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Casas CPR, Albuquerque RDCRD, Loureiro RB, Gollner AM, Freitas MGD, Duque GPDN, Viscondi JYK. Cervical cancer screening in low- and middle-income countries: A systematic review of economic evaluation studies. Clinics (Sao Paulo) 2022; 77:100080. [PMID: 35905574 PMCID: PMC9335392 DOI: 10.1016/j.clinsp.2022.100080] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 05/04/2022] [Indexed: 11/28/2022] Open
Abstract
Economic assessments are relevant to support the decision to incorporate more cost-effective strategies to reduce Cervical Cancer (CC) mortality. This systematic review analyzes the economic evaluation studies of CC prevention strategies (HPV DNA-based tests and conventional cytology) in low- and middle-income countries. Medline, EMBASE, CRD, and LILACS were searched for economic evaluation studies that reported cost and effectiveness measures of HPV DNA-based tests for CC screening and conventional cytology in women, without age, language, or publication date restrictions. Selection and data extraction were carried out independently. For comparability of results, cost-effectiveness measures were converted to international dollars (2019). Report quality was assessed using the CHEERS checklist. The Dominance Matrix Ranking (DRM) was used to analyze and interpret the results. The review included 15 studies from 12 countries, with cost-effectiveness analyzes from the health system's perspective and a 3% discount rate. The strategies varied in age and frequency of screening. Most studies used the Markov analytical model, and the cost-benefit threshold was based on the per capita GDP of each country. The sensitivity analysis performed in most studies was deterministic. The completeness of the report was considered sufficient in most of the items evaluated by CHEERS. The Dominance Interpretation (DRM) varied; in 6 studies, the HPV test was dominant, 5 studies showed a weak dominance evaluating greater effectiveness of the HPV test at a higher cost, yet in 2 studies conventional cytology was dominant. Although the context-dependent nature of economic evaluations, this review points out the challenge of methodological standardization in the analytical models.
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Affiliation(s)
- Carmen Phang Romero Casas
- Centro de Desenvolvimento Tecnológico em Saúde (CDTS), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil.
| | | | - Rafaela Borge Loureiro
- Laboratório de Epidemiologia (Lab-Epi), Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil
| | - Angela Maria Gollner
- Hospital Universitário da Universidade Federal de Juiz de Fora (HU-UFJF/ EBSERH), Juiz de Fora, MG, Brazil
| | - Marina Gonçalves de Freitas
- Câmara de Regulação do Mercado de Medicamentos (CMED), Agência Nacional de Vigilância Sanitária (ANVISA), Brazil
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Rezapour A, Jahangiri R, Olyaeemanesh A, Kalaghchi B, Nouhi M, Nahvijou A. The economic burden of oral cancer in Iran. PLoS One 2018; 13:e0203059. [PMID: 30260976 PMCID: PMC6160006 DOI: 10.1371/journal.pone.0203059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 08/14/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Cancer is one of the leading causes of death in the world, among which, oral cancer is associated with significant morbidity, and low survival. A large part of the budget allocated to health care is attributed to cancer. In this study we aim to estimate the economic burden of oral cancer in Iran for the year 2014. METHODS In this study, we generated a prevalence-based estimate of the cost-of-illness of oral cancer in Iran. A societal perspective was used for this study, in which the direct costs and productivity losses of oral cancer cases in 2014 were estimated. The human capital approach was adopted for estimating productivity losses. Several data sources contributed to this study, including national cancer registry reports, hospital records, occupational data, and interviews with experts. RESULT Nearly 53% of patients were diagnosed in an advanced stage of oral cancer. The economic burden of oral cancer was $64,245,173 most of which (50%) was attributed to productivity losses. The direct medical cost accounted for 42% of the estimated total cost. Treatment expenses for advanced stages were five times higher than the early stages ($10,532 vs. $2,225). CONCLUSION The economic burden of oral cancer is high in Iran. Planning an early detection and screening program for oral cancer may potentially decrease health care costs, morbidity, and mortality.
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Affiliation(s)
- Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Jahangiri
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Olyaeemanesh
- Health Equity Research Center, Tehran university of medical sciences, Tehran, Iran
- National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Bita Kalaghchi
- Radiation oncology research center, Tehran university of medical sciences, Tehran, Iran
| | - Mojtaba Nouhi
- Health Equity Research Center, Tehran university of medical sciences, Tehran, Iran
| | - Azin Nahvijou
- Cancer Research Center of Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
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Nahvijou A, Daroudi R, Tahmasebi M, Amouzegar Hashemi F, Rezaei Hemami M, Akbari Sari A, Barati Marenani A, Zendehdel K. Cost-Effectiveness of Different Cervical Screening Strategies in Islamic Republic of Iran: A Middle-Income Country with a Low Incidence Rate of Cervical Cancer. PLoS One 2016; 11:e0156705. [PMID: 27276093 PMCID: PMC4898767 DOI: 10.1371/journal.pone.0156705] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/18/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Invasive cervical cancer (ICC) is the fourth most common cancer among women worldwide. Cervical screening programs have reduced the incidence and mortality rates of ICC. We studied the cost-effectiveness of different cervical screening strategies in the Islamic Republic of Iran, a Muslim country with a low incidence rate of ICC. METHODS We constructed an 11-state Markov model, in which the parameters included regression and progression probabilities, test characteristics, costs, and utilities; these were extracted from primary data and the literature. Our strategies included Pap smear screening and human papillomavirus (HPV) DNA testing plus Pap smear triaging with different starting ages and screening intervals. Model outcomes included lifetime costs, life years gained, quality-adjusted life years (QALY), and incremental cost-effectiveness ratios (ICERs). One-way sensitivity analysis was performed to examine the stability of the results. RESULTS We found that the prevented mortalities for the 11 strategies compared with no screening varied from 26% to 64%. The most cost-effective strategy was HPV screening, starting at age 35 years and repeated every 10 years. The ICER of this strategy was $8,875 per QALY compared with no screening. We found that screening at 5-year intervals was also cost-effective based on GDP per capita in Iran. CONCLUSION We recommend organized cervical screening with HPV DNA testing for women in Iran, beginning at age 35 and repeated every 10 or 5 years. The results of this study could be generalized to other countries with low incidence rates of cervical cancer.
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Affiliation(s)
- Azin Nahvijou
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, I. R. Iran
| | - Rajabali Daroudi
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, I. R. Iran
| | - Mamak Tahmasebi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, I. R. Iran
| | - Farnaz Amouzegar Hashemi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, I. R. Iran
| | - Mohsen Rezaei Hemami
- Institute of Health & Wellbeing Health Economics & Health Technology Assessment University of Glasgow, Scotland, United Kingdom
| | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, I. R. Iran
| | - Ahmad Barati Marenani
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, I. R. Iran
| | - Kazem Zendehdel
- Cancer Model Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, I. R. Iran
- * E-mail:
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Majidi A, Ghiasvand R, Hadji M, Nahvijou A, Mousavi AS, Pakgohar M, Khodakarami N, Abedini M, Amouzegar Hashemi F, Rahnamaye Farzami M, Shahsiah R, Sajedinejhad S, Mohagheghi MA, Nadali F, Rashidian A, Weiderpass E, Mogensen O, Zendehdel K. Priority Setting for Improvement of Cervical Cancer Prevention in Iran. Int J Health Policy Manag 2015; 5:225-32. [PMID: 27239863 DOI: 10.15171/ijhpm.2015.201] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 11/06/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Cervical cancer is the fourth most common cancer among women worldwide. Organized cervical screening and vaccination against human papilloma virus (HPV) have been successful interventions for prevention of invasive cervical cancer (ICC). Because of cultural and religious considerations, ICC has low incidence in Iran and many other Muslim countries. There is no organized cervical screening in these countries. Therefore, ICC is usually diagnosed in advanced stages with poor prognosis in these countries. We performed a priority setting exercise and suggested priorities for prevention of ICC in this setting. METHODS We invited experts and researchers to a workshop and asked them to list important suggestions for ICC prevention in Iran. After merging similar items and removing the duplicates, we asked the experts to rank the list of suggested items. We used a strategy grid and Go-zone analysis to determine final list of priorities for ICC prevention in Iran. RESULTS From 26 final items suggested as priorities for prevention of ICC, the most important priorities were developing national guidelines for cervical screening and quality control protocol for patient follow-up and management of precancerous lesions. In addition, we emphasized considering insurance coverage for cervical screening, public awareness, and research priorities, and establishment of a cervical screening registry. CONCLUSION A comprehensive approach and implementation of organized cervical screening program is necessary for prevention of ICC in Iran and other low incidence Muslim countries. Because of high cost for vaccination and low incidence of cervical cancer, we do not recommend HPV vaccination for the time being in Iran.
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Affiliation(s)
- Azam Majidi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Ghiasvand
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.,Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Maryam Hadji
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Azin Nahvijou
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Azam-Sadat Mousavi
- Department of Genecology Oncology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Minoo Pakgohar
- Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Nahid Khodakarami
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrandokht Abedini
- Deputy of Public Health, Maternal Office, Ministry of Health and Medical Education, Tehran, Iran
| | - Farnaz Amouzegar Hashemi
- Radiotherapy Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Reza Shahsiah
- Department of Pathology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sima Sajedinejhad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mohagheghi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Nadali
- Faculty of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.,Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway.,Department of Genetic Epidemiology, Folkhälsan Research Center, Helsinki, Finland
| | - Ole Mogensen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Kazem Zendehdel
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.,Cancer Model Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
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