| dc.description.abstract | Background: Cervical cancer is the second leading cause of cancer mortality in women in low- and middle-income countries (LMICs). About 90% of all cervical cancer mortality occurs in LMICs. WHO recommends the use of thermal ablation, cryotherapy, loop electrosurgical excision procedure (LEEP), and cold knife colonization (CKC) for the treatment of precancerous lesions and as the second prevention for cervical cancer. This study aims to collate data about the cost and cost-effectiveness of the recommended strategies for the treatment of cervical precancerous lesions in LMIC to help policy-makers, managers, program officers, and other health professionals to make informed resource allocation decisions. Methods: A systematic search of published and unpublished literature was conducted to identify cost and cost-effectiveness studies of cervical precancerous lesions treatment in LMICs. The search was conducted in MEDLINE, EMBASE, and Web of Science databases, and grey literature. The search was limited to the English language and without time restriction. The review was registered in PROSPERO with registration number CRD42022333979. Rayyan and Endnote Software were used for screening the identified studies, which was done by two reviewers independently followed by risk of bias assessment. Cost and cost-effectiveness data were extracted and converted to 2021 US Dollars using relevant Consumer Price Indices. Results: 99 studies were identified and after removing duplicates and screening, eight studies were included in the analysis. The provider cost for treatment of cervical precancerous lesions using cryotherapy ranged from $3.85 in Tanzania to $134.35 in South Africa, and for LEEP it ranged from $74.66 in Tanzania to $596.73 in South Africa. for CKC, the cost ranged from $335.03 in India to $766.86 in Thailand. One study from Kenya reported the cost of $52.89 for cryotherapy and $113.20 for LEEP, from the societal perspective. Only one cost-effectiveness study was identified, which reported that cryotherapy was more cost-effective than LEEP with an Incremental Cost-effectiveness Ratio (ICER) per disease-free case of $566.81 (2021 USD) in South Africa. Conclusion: The number of cost and cost-effectiveness studies for the recommended treatment strategies of cervical precancerous lesions in LMICs is scarce. However, the few existing studies show that treatment costs for cervical precancerous lesions in LMIC vary widely and are high relative to the Gross National Income (GNI) per capita of their respective countries. More studies should be conducted on cost and cost-effectiveness of the recommended treatment strategies to provide information for evidence-based decisions. | |
