Evaluation of the Cost-Effectiveness of Evidence-Based Interventions to Increase Female Breast and Cervical Cancer Screens: A Systematic Review

Simple Summary The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) in the United States supports outreach programs which aim to increase breast and cervical cancer screening rates for low-income, underserved, and uninsured women. Given that resources are limited, we conducted a systematic review of the cost-effectiveness of evidence-based, community outreach programs to increase screening rates among hard-to-reach women. We identified eleven studies for the period 1999-2021, nine for breast cancer and two for cervical cancer. One-on-one education was the most common approach. We found that the average cost to increase breast cancer screening through outreach for one additional woman was USD 545, while the average cost for cervical cancer was USD 197. Cost-effectiveness estimates varied substantially by outreach approach, the population included, and the intervention setting. Uncertainty in cost and effect estimates and program replicability in other settings and with other populations were not addressed, which precludes using existing cost-effectiveness estimates to inform program funding.Abstract Purpose: To systematically review published cost-effectiveness analyses of Evidence-Based Interventions (EBIs) recommended by the United States Community Preventive Services Task Force (CPSTF) to increase breast and cervical cancer screening. Methods: We searched PubMed and Embase for prospective cost-effectiveness evaluations of EBIs for breast and cervical cancer screening since 1999. We reviewed studies according to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and compared the incremental cost-effectiveness ratio (ICERs), defined as cost per additional woman screened, adjusted to 2021 USD, within and across EBIs by cancer type. Results: We identified eleven studies meeting our review criteria: nine were breast cancer-focused, one breast and cervical cancer combined, and one cervical only, which together reported twenty-four cost-effectiveness assessments of outreach programs spanning eight EBIs. One-on-one education programs were the most common EBI evaluated. The average ICER across breast cancer studies was USD 545 (standard deviation [SD] = USD 729.3), while that for cervical cancer studies was USD 197 (SD = 186.6. Provider reminder/recall systems for women already linked to formal care were the most cost-effective, with an average ICERs of USD 41.3 and USD 10.6 for breast and cervical cancer, respectively. Conclusions: Variability in ICERs across and within EBIs reflect the population studied, the specific EBI, and study settings, and was relatively high. ICER estimate uncertainty and the potential for program replicability in other settings and with other populations were not addressed. Given these limitations, using existing cost-effectiveness estimates to inform program funding allocations is not warranted at this time. Additional research is needed on outreach programs for cervical cancer and those which serve minority populations for either of the female cancer screens.