International Agency for Research on Cancer, (IARC/WHO), Early Detection, Prevention and Infections Branch, Lyon, France.
Department of Community Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
JCO Glob Oncol. 2024 Aug;10:e2400066. doi: 10.1200/GO.24.00066.
To review the economic burden assessment of cervical cancer in low- and middle-income countries (LMICs) and use the findings to develop a pragmatic, standardized framework for such assessment.
We first systematically reviewed articles indexed in scientific databases reporting the methodology for collecting and calculating costs related to the cervical cancer burden in LMICs. Data on study design, costing approach, cost perspective, costing period, and cost type (direct medical costs [DMC], direct nonmedical costs [DNMC], and indirect costs [IC]) were extracted. Finally, we summarized the reported limitations in the methodology and used the solutions to inform our framework.
Cervical cancer treatment costs across LMICs vary greatly and can be extremely expensive, up to 70,968 International US dollars. Economic and financial assessment methods also vary greatly across countries. Of the 28 reviewed articles, 25 studies reported DMC for cervical cancer treatment by extracting cost information from billing or insurance databases (eight studies), conducting surveys (five), and estimating the costs (12). Only 11 studies-mainly through surveys-reported DNMC and IC. The economic burden assessment framework includes health care/payer and societal perspectives (DMC, DNMC, IC, and human capital loss) across the cervical cancer screening and treatment continuum. To assess health care/payer costs, we recommend combining the predefined treatment standards with actual local treatment practices, multiplied by unit costs. To assess societal costs, we recommend conducting a cost survey in line with a standardized yet adaptable protocol.
Our standardized, pragmatic framework allows assessment of economic and financial burden of cervical cancer in LMICs despite the different levels of available resources across countries. This framework will facilitate global comparisons and monitoring and may also be applied to other cancers.
回顾中低收入国家（LMICs）宫颈癌经济负担评估，并利用研究结果制定一种实用且标准化的评估框架。
我们首先系统地回顾了科学数据库中索引的报告 LMICs 中与宫颈癌负担相关的成本收集和计算方法的文章。提取了研究设计、成本计算方法、成本视角、成本期和成本类型（直接医疗成本[DMC]、直接非医疗成本[DNMC]和间接成本[IC]）的数据。最后，我们总结了方法学中报告的局限性，并利用解决方案为我们的框架提供信息。
LMICs 之间的宫颈癌治疗费用差异很大，可能非常昂贵，高达 70968 国际美元。各国的经济和财务评估方法也有很大差异。在所审查的 28 篇文章中，25 篇研究通过从计费或保险数据库中提取成本信息（8 篇研究）、进行调查（5 篇研究）和估计成本（12 篇研究）报告了宫颈癌治疗的 DMC。只有 11 项研究——主要通过调查——报告了 DNMC 和 IC。经济负担评估框架包括整个宫颈癌筛查和治疗连续体的医疗保健/支付方和社会视角（DMC、DNMC、IC 和人力资本损失）。为了评估医疗保健/支付方的成本，我们建议将预定义的治疗标准与实际的当地治疗实践相结合，乘以单位成本。为了评估社会成本，我们建议按照标准化但可适应的协议进行成本调查。
尽管各国的资源水平不同，但我们的标准化实用框架允许对 LMICs 中宫颈癌的经济和财务负担进行评估。该框架将促进全球比较和监测，也可应用于其他癌症。
