Cost and Cost-Effectiveness of Conventional and Liquid-Based Cytology in South Africa: A Laboratory Service Provider Perspective

ABSTRACT

Background. South Africa has a high prevalence of cervical cancer. Early detection can significantly reduce the burden of this disease. New screening technologies to detect cervical pathology have become available in recent years.Objectives. To determine the cost and cost-effectiveness of liquid-based cytology (LBC) versus conventional cervical cytology; from the perspective of the National Health Laboratory Service (NHLS). Methods. The unit of effectiveness was defined as the number of cervical intraepithelial neoplasm (CIN) II or higher lesions detected. Costs were assessed retrospectively for the financial year (2010/11) from a laboratory service provider perspective. A cost-effectiveness analysis was performed by combining secondary data collected from NHLS expenditure records and cytology laboratory data sources with data from the literature. Results. Total average cost per conventional slide was found to be R (South African rands) 64 (95confidence interval (CI) 59 - 69) compared with R85 (95 CI 77 - 92) for an LBC slide. Conventional cytology was found to be more cost-effective (R10 786; 95 CI 9 335 - 12 699) than LBC (R18 911; 95 CI 16 180 - 22 435) in detecting CIN II or greater lesions. An improvement in the specificity of LBC and/or a decrease in the cost of consumables utilised in processing LBC specimens could potentially make it a cost-effective alternative to conventional cytology.Conclusion. An estimate of the total average public sector laboratory cost per slide for each modality was calculated. Definitive assessment of cost-effectiveness will require a prospective study that incorporates human papillomavirus testing and is conducted from a societal perspective