Malawi has the highest rates of cervical cancer incidence and mortality in the world. This project aims to (1)
identify the most effective and cost-effective approach to cervical cancer prevention for women in Malawi via
screening and treatment of precancerous lesions; and (2) calculate the likely budgetary impact of implementing
this strategy at-scale.
A computerized decision model will be used to compare the relative impact (health outcomes, costs, and cost-
effectiveness) of different cervical cancer prevention strategies among women in Malawi. This analysis will be
the first to include thermocoagulation, a reemerging technology for lesion removal; and will be unique in its risk
stratification by HIV status. It will also innovate around how budget impact analyses can be used to inform more
nuanced strategies for implementation and scale-up in resource-limited settings.
The project will leverage a long-standing partnership between UCLA and Partners in Hope, a Malawian medical
organization. New information, including about thermocoagulation in the Malawian context, will be included in
this analysis. Malawi recently recommended biannual screening and treatment to prevent cervical cancer, for all
women in HIV care. It is essential to consider the implications of this policy, particularly given resource constraints
within the Malawian health system, and the potential costs (in dollars and health outcomes) of biannual lesion
screening and removal.
Economic evaluation studies as proposed here are essential for informing evidence-based policymaking,
particularly when real-world evaluation studies are not practical -- and have shaped cancer screening guidelines
here in the United States. As cervical cancer is a major challenge in many low-income countries, this study may
also inform practice and policy in other settings. It will also provide insights about opportunities to leverage other
health services (i.e., for HIV care) to address cancer, which is an area of emerging interest for researchers and
policymakers in resource-poor settings worldwide even in high-income countries.
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