Vodicka Elisabeth L, Babigumira Joseph B, Mann Marita R, Kosgei Rose J, Lee Fan, Mugo Nelly R, Okech Timothy C, Sakr Samah R, Garrison Louis P, Chung Michael H
University of Washington, Seattle, WA, USA.
University of Nairobi, Nairobi, Kenya.
Int J Gynaecol Obstet. 2017 Feb;136(2):220-228. doi: 10.1002/ijgo.12025. Epub 2016 Nov 21.
To estimate the societal-level costs of integrating cervical cancer screening into HIV clinics in Nairobi, Kenya.
A cross-sectional micro-costing study was performed at Coptic Hope Center for Infectious Diseases and Kenyatta National Hospital, Kenya, between July 1 and October 31, 2014. To estimate direct medical, non-medical, and indirect costs associated with screening, a time-and-motion study was performed, and semi-structured interviews were conducted with women aged at least 18 years attending the clinic for screening during the study period and with clinic staff who had experience relevant to cervical cancer screening.
There were 148 patients and 23 clinic staff who participated in interviews. Visual inspection with acetic acid was associated with the lowest estimated marginal per-screening costs ($3.30), followed by careHPV ($18.28), Papanicolaou ($24.59), and Hybrid Capture 2 screening ($31.15). Laboratory expenses were the main cost drivers for Papanicolaou and Hybrid Capture 2 testing ($11.61 and $16.41, respectively). Overhead and patient transportation affected the costs of all methods. Indirect costs were cheaper for single-visit screening methods ($0.43 per screening) than two-visit screening methods ($2.88 per screening).
Integrating cervical cancer screening into HIV clinics would be cost-saving from a societal perspective compared with non-integrated screening. These findings could be used in cost-effectiveness analyses to assess incremental costs per clinical outcome in an integrated setting.
评估在肯尼亚内罗毕将宫颈癌筛查纳入艾滋病诊所的社会层面成本。
2014年7月1日至10月31日期间，在肯尼亚科普特传染病希望中心和肯雅塔国家医院开展了一项横断面微观成本核算研究。为估算与筛查相关的直接医疗成本、非医疗成本和间接成本，进行了一项时间与动作研究，并对研究期间到诊所进行筛查的至少18岁女性以及有宫颈癌筛查相关经验的诊所工作人员进行了半结构化访谈。
共有148名患者和23名诊所工作人员参与了访谈。醋酸肉眼观察法的每次筛查估计边际成本最低（3.30美元），其次是careHPV（18.28美元）、巴氏涂片法（24.59美元）和杂交捕获2法筛查（31.15美元）。实验室费用是巴氏涂片法和杂交捕获2法检测的主要成本驱动因素（分别为11.61美元和16.41美元）。间接费用和患者交通费用影响了所有筛查方法的成本。单次就诊筛查方法的间接成本（每次筛查0.43美元）比两次就诊筛查方法（每次筛查2.88美元）更低。
从社会角度来看，与未整合的筛查相比，将宫颈癌筛查纳入艾滋病诊所可节省成本。这些研究结果可用于成本效益分析，以评估整合环境下每个临床结果的增量成本。
