Abstract:
Background: Cervical cancer is the most frequent neoplasm among Kenyan women, with
4800 diagnoses and 2400 deaths per year. One reason is an extremely low rate of
screening through pap smears, at 13.8% in 2014. Knowing the costs of screening will
help planners and policymakers design, implement, and scale programs.
Methods: We conducted HPV-based cervical cancer screening via self-collection in 12
communities in rural Migori County, Kenya. Six communities were randomized to
community health campaigns (CHCs), and six to screening at government clinics. All
HPV-positive women were referred for cryotherapy at Migori County Hospital. We
prospectively estimated direct costs from the health system perspective, using micro-
costing methods. Cost data were extracted from expenditure records, staff interviews, and
time and motion logs. Total costs per woman screening included three activities:
outreach, HPV-based screening, and notification. Types of inputs include personnel,
recurrent goods, capital goods, and services. We costed potential changes to
implementation for scaling.
Results: From January to September 2016, 2899 women were screened in CHCs and
2042 in clinics. Each CHC lasted for 30 working days, 10 days each for outreach,
screening, and notification. The mean cost per woman screened was $25.00 for CHCs
[median: $25.09; Range: $22.06-30.21] and $29.56 for clinics [$28.90; $25.27-37.08].
Clinics had higher costs than CHCs for personnel ($14.27 vs. $11.26) and capital ($5.55
vs. $2.80). Screening costs were higher for clinics at $21.84, compared to $17.48 for
CHCs. In contrast, CHCs had higher outreach costs ($3.34 vs. $0.17). After modeling a
reduction in staffing, clinic per-screening costs ($25.69) were approximately equivalent
to CHCs.
Conclusions: HPV-based cervical cancer screening through community health campaigns
achieved lower costs per woman screened, compared to screening at clinics. Periodic
high-volume CHCs appear to be a viable low-cost strategy for implementing cervical
cancer screening.