-28.75192) |
125 (104-148) |
69.2 (64.2-75.1) |
37.65 (34.76-40.02) |
25.34011 (25.33346-25.34958) |
42 (35-48) |
| LTFU: 40% | ||||||||||||
| 2-visit | 48.4 (36.2-62.9) |
27.54 (25.26-29.73) |
27.78180 (27.81012-27.82500) |
– | 51.8 (45.3-59.0) |
55.24 (50.64-59.90) |
28.69851 (28.68045-28.71844) |
– | 52.8 (48.3-58.3) |
40.61 (38.52-41.95) |
25.30545 (25.29383-25.32110) |
– |
| 1-visit | 64.0 (50.4-78.9) |
27.30 (24.74-29.73) |
27.82872 (27.82352-27.83453) |
59 (51-77) |
67.5 (60.5-75.2) |
48.99 (44.80-52.92) |
28.73577 (28.72275-28.75003) |
181 (153-213) |
68.9 (63.8-74.8) |
37.60 (34.71-39.97) |
25.33789 (25.33107-25.34820) |
58 (49-66) |
| LTFU: 50% | ||||||||||||
| 2-visit | 42.6 (31.3-56.2) |
26.92 (24.71-29.22) |
27.81361 (27.80433-27.82065) |
– | 45.6 (39.5-52.2) |
56.62 (51.93-61.68) |
28.68319 (28.66223-28.70486) | – | 46.4 (42.4-51.5) |
39.08 (27.19-40.42) |
25.29166 (25.27809-25.30957) |
– |
| 1-visit | 63.9 (50.2-78.9) |
27.29 (24.70-29.70) |
27.82818 (27.82289-27.83407) |
79 (69-105) |
67.2 (60.2-75.0) |
49.01 (44.81-52.95) |
28.73386 (28.72017-28.74855) | 245 (211-289) |
68.6 (63.5-74.5) |
37.54 (34.66-39.91) |
25.33606 (25.32892-25.34684) |
77 (65-88) |
| LTFU: 60% | ||||||||||||
| 2-visit | 35.7 (25.7-47.8) |
26.39 (24.31-28.90) |
27.80868 (27.79781-27.81552) |
– | 38.3 (32.9-44.2) |
58.38 (53.62-63.84) |
28.66565 (28.65149-28.68919) |
– | 39.1 (35.4-43.6) |
37.66 (35.86-39.03) |
25.27631 (25.26027-25.29619) |
– |
| 1-visit | 63.7 (49.9-78.7) |
27.28 (24.69-29.71) |
27.82763 (27.82222-27.83379) |
102 (88-137) |
67.0 (60.0-74.9) |
49.04 (44.83-52.96) |
28.73182 (28.71765-28.74704) |
320 (279-377) |
68.4 (63.2-74.3) |
37.49 (34.60-39.87) |
25.33429 (25.32690-25.34550) |
98 (84-113) |
| LTFU: 70% | ||||||||||||
| 2-visit | 28.2 (20.3-37.9) |
25.89 (23.96-28.62) |
27.80362 (27.79067-27.81054) |
– | 30.2 (26.0-35.2) |
60.44 (55.49-66.41) |
28.64712 (28.62014-28.67254) |
– | 30.9 (27.9-34.7) |
36.33 (34.63-37.76) |
25.26014 (25.32487-25.34428) |
– |
| 1-visit | 63.5 (49.6-78.7) |
27.27 (24.68-29.69) |
27.82722 (27.82182-27.83347) |
127 (106-174) |
66.9 (59.9-74.8) |
49.04 (44.82-52.97) |
28.72980 (28.71518-28.74542) |
399 (350-468) |
68.3 (63.1-74.2) |
37.44 (34.55-39.82) |
25.33251 (25.32487-25.34428) |
121 (105-140) |
aAverage values represent the outcomes using 50 calibrated parameter sets for each country; parentheses indicate the minimum and maximum values across 50 calibrated parameter sets. GDP: gross domestic product; I$: international dollars; INMB: incremental net monetary benefit; LTFU: loss to follow-up
bStrategies are listed in order of increasing health benefit, and include either 2-visit screen-and-treat or 1-visit screen-and-treat for women aged 30, 35, and 40 years. Under both strategies, screening coverage was 100%, with LTFU for each clinical encounter. For the 2-visit strategy, LTFU applied to the results/treatment visit; for both strategies, LTFU applied to diagnostic testing with colposcopy and treatment of colposcopically confirmed CIN1+ for women who were not eligible for immediate cryotherapy at a primary facility
cCancer incidence reduction reflects the percent reduction in lifetime risk of cancer incidence compared to no screening
dTotal discounted lifetime cost per woman
eTotal discounted life expectancy
fThe INMB for 1-visit screen-and-treat is calculated against 2-visit screen-and-treat, at the specified level of LTFU. The INMB for 1-visit screen-and-treat provides a measure of how much economic investment could be made per woman to achieve a reduction in visits (relative to the 2-visit screen-and-treat scenario) without exceeding a country’s willingness to pay (WTP), at each level of LTFU. We considered each country’s WTP to be equivalent to GDP per capita