Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
권호 표지
DOI QR코드

DOI QR Code

Management of Precancerous Cervical Lesions in Iran: A Cost Minimizing Study

  • Nahvijou, Azin (Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences) ;
  • Sari, Ali Akbari (Department of Health Economics and Management, School of Public Health, and Knowledge Utilization Research Center (KURC)) ;
  • Zendehdel, Kazem (Cancer Research Center of Cancer Institute of Iran, Tehran University of Medical Sciences) ;
  • Marnani, Ahmad Barati (Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences)
  • Published : 2014.10.23
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Cervical cancer is a common, preventable and manageable disease in women worldwide. Objectives: This study was conducted to determine the cost of follow-up for suspicious precancerous cervical lesions within a screening program using Pap smear or HPV DNA test through the decision tree. Materials and Methods: Patient follow-up processes were determined using standard guidelines and consultation with specialists to design a decision tree model. Costs of treatment in both public and private sectors were identified according to the national tariffs in 2010 and determined based on decision tree and provided services (visits to specialists, colposcopy, and conization) with two modalities: Pap smear and HPV DNA test. The number of patients and the mean cost of treatment in each sector were calculated. The prevalence of lesions and HPV were obtained from literature to estimate the cost of treatment for each woman in the population. Results: Follow-up costs were determined using seven processes for Pap smear and 11 processes for HPV DNA test. The total cost of using Pap smear and HPV DNA process for each woman in the population was 36.1$ and 174$ respectively. Conclusions: The follow-up process for patients with suspicious cervical lesions needs to be included in the existing screening program. HPV DNA test is currently more expensive than Pap smear, it is suggested that we manage precancerous cervical lesions with this latter test.

Keywords

References

  1. Afrakhteh M, Khodakarami N, Moradi A, et al (2007). A study of 13315 papanicolau smear diagnoses in shohada hospital. J Family Reprod Health, 1, 74-78.
  2. Andrae B, Kemetli L, Sparen P, et al (2008). Screeningpreventable cervical cancer risks: evidence from a nationwide audit in Sweden. J Natl Cancer Inst, 100, 622-29. https://doi.org/10.1093/jnci/djn099
  3. Andres-Gamboa O, Chicaiza L, Garcia-Molina M, et al (2008). Cost-effectiveness of conventional cytology and HPV DNA testing for cervical cancer screening in Colombia. Salud Publica Mex, 50, 276-85. https://doi.org/10.1590/S0036-36342008000400005
  4. Anttila A, Pukkala E, Soderman B, et al (1999). Effect of organised screening on cervical cancer incidence and mortality in Finland, 1963-1995: recent increase in cervical cancer incidence. Int J Cancer, 83, 59-65. https://doi.org/10.1002/(SICI)1097-0215(19990924)83:1<59::AID-IJC12>3.0.CO;2-N
  5. Arab M, Noghabaei G, Kazemi SN (2014). Comparison of crude and age-specific incidence rates of breast, ovary, endometrium and cervix cancers in Iran, 2005. Asian Pac J Cancer Pre, 15, 2461. https://doi.org/10.7314/APJCP.2014.15.6.2461
  6. Behtash N, Nazari Z, Khaniki M, et al (2008). Liqui $prep^{TM}$ a new liquid based cervical cytology method in comparison with conventional Pap smear in developing counteries. ResJ Biological Sciences, 3, 627-30.
  7. Berkhof J, Coupe VM, Bogaards JA, et al (2010). The health and economic effects of HPV DNA screening in The Netherlands. Int J Cancer, 127, 2147-58. https://doi.org/10.1002/ijc.25211
  8. Bosch F, Munoz N, De Sanjose S, et al (1993). Human papillomavirus and cervical intraepithelial neoplasia grade III/carcinoma in situ: a case-control study in Spain and Colombia. Cancer Epidemiol Biomarkers Prev, 2, 415-22.
  9. Burr J M, Mowatt G, Hernandez R A, et al. (2007). The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma: a systematic review and economic evaluation. Health Technology Assessment 2007, 11, 41.
  10. Center for Disease Control and Prevention Noncomunicable Diseases Unit Cancer Office. (2012). Iranian annual of national cancer registration report 2009-2010 [Online]. Iran.
  11. Chalkidou K, Marquez P, Dhillon PK, et al (2014). Evidenceinformed frameworks for cost-effective cancer care and prevention in low, middle, and high-income countries. Lancet Oncol, 15, 119-31. https://doi.org/10.1016/S1470-2045(13)70547-3
  12. Chawla PC, Chawla AK, Shrivastava R, et al (2014). Situation analysis of existing facilities for screening, treatment and prevention of cervical cancer in hospitals/primary health centers of delhi-NCR Region, India. Asian Pac J Cancer Prev, 15, 5475. https://doi.org/10.7314/APJCP.2014.15.13.5475
  13. Chow IH, Tang C, You S, et al (2010). Cost-effectiveness analysis of human papillomavirus DNA testing and Pap smear for cervical cancer screening in a publicly financed health-care system. Br J Cancer, 103, 1773-82. https://doi.org/10.1038/sj.bjc.6605974
  14. Chuck A (2010). Cost Effectiveness of 21 alternative cervical cancer screening strategies. Value in Health, 13, 169-79. https://doi.org/10.1111/j.1524-4733.2009.00611.x
  15. De Kok I M, Van Rosmalen J, Dillner J, et al (2012). Primary screening for human papillomavirus compared with cytology screening for cervical cancer in European settings: cost effectiveness analysis based on a Dutch microsimulation model. BMJ: British Medical Journal, 344, 1-14.
  16. Doshmangir L, Rashidian a, Akbari Sari A. (2011). Unresolved issues in medical tariffs: Challenges and respective solutions to improve tariff system in Iranian health sectors. Hospital J, 10, 2-10.
  17. Dzuba I G, Diaz E Y, Allen B, et al (2002). The acceptability of self-collected samples for HPV testing vs. the pap test as alternatives in cervical cancer screening. J Womens Health Gend Based Med, 11, 265-75. https://doi.org/10.1089/152460902753668466
  18. Ferlay J, Soerjomataram I, Ervik M, et al (2013). GLOBOCAN 2012 v1.0, Cancer incidence and mortality worldwide: IARC Cancer Base Lyon, France: International Agency for Research on Cancer.
  19. Forman D, Bray F, Brewster D, et al (2013). Cancer incidence in five continents, Vol. X (electronic version). Lyon, IARC.
  20. Franco El, Duarte-Franco E, Ferenczy L, et al (2001). Cervical cancer: epidemiology, prevention and the role of human papillomavirus infection. Can Med Assoc J, 164, 1017-25.
  21. Gakidou E, Nordhagen S, Obermeyer Z (2008). Coverage of cervical cancer screening in 57 countries: low average levels and large inequalities. PLoS Med, 5, 132. https://doi.org/10.1371/journal.pmed.0050132
  22. Khodakarami N, Clifford GM, Yavari P, et al (2012). Human papillomavirus infection in women with and without cervical cancer in Tehran, Iran. Int J Cancer, 131, 156-61. https://doi.org/10.1002/ijc.26488
  23. Khorasanizadeh F, Hassanloo J, Khaksar N, et al (2013). Epidemiology of cervical cancer and human papilloma virus infection among Iranian women-Analyses of national data and systematic review of the literature. Gynecol Oncol, 128, 277-81. https://doi.org/10.1016/j.ygyno.2012.11.032
  24. Kuhn L, Denny L, Pollack A, et al (2000). Human papillomavirus DNA testing for cervical cancer screening in low-resource settings. J Nat Cancer Inst, 92, 818-25. https://doi.org/10.1093/jnci/92.10.818
  25. Mahlck C, Jonsson H, Lenner P (1994). Pap smear screening and changes in cervical cancer mortality in Sweden. Int J Gynecol Obstetrics, 44, 267-72. https://doi.org/10.1016/0020-7292(94)90177-5
  26. Malloy C, Sherris J, Herdman C (2000). HPV DNA Testing: Technical and Programmatic. Seattle, Washington, Program for Appropriate Technology in Health [http://www.popline.org], 2000 Dec. 27 p.
  27. Nabandith V, Pholsena V, Mounthisone P, et al (2012). First trial of cervical cytology in healthy women of urban Laos using by self-sampling instrument. Asian Pac J Cancer Prev, 13, 4665-67. https://doi.org/10.7314/APJCP.2012.13.9.4665
  28. Partridge EE, Abu-Rustum NR, Campos SM, et al (2010). Cervical cancer screening. J Natl Compr Canc Netw, 8, 1358-86.
  29. Pity I S, Shamdeen M Y ,Wais S A (2012). Follow up of atypical squamous cell Pap Smears in Iraqi women. Asian Pac J Cancer Prev, 13, 3455-60. https://doi.org/10.7314/APJCP.2012.13.7.3455
  30. R. N. (2014). FDA OKs HPV DNA Test for Primary Cervical Cancer Screening [Online]. Available: http://www.medscape.com/viewarticle/824114 [Accessed 24 April 2014].
  31. Ries L, Eisner M, Kosary C, et al (2002). SEER Cancer Statistics Review, 1973-1999, National Cancer Institute. Bethesda, MD. Table VI-1. Available from URL: http://seer. cancer. gov/csr/1973_1999.
  32. Sankaranarayanan R, Budukh A M ,Rajkumar R (2001). Effective screening programmes for cervical cancer in low-and middle-income developing countries. Bull WHO, 79, 954-62.
  33. Saxena U, Sauvaget C ,Sankaranarayanan R (2012). Evidencebased screening, early diagnosis and treatment strategy of cervical cancer for national policy in low-resource countries: example of India. Asian Pac J Cancer Prev, 13, 1699-703. https://doi.org/10.7314/APJCP.2012.13.4.1699
  34. Sengul D, Altinay S, Oksuz H, et al (2014). Population-based cervical screening outcomes in Turkey over a period of approximately nine and a half years with emphasis on results for women aged 30-34. Asian Pac J Cancer Prev: APJCP, 15, 2069. https://doi.org/10.7314/APJCP.2014.15.5.2069
  35. Shi JF, Canfell K, Lew JB, et al (2011). Evaluation of primary HPV-DNA testing in relation to visual inspection methods for cervical cancer screening in rural China: an epidemiologic and cost-effectiveness modelling study. BMC Cancer, 11, 239. https://doi.org/10.1186/1471-2407-11-239
  36. Tanprasertkul C, Sritipsukno P (2010). HPV DNA testing for cervical cancer screening: a systematic review and metaanalysis. Thammasat Medical J, 9, 15-25.
  37. Treatment. M O H a M E I D O (2010). Diagnostic and treatment service tariffs in public and private sectors in 2010, Teheran, Rahavard
  38. Walboomers JM, Jacobs MV, Manos MM, et al (1999). Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol, 189, 12-9. https://doi.org/10.1002/(SICI)1096-9896(199909)189:1<12::AID-PATH431>3.0.CO;2-F
  39. Wang JL, Yang YZ, Dong WW, et al (2013). Application of human papillomavirus in screening for cervical cancer and precancerous lesions. Asian Pac J Cancer Prev, 14, 2979-82. https://doi.org/10.7314/APJCP.2013.14.5.2979
  40. World B (2012). World development indicators 2012, world bank publications.
  41. Zendehdel K, Sedighi Z, Hasanlou Z, Nahvijou A (2010). Improving quality of cancer registration in Iran. Part1: evaluation and comparison of cancer registration results in the country. HAKIM.

Cited by

  1. Cost-Effectiveness of Different Cervical Screening Strategies in Islamic Republic of Iran: A Middle-Income Country with a Low Incidence Rate of Cervical Cancer vol.11, pp.6, 2016, https://doi.org/10.1371/journal.pone.0156705