title: Estimation of the costs of cervical cancer screening, diagnosis and treatment in rural Shanxi Province, China: a micro-costing study.
abstract: BACKGROUND
  Cost estimation is a central feature of health economic analyses. The aim of this study was to use a micro-costing approach and a societal perspective to estimate aggregated costs associated with cervical cancer screening, diagnosis and treatment in rural China.
  
  
  METHODS
  We assumed that future screening programs will be organized at a county level (population ~250,000), and related treatments will be performed at county or prefecture hospitals; therefore, this study was conducted in a county and a prefecture hospital in Shanxi during 2008-9. Direct medical costs were estimated by gathering information on quantities and prices of drugs, supplies, equipment and labour. Direct non-medical costs were estimated via structured patient interviews and expert opinion.
  
  
  RESULTS
  Under the base case assumption of a high-volume screening initiative (11,475 women screened annually per county), the aggregated direct medical costs of visual inspection, self-sampled careHPV (Qiagen USA) screening, clinician-sampled careHPV, colposcopy and biopsy were estimated as US$2.64,$7.49,$7.95,$3.90 and $5.76, respectively. Screening costs were robust to screening volume (<5% variation if 2,000 women screened annually), but costs of colposcopy/biopsy tripled at the lower volume. Direct medical costs of Loop Excision, Cold-Knife Conization and Simple and Radical Hysterectomy varied from $61-544, depending on the procedure and whether conducted at county or prefecture level. Direct non-medical expenditure varied from $0.68-$3.09 for screening/diagnosis and $83-$494 for pre-cancer/cancer treatment.
  
  
  CONCLUSIONS
  Diagnostic costs were comparable to screening costs for high-volume screening but were greatly increased in lower-volume situations, which is a key consideration for the scale-up phase of new programs. The study's findings will facilitate cost-effectiveness evaluation and budget planning for cervical cancer prevention initiatives in China.
authors.affiliation: Department of Cancer Epidemiology, Cancer Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, 17 South Panjiayuan Lane, Beijing, Chaoyang District, 100021, China.
authors.forename: Ju-Fang
authors.initials: JF
authors.lastname: Shi
authors.forename: Jun-Feng
authors.initials: JF
authors.lastname: Chen
authors.forename: Karen
authors.initials: K
authors.lastname: Canfell
authors.forename: Xiang-Xian
authors.initials: XX
authors.lastname: Feng
authors.forename: Jun-Fei
authors.initials: JF
authors.lastname: Ma
authors.forename: Yong-Zhen
authors.initials: YZ
authors.lastname: Zhang
authors.forename: Fang-Hui
authors.initials: FH
authors.lastname: Zhao
authors.forename: Rong
authors.initials: R
authors.lastname: Li
authors.forename: Li
authors.initials: L
authors.lastname: Ma
authors.forename: Zhi-Fang
authors.initials: ZF
authors.lastname: Li
authors.forename: Jie-Bin
authors.initials: JB
authors.lastname: Lew
authors.forename: Yan
authors.initials: Y
authors.lastname: Ning
authors.forename: You-Lin
authors.initials: YL
authors.lastname: Qiao
mesh_terms: D000328:Adult; D002681:China; D003365:Costs and Cost Analysis; D055088:Early Detection of Cancer / Q000191:economics*; D005260:Female; D017048:Health Care Costs / Q000639:trends*; D006801:Humans; D008875:Middle Aged; D036301:Qualitative Research; D019035:Rural Health Services / Q000191:economics*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000601:surgery* / Q000628:therapy*