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PROJECT Situation analysis and cost-effectiveness analysis of cervical cancer screening in Russia . Coordinator of the project: N. Koroleva. PURPOSE.

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Project situation analysis and cost effectiveness analysis of cervical cancer screening in russia l.jpg

PROJECTSituation analysis and cost-effectiveness analysis of cervical cancer screening in Russia

Coordinator

of the project:

N. Koroleva


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PURPOSE

To undertake a situation analysis in relation of existing cervical cancer screening programs in Russia, supplemented by an economic analysis of various options to systematize and extend coverage, so as to be able to recommend an effective and acceptable method of population screening

Cost-effectiveness of cervical cancer screening programs for Russia


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GENERAL OBJECTIVES

  • To describe the epidemiology of cervical cancer in Russia

  • To describe the current policy of the MoH on screening for cervical cancer

  • To understand and explain the existing infrastructure and resources available

  • To identify factors that affect screening uptake in Russia

  • To carry out a cost-effectiveness analysis of existing and potential screening protocols using data specified to the Russian context

  • To make evidence-based recommendations to the Government of Russia and non-governmental organizations on options for implementation of cervical cancer screening in Russia


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PILOT REGIONS

  • Tver

  • St-Petersburg

  • Nalchik

  • Tula


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MAJOR FINDINGS

1. Epidemiology of cervical cancer in Russia

  • Cervical cancer is a second cause of cancer related death among women in Russia

  • Average age of cervical cancer is 45.6 years

  • Russia has one of the highest (7 per 100000 women) SDR among European countries

  • 70% of all cervical cancer cases are diagnosed at an advanced, incurable stages

  • 5-years survival rate is: 92% for local, 49% regional, 15% distant

  • Stage distribution in %: CIS – 6.6, I - 8.8, II – 28, III – 36.7, IV – 19.9


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MAJOR FINDINGS

2. Description of the current policy of the Russian Ministry of Health on screening for cervical cancer

The current policy of the Russian Ministry of Health in relation to the screening for cervical cancer is consistent to the international standards such as proposed by WHO and EU


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MAJOR FINDINGS

3. Existing infrastructure and resources available

Review of the medical equipment condition in the hospitals and gynecological consultations showed that equipment has been 80% depreciated

Some types of medical equipment have been exploited for 15-20 years

Requirements of the hospitals and policlinics with medical equipment are satisfied to 30-40%


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MAJOR FINDINGS

4. To identify factors that affect screening uptake in Russia

1) Knowledge, attitudes, beliefs and practices of medical personnel and women in relation to cervical cancer

Methods: a face-to-face interviews of 400 randomly selected women were conducted at home by family physicians using a structured questionnaire


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MAJOR FINDINGS

Screening Coverage:

30% of women reported ever having PAP test

  • About 2/3 of them had it more than once

  • About 2/3 of them had it less than two years ago

    AGE GROUPS

  • 69,6% of them at age 35-64 years (p ≤ 0.001)

  • 22,7% at age 15-34


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MAJOR FINDINGS

Knowledge of women about Pap smear

  • 42% of interviewed have never heard about screening as a method of cervical cancer prevention, PAP smear

  • 1/3 of those who know about PAP smear aware that test is used to diagnose CANCER (rather than CIN)Fear to go to the physician

    Sources of information

  • Most of those who know about screening reported that they received an information about cervical cancer from physicians (gynecologists)


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MAJOR FINDINGS

Results:

  • Most of women recognized age as a risk factor

    At the same time

  • 1/3 of interviewed reported that cervical cancer is not curable and there is no method to prevent or influence the disease outcome

  • Only few women were aware that cervical cancer is one of the most commonly occurring among Russian women

  • Heredity is the main factor for cervical cancer and the are not at risk as they have a “good heredity”


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MAJOR FINDINGS

Role of physicians

  • The lack of physicians recommendations came up spontaneously from all pilot regions

  • 25% of women who ever had Pap smear reported that they were not informed about results of the analysis

  • Most of women said that doctors don’t encourage them to have screening


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MAJOR FINDINGS

Role of physicians

Almost all women reported that they want to have more information on what tests they are having, the reasons for these tests and the results but if they express any interest and ask doctors what is it used for the most common answer they receive is : you don’t need to know it


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MAJOR FINDINGS

5. Results of cost-effectiveness analysis:

CEA of 3 screening policies (depending on model of screening design, guidelines of follow up of women with detected CIN, interval of screening)

Cost-effectiveness of cervical cancer screening programs for Russia


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Cost-Effectiveness Analysis - Validity of Screening tests

Validity of screening tests makes a great influence on the results of cost-effectiveness analysis.

There is no data on validity of screening tests in Russia

Therefore,

84 schemes (depending on the validity of screening test)


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Cost and LYS for 84 screening alternatives


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Efficient screening combinations (as the World Bank proposed we used GNP per capita in 2002 as a cut-off-point below which the program is not effective)


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  • Results of cost-effectiveness analysis:

  • 12 efficient screening policies (i.e., no alternativepolicy exists that results in more life-years gained for lowercosts).

  • For the efficient policies,the predicted gain in life expectancy ranged from 2.04 to 2.45 life-year saved per 1000 women per year of screening depending on the screening strategy

  • The total cost of screening program varies between 2950 and 4100$ US per 1000 women per year of screening

  • In the whole of Russia it is result in total 2.8-3.8 billion rubles (from 93 to 127 mln dollars US) in the frame of 12 effective strategies varies between

MAJOR FINDINGS


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CONCLUSION

The current screening program is not effective in reaching the majority of population

A major negative factor of low test currency was low educational level.

With few exceptions, beliefs and attitudes were not very important barriers

Lack of recommendations coming from physicians

Negligence, absence of medical problem, fear, lack of knowledge were the main reasons given for not being screened

Validity of screening tests - crucial


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References


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THANK YOU


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