A Systematic Review of Economic Evaluations of Cervical Cancer Screening Methods

Congratulations to Thatohasti Sefuthi whose paper was approved for a oral presentation at the ISPOR Conference 2023.

This paper, “A Systematic Review of Economic Evaluations of Cervical Cancer Screening Methods,” was accepted for an oral poster presentation at the ISPOR Conference 2023, which I attended in Boston, Massachusetts, from the 7th-10th May.

Cervical Cancer is the most significant cause of cancer-related mortality globally. In Lesotho, the high HIV prevalence is associated with increased cervical cancer incidence. Optimal Cervical Cancer screening strategies present an opportunity to improve the identification of CIN 2 and CIN 3 cervix cells and to avert disease progression. Diagnostic properties and cost-effectiveness differ based on the specific screening method used. Selecting optimal tests and testing strategies is critical and should be evidence-based. Lesotho, like other countries, has a resource-constrained health system. Economic evaluations of Lesotho’s cervical cancer program are essential to enable best-in-hand screening practices congruent with optimized resource allocation.

Against this backdrop, the study aimed to provide a contextual summary of valuation outcomes associated with three types of cervical cancer screening tests: visual inspection with acetic acid, human papillomavirus deoxyribonucleic acid, and Papanicolaou smear.

Study Methods:

The study summarized findings on the economic evaluation outcomes of various cervical screening methods. Economic evaluation methods of interest were the following: cost-effectiveness analysis, cost-utility analysis, cost-minimization analysis, cost-benefit analysis, and cost-consequence analysis. The authors examined five databases for studies of economic evaluations of cervical cancer screening methods. The generated search strategy did not apply any date restrictions. Both model and primary-based studies were included for analysis. Studies included for analysis were appraised by the primary study investigator, while a second reviewer independently reviewed appraisal findings for any inconsistencies. Data were extracted using a validated data tool. After screening 671 records, 44 studies were identified as eligible for analysis.

Study Results:

Out of the 44 studies, 43 were cost-effectiveness analyses, while one documented cost-effectiveness and cost-utility findings. Most records (n=21) identified HPV DNA testing as the most dominant test, while 5 and 3 studies identified VIA and Cytology-based screening strategies as dominant, respectively. Study findings posited that HPV-based and VIA testing strategies are cost-effective, depending on the country’s context. Cytology-based testing was reported as the least cost-effective due to the need for testing-centric infrastructure and human resources. Study findings were published by Sefuthi et al. in 2022 (19).

Lesotho (and other countries at large) may use findings from this review to orient itself with the current cervical cancer screening landscape, focusing on best-in-hand evidence from other countries. This information can further define what a fit-for-purpose economic evaluation of cervical screening methods in Lesotho entails and inform the selection of primary cervical cancer screening methods while achieving resource-allocative efficiency.

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