title: Costs of cervical cancer screening and treatment using visual inspection with acetic acid (VIA) and cryotherapy in Ghana: the importance of scale.
abstract: OBJECTIVE
  To estimate the incremental costs of visual inspection with acetic acid (VIA) and cryotherapy at cervical cancer screening facilities in Ghana; to explore determinants of costs through modelling; and to estimate national scale-up and annual programme costs.
  
  
  METHODS
  Resource-use data were collected at four out of six active VIA screening centres, and unit costs were ascertained to estimate the costs per woman of VIA and cryotherapy. Modelling and sensitivity analysis were used to explore the influence of observed differences between screening facilities on estimated costs and to calculate national costs.
  
  
  RESULTS
  Incremental economic costs per woman screened with VIA ranged from 4.93 US$ to 14.75 US$, and costs of cryotherapy were between 47.26 US$ and 84.48 US$ at surveyed facilities. Under base case assumptions, our model estimated the costs of VIA to be 6.12 US$ per woman and those of cryotherapy to be 27.96 US$. Sensitivity analysis showed that the number of women screened per provider and treated per facility was the most important determinants of costs. National annual programme costs were estimated to be between 0.6 and 4.0 million US$ depending on assumed coverage and adopted screening strategy.
  
  
  CONCLUSIONS
  When choosing between different cervical cancer prevention strategies, the feasibility of increasing uptake to achieve economies of scale should be a major concern.
authors.affiliation: Department of Health Care Management, Technische Universität, Berlin, Germany. wilm.quentin@tu-berlin.de
authors.forename: Wilm
authors.initials: W
authors.lastname: Quentin
authors.forename: Yaw
authors.initials: Y
authors.lastname: Adu-Sarkodie
authors.forename: Fern
authors.initials: F
authors.lastname: Terris-Prestholt
authors.forename: Rosa
authors.initials: R
authors.lastname: Legood
authors.forename: Baafuor K
authors.initials: BK
authors.lastname: Opoku
authors.forename: Philippe
authors.initials: P
authors.lastname: Mayaud
mesh_terms: D019342:Acetic Acid; D017679:Cryotherapy / Q000191:economics*; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods; D042241:Early Diagnosis; D005260:Female; D005869:Ghana; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007202:Indicators and Reagents; D017059:Models, Econometric; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000601:surgery
chemical_list: D007202:Indicators and Reagents; D019342:Acetic Acid