Cost-Effectiveness Analysis of Screening for Cervical Lesion and Diagnosis and Treatment of Cervical Cancer in Nigeria

Abstract

OBJECTIVES: Cervical cancer is a significant public health and economic burden, particularly in low- and middle-income countries (LMICs) like Nigeria, where healthcare resources are constrained. Globally, it accounted for 660,000 new cases and 350,000 deaths in 2022 (WHO, 2024). This study evaluates the cost-effectiveness of cervical lesion screening versus cervical cancer treatment in Nigeria, addressing financial and health challenges while exploring trade-offs in accessibility, efficiency, and performance. METHODS: A cost-effectiveness analysis assessed three scenarios for cervical lesion screening and treatment using a stepwise approach to define cost parameters, compute total and average costs, and conduct sensitivity analyses. Screening costs ranged from ₦57,625 ($34.57) to ₦108,260 ($64.96) per woman, while treatment costs ranged between ₦1,853,455 ($1,112) and ₦4,710,603 ($2,826) per patient. Disease prevalence, cervical cancer incidence, and disability-adjusted life years (DALYs) were derived from health literature and local data. RESULTS: The total screening cost across all scenarios was ₦243.21 billion ($145.8 million), with an average cost of ₦83,769 ($50.27) per woman. Scenario 3 had the greatest health impact, averting 4,423 DALYs at ₦12.37 million ($7,422) per DALY averted. Scenario 1 showed no DALYs averted. Treatment costs totaled ₦58.77 billion ($35.26 million), with Scenario 3 incurring the highest DALYs (86,137) at ₦245,155 ($147.09) per DALY. Sensitivity analyses revealed that scaling screening between 5 million to 17 million women at the lowest accessible cost ₦10,000 ($6), could cost about ₦20 billion ($12 million) to ₦334 billion ($200 million) and ultimately screen more women. CONCLUSION: Early detection and screening are the most cost-effective strategies to avert significant Disability-Adjusted Life Years (DALYs) from cervical cancer. These findings emphasize the need for preventive care, coordinated efforts, expanded healthcare access, education, and addressing socioeconomic barriers to improve health outcomes and reduce the societal and economic burden of cervical cancer in Nigeria.