Transcript Cost-effectiveness of cervical cancer screening programs for Russia

PROJECT
Situation analysis and costeffectiveness analysis of
cervical cancer screening
in Russia
Coordinator
of the project:
N. Koroleva
PURPOSE
To undertake a situation analysis in
relation of existing cervical cancer
screening programs in Russia,
supplemented by an economic analysis of
various options to systematize and
extend coverage, so as to be able to
recommend an effective and acceptable
method of population screening
Cost-effectiveness of cervical cancer screening programs for Russia
GENERAL OBJECTIVES
1. To describe the epidemiology of cervical cancer in
Russia
2. To describe the current policy of the MoH on
screening for cervical cancer
3. To understand and explain the existing
infrastructure and resources available
4. To identify factors that affect screening uptake in
Russia
5. To carry out a cost-effectiveness analysis of
existing and potential screening protocols using
data specified to the Russian context
6. To make evidence-based recommendations to the
Government of Russia and non-governmental
organizations on options for implementation of
cervical cancer screening in Russia
PILOT REGIONS
• Tver
• St-Petersburg
• Nalchik
• Tula
MAJOR FINDINGS
1. Epidemiology of cervical cancer in Russia
• Cervical cancer is a second cause of cancer
related death among women in Russia
• Average age of cervical cancer is 45.6 years
• Russia has one of the highest (7 per 100000
women) SDR among European countries
• 70% of all cervical cancer cases are diagnosed
at an advanced, incurable stages
• 5-years survival rate is: 92% for local, 49%
regional, 15% distant
• Stage distribution in %: CIS – 6.6, I - 8.8,
II – 28, III – 36.7, IV – 19.9
100302 +SDR,cancer of cervix,all age,per 100000
9
8
7
6
5
4
3
2
1
1970
1975
1980
1985
1990
1995
2000
France
Sweden
Germany
United Kingdom
Russia
2005
100401 +Cervix uteri cancer incidence per 100000
20
19
18
17
16
15
14
13
12
11
10
9
1970
1975
1980
1985
1990
1995
2000
France
Sweden
Germany
United Kingdom
Russia
2005
MAJOR FINDINGS
2. Description of the current policy of
the Russian Ministry of Health on
screening for cervical cancer
The current policy of the Russian
Ministry of Health in relation to the
screening for cervical cancer is
consistent to the international
standards such as proposed by WHO
and EU
MAJOR FINDINGS
3. Existing infrastructure and
resources available
Review of the medical equipment
condition in the hospitals and
gynecological consultations showed that
equipment has been 80% depreciated
Some types of medical equipment have
been exploited for 15-20 years
Requirements of the hospitals and
policlinics with medical equipment are
satisfied to 30-40%
Specific ratio of expenditures in the total amount of allocations
provided to finance the equipment
Funds to purchase
equipment
Total health expenditures
MAJOR FINDINGS
4. To identify factors that affect
screening uptake in Russia
1) Knowledge, attitudes, beliefs and
practices of medical personnel and
women in relation to cervical cancer
Methods: a face-to-face interviews
of 400 randomly selected women
were conducted at home by family
physicians using a structured
questionnaire
MAJOR FINDINGS
Screening Coverage:
30% of women reported ever having PAP
test
• About 2/3 of them had it more than once
• About 2/3 of them had it less than two years
ago
AGE GROUPS
•
69,6% of them at age 35-64 years (p ≤ 0.001)
•
22,7% at age 15-34
MAJOR FINDINGS
Knowledge of women about Pap smear
• 42% of interviewed have never heard about
screening as a method of cervical cancer
prevention, PAP smear
• 1/3 of those who know about PAP smear
aware that test is used to diagnose CANCER
(rather than CIN)
Fear to go to the physician
Sources of information
• Most of those who know about screening reported
that they received an information about cervical
cancer from physicians (gynecologists)
MAJOR FINDINGS
Results:
• Most of women recognized age as a risk factor
At the same time
• 1/3 of interviewed reported that cervical cancer
is not curable and there is no method to prevent
or influence the disease outcome
• Only few women were aware that cervical cancer
is one of the most commonly occurring among
Russian women
• Heredity is the main factor for cervical cancer
and the are not at risk as they have a “good
heredity”
MAJOR FINDINGS
Role of physicians
• The lack of physicians recommendations
came up spontaneously from all pilot
regions
• 25% of women who ever had Pap smear
reported that they were not informed
about results of the analysis
• Most of women said that doctors don’t
encourage them to have screening
MAJOR FINDINGS
Role of physicians
Almost all women reported that they
want to have more information on
what tests they are having, the reasons
for these tests and the results but if
they express any interest and ask
doctors what is it used for the most
common answer they receive is : you
don’t need to know it
MAJOR FINDINGS
5. Results of cost-effectiveness
analysis:
CEA of 3 screening policies (depending
on model of screening design,
guidelines of follow up of women with
detected CIN, interval of screening)
Cost-effectiveness of cervical cancer screening
programs for Russia
Cost-Effectiveness Analysis Validity of Screening tests
Validity of screening tests makes a
great influence on the results of
cost-effectiveness analysis.
There is no data on validity of
screening tests in Russia
Therefore,
84 schemes (depending on the
validity of screening test)
Cost per life-year saved
Cost per life-year saved by validity of cytology
350000
300000
Sensitivity 50
250000
Sensitivity 60
200000
Sensitivity 70
150000
Sensitivity 80
100000
Sensitivity 87
50000
0
86
90
95
Specificity of cytology
100
Cost and LYS for 84 screening alternatives
Estimates of cost and life-ye ar saved
for 84 scree ning alte rnatives
3.0
2.5
2.0
1.5
1.0
.5
0.0
0
100000
200000
Cost per life-year saved
300000
400000
Efficient screening combinations
(as the World Bank proposed we used GNP per capita
in 2002 as a cut-off-point below which the program
is not effective)
MAJOR FINDINGS
Results of cost-effectiveness analysis:
12 efficient screening policies (i.e., no alternative
policy exists that results in more life-years gained for
lower costs).
For the efficient policies, the predicted gain in life
expectancy ranged from 2.04 to 2.45 life-year saved
per 1000 women per year of screening depending on
the screening strategy
The total cost of screening program varies between
2950 and 4100$ US per 1000 women per year of
screening
In the whole of Russia it is result in total 2.8-3.8
billion rubles (from 93 to 127 mln dollars US) in the
frame of 12 effective strategies varies between
CONCLUSION
The current screening program is not effective in
reaching the majority of population
A major negative factor of low test currency was
low educational level.
With few exceptions, beliefs and attitudes were
not very important barriers
Lack of recommendations coming from
physicians
Negligence, absence of medical problem, fear,
lack of knowledge were the main reasons given
for not being screened
Validity of screening tests - crucial
References
THANK YOU