Background: Visual inspection of the cervix with acetic acid (VIA) combined with cryotherapy is one of the management strategies advocated to achieve a reduction in invasive cervical cancer (ICC) mortality in developing countries. Policymakers and researchers need information on costs of VIA and cryotherapy in order to plan for successful scale-up of ICC management programmes, and to estimate the cost-effectiveness of these and alternative prevention strategies. Objectives: To estimate 1) the costs of VIA and cryotherapy at existing VIA/cryotherapy sites in Ghana, and 2) the resource requirements for scaling up to a national screening and management programme. Methods: Resource-use data were collected at four out of six active VIA screening centres in Ghana and unit costs were ascertained in order to estimate the costs per woman of VIA and cryotherapy. Modelling and sensitivity analysis were used to explore the influence of observed differences between screening facilities on estimated costs, and to calculate national scale-up costs. Findings: The number of women screened per provider and treated per facility per year were the most important determinants of costs per woman of VIA and cryotherapy. Estimated national scale-up costs showed high variation depending on screening and management strategy and cost scenario. Conclusion: Policymakers and researchers need to pay attention to the specific determinants of costs and should consider that economies of scale may exist when planning for the scale-up of VIA and cryotherapy in Ghana.
Programme for Research and Capacity Building in Sexual and Reproductive Health and HIV in Developing Countries research briefing no. 2, January 2010. 4 pp.