Economic Evaluation of Cervical Cancer Screening: Are Costs Outside Health Care Included?

Abstract

BACKGROUND: Economic evaluation of health programs primarily captures costs within the health care system, but may also capture costs that fall on patients, relatives, other public sectors or society in general. Guidelines vary with respect to nomenclature and which costs to be included, and systematic reviews of economic evaluation indicate that this variation carries over to published analyses. For certain health interventions, such as cervical cancer screening, exclusion of non-health-care costs can lead to a biased outcome. OBJECTIVES: The aim of this thesis was first to explore to what extent economic evaluation of cervical cancer screening includes non-health-care costs, and second, to study the methodological disparities shown in estimation and incorporation of non-health-care costs. METHODS: A systematic search of three electronic databases was conducted to identify relevant publications on economic evaluation of cervical cancer screening. Included articles were reviewed to explore 1) whether non-health-care costs were included, 2) which cost components were included, and 3) how they were incorporated into estimation. For those studies including non-health-care costs, the magnitude of non-health-care costs compared to health care costs were estimated. RESULTS: In total, 82 articles were included in the study, and 40 of which included non-health-care costs which were slightly less than half of studies. The studies varied considerably in identification, measurement and valuation of non-health-care costs. Several studies made un unclear distinction between time and productivity costs, and showed low adherence to the recommendations of guidelines. The included studies showed variations in terms of the magnitude of non-health-care costs compared to the health care costs. Travel and time costs account for 0.04-76% of the total screening costs, and 5-48% of cancer treatment costs. CONCLUSION: Non-health-care costs involved in screening for cervical cancer are not insignificant. Therefore, studies which did not consider such costs may have limited implications for social resource allocation. Consequently, this study calls for more clear and explicit definitions of non-health-care costs, more consistent guidelines and better reporting of economic evaluation.