Cost-effectiveness Analysis of “Test and Treat” Strategy compared to “Test, Triage and Treat” Strategy for screening pre- cervical cancer lesions among women Living with HIV at Uganda Cancer institute

Cost-effectiveness Analysis of “Test and Treat” Strategy compared to “Test, Triage and Treat” Strategy for screening pre- cervical cancer lesions among women Living with HIV at Uganda Cancer institute | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cost-effectiveness Analysis of “Test and Treat” Strategy compared to “Test, Triage and Treat” Strategy for screening pre- cervical cancer lesions among women Living with HIV at Uganda Cancer institute Geofrey Emesu, Joseph Kagaayi, David L Ejalu, Jatho Alfred, Mallina Mueller This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7976786/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Cervical cancer is the fourth most common cancer in women globally, with around 660,000 new cases and 350,000 deaths and Uganda is among the top ten countries with the highest incidence of cervical cancer. In 2021, Uganda adopted "Test, Triage and Treat" (TTT) incorporating HPV DNA testing. However, the cost effectiveness of "TTT” approach has been questionable with recent studies indicating no improvement in test accuracy compared with VIA alone undermining its cost-effectiveness This study compared the cost-effectiveness of these approaches at the Uganda Cancer Institute. Methods: A cross-sectional cost-effectiveness analysis was conducted from the healthcare provider perspective over one month. Activity-based costing identified costs and drivers. Costs were converted to US$ (mid-2024 rate). Cost-effectiveness was calculated as cost per correctly diagnosed client. Sensitivity analyses assessed parameter influence and cost-effectiveness against willingness-to-pay (WTP) thresholds. Data analysis was done in Microsoft Excel siftware using decision tree modelling. Results: The unit cost was US$4.74 for S&T and US$14.70 for TTT. The primary cost driver for T&T was human resources, while consumables drove costs for TTT after one-way sensitivity analysis. Despite higher costs, the TTT approach was more effective. The Incremental cost effectiveness Ration was 249.025US$ per additionally correctly diagnosed client and “TTT” approach was more cost effective after Probabilistic sensitivity analysis comparing to Uganda's WTP threshold, TTT emerged as the more cost-effective strategy. Discussion and Conclusion: This study found the TTT approach to be more cost-effective than T&T for cervical cancer screening at the Uganda Cancer Institute, supporting its adoption. A unique aspect was the use of overall test accuracy for comparison, differing from studies focusing solely on sensitivity or specificity. Further research is warranted to determine the optimal method for evaluating test accuracy within these screening strategies. These findings provide valuable evidence for cervical cancer screening policy in Uganda . Cost-effectiveness Health Economics Cost of Health care Health Policy Full Text Additional Declarations No competing interests reported. Supplementary Files SupplementaryFigure1PoolesSensitivity.pdf SupplementaryFigure2PooledSpecifcity.pdf SupplementaryFigure3scatterplot.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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In 2021, Uganda adopted \"Test, Triage and Treat\" (TTT) incorporating HPV DNA testing. However, the cost effectiveness of \"TTT” approach has been questionable with recent studies indicating no improvement in test accuracy compared with VIA alone undermining its cost-effectiveness This study compared the cost-effectiveness of these approaches at the Uganda Cancer Institute.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA cross-sectional cost-effectiveness analysis was conducted from the healthcare provider perspective over one month. Activity-based costing identified costs and drivers. Costs were converted to US$ (mid-2024 rate). Cost-effectiveness was calculated as cost per correctly diagnosed client. Sensitivity analyses assessed parameter influence and cost-effectiveness against willingness-to-pay (WTP) thresholds. Data analysis was done in Microsoft Excel siftware using decision tree modelling.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe unit cost was US$4.74 for S\u0026amp;T and US$14.70 for TTT. The primary cost driver for T\u0026amp;T was human resources, while consumables drove costs for TTT after one-way sensitivity analysis. Despite higher costs, the TTT approach was more effective. The Incremental cost effectiveness Ration was 249.025US$ per additionally correctly diagnosed client and “TTT” approach was more cost effective after Probabilistic sensitivity analysis comparing to Uganda's WTP threshold, TTT emerged as the more cost-effective strategy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion and Conclusion: \u003c/strong\u003eThis study found the TTT approach to be more cost-effective than T\u0026amp;T for cervical cancer screening at the Uganda Cancer Institute, supporting its adoption. A unique aspect was the use of overall test accuracy for comparison, differing from studies focusing solely on sensitivity or specificity. Further research is warranted to determine the optimal method for evaluating test accuracy within these screening strategies. 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