Abstract
Background: Cervical cancer screening is an important public health priority with the potential to improve the detection of pre-cancerous lesions in high-risk females for early intervention and disease prevention. Test performance and cost-effectiveness differs based on the specific screening method used across different platforms. There is a need to appraise existing economic evaluations of cervical cancer screening. The objective of the present systematic review was to identify primary and model-based economic evaluations of cervical cancer screening methods, and to provide a contextual summary of associated outcomes associated with screening modalities. Methods: The review considered primary-based and model-based full economic evaluations of cervical cancer screening methods. Such evaluations methods include cost-effectiveness analysis, cost-utility analysis, cost-minimization analysis, cost-benefit analysis, and cost-consequence analysis. We searched the following databases for full economic evaluations of cancer screening methods globally: SCOPUS, Pubmed, National Health Economic Evaluation Database (NH EED), Cochrane, and Health Economic Evaluation Database (HEED). No date restrictions were applied. Model-based and primary-based full economic evaluations were included. A critical appraisal of included studies was performed by the main investigator, while a second independent reviewer assessed critical appraisal findings for any inconsistencies. Data were extracted using a standardized data extraction tool for economic evaluations. Data extracted from included studies were analysed and summarised to answer the study objective using the Joanna Briggs Institute (JBI) Dominance Ranking Matrix (DRM).Results: Out of 671 screened studies, 44 met the study inclusion criteria. Forty-three studies were cost-effectiveness analyses while two studies reported cost-utilities of cervical cancer screening methods.HPV DNA testing was reported as a dominant standalone screening test by 14 studies, while 5 studies reported VIA as a dominant standalone screening test. Primary HPV screening strategies were dominant in 21 studies, while three studies reported Cytology-based screening strategies as the dominant screening method. Conclusions: Evidence indicates that HPV-based and VIA testing strategies are cost-effective, but this is influenced by setting. Our review suggests the limited cost-effectiveness of cytology-based testing, which may be due in part to the need for specific infrastructures and human resources. Systematic Review Prospero Registration: CRD42020212454. The review protocol may also be found on Prospero.
Cost-effectiveness of cervical cancer screening methods in low- and middle-income countries: A systematic review
