ArticleInternational journal of cancer2017
To expand coverage, or increase frequency: Quantifying the tradeoffs between equity and efficiency facing cervical cancer screening programs in low-resource settings.
Article in International journal of cancer, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 2 of them syntheses that pooled it.
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Who cites it
32 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Methodological heterogeneity and equity challenges of distributional cost-effectiveness analysis in healthcare: a systematic review from 2017 to 2025.Archives of public health = Archives belges de sante publique · 2026Pooled it
- Secondary Prevention of Cervical Cancer: ASCO Resource-Stratified Guideline Update.JCO global oncology · 2022Guideline
- Increased Knowledge Mediates the Effect of Game Changers for Cervical Cancer Prevention on Diffusion of Cervical Cancer Screening Advocacy Among Social Network Members in a Pilot Trial.International journal of behavioral medicine · 2024Trial
- Factors Influencing Universal Coverage of AI-Assisted Cervical Cancer Screening: Qualitative Study Based on the Macro Model of Health System.Journal of medical Internet research · 2026Article
- Cervical cancer prevention behaviors and determinants among Indigenous women in rural Nepal.Health promotion international · 2026Article
- Integrating the behavior change wheel and co-design approach in selecting strategies for improving cervical cancer screening literacy among rural women living with HIV in Eastern Uganda.BMC health services research · 2026Article
- User-Centered Design of Strategies for Improving Cervical Cancer Screening Literacy Among Rural Women Living with HIV in Eastern Uganda.Patient preference and adherence · 2026Article
- Review
- Modelling epidemiological and economics processes - the case of cervical cancer.Health economics review · 2025Review
- Views on cervical cancer screening among female caregivers at the Uganda cancer Institute.Gynecologic oncology reports · 2025Article
- Migrant women's perception toward cervical and breast cancer screening in Türkiye: a qualitative analysis.BMC public health · 2025Article
- Factors associated with utilization of cervical cancer screening services among women at a tertiary hospital in eastern Uganda: A cross sectional study.International journal of Africa nursing sciences · 2025Article
- Article
- Identifying and prioritizing inefficiency causes in Iran's health system.Cost effectiveness and resource allocation : C/E · 2024Article
- Effects of screening coverage and screening quality assurance on cervical cancer mortality: Implication for integrated framework to monitor global implementation of cervical cancer screening programmes.Journal of global health · 2024Article
- Early evaluation of a screen-and-treat strategy using high-risk HPV testing for Uganda: Implications for screening coverage and treatment.Journal of global health · 2024Article
- Barriers and facilitators of cervical cancer screening literacy among rural women with HIV attending rural public health facilities in East Central Uganda: a qualitative study using the integrated model of health literacy.BMC women's health · 2024Article
- Cost-effectiveness of approaches to cervical cancer screening in Malawi: comparison of frequencies, lesion treatment techniques, and risk-stratified approaches.BMC health services research · 2024Article
- Cervical Cancer Screening via Visual Inspection With Acetic Acid and Lugol Iodine for Triage of HPV-Positive Women.JAMA network open · 2024Article
- Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Cervical cancer is a leading cause of cancer death worldwide, with 85% of the disease burden residing in less developed regions. To inform evidence-based decision-making as cervical cancer screening programs are planned, implemented, and scaled in low- and middle-income countries, we used cost and test performance data from the START-UP demonstration project in Uganda and a microsimulation model of HPV infection and cervical carcinogenesis to quantify the health benefits, distributional equity, cost-effectiveness, and financial impact of either (1) improving access to cervical cancer screening or (2) increasing the number of lifetime screening opportunities for women who already have access. We found that when baseline screening coverage was low (i.e., 30%), expanding coverage of screening once in a lifetime to 50% can yield comparable reductions in cancer risk to screening two or three times in a lifetime at 30% coverage, lead to greater reductions in health disparities, and cost 150 international dollars (I$) per year of life saved (YLS). At higher baseline screening coverage levels (i.e., 70%), screening three times in a lifetime yielded greater health benefits than expanding screening once in a lifetime to 90% coverage, and would have a cost-effectiveness ratio (I$590 per YLS) below Uganda's per capita GDP. Given very low baseline coverage at present, we conclude that a policy focus on increasing access for previously unscreened women appears to be more compatible with improving both equity and efficiency than a focus on increasing frequency for a small subset of women.
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