Cost-effectiveness Analysis of “Test and Treat” Strategy compared to “Test, Triage and Treat” Strategy for screening pre- cervical cancer lesions among women Living with HIV at Uganda Cancer institute

Background: Cervical cancer is the fourth most common cancer in women globally, with around 660,000 new cases and 350,000 deaths and Uganda is among the top ten countries with the highest incidence of cervical cancer. In 2021, Uganda adopted "Test, Triage and Treat" (TTT) incorporating HPV DNA testing. However, the cost effectiveness of "TTT” approach has been questionable with recent studies indicating no improvement in test accuracy compared with VIA alone undermining its cost-effectiveness This study compared the cost-effectiveness of these approaches at the Uganda Cancer Institute. Methods: A cross-sectional cost-effectiveness analysis was conducted from the healthcare provider perspective over one month. Activity-based costing identified costs and drivers. Costs were converted to US$ (mid-2024 rate). Cost-effectiveness was calculated as cost per correctly diagnosed client. Sensitivity analyses assessed parameter influence and cost-effectiveness against willingness-to-pay (WTP) thresholds. Data analysis was done in Microsoft Excel siftware using decision tree modelling. Results: The unit cost was US$4.74 for S&T and US$14.70 for TTT. The primary cost driver for T&T was human resources, while consumables drove costs for TTT after one-way sensitivity analysis. Despite higher costs, the TTT approach was more effective. The Incremental cost effectiveness Ration was 249.025US$ per additionally correctly diagnosed client and “TTT” approach was more cost effective after Probabilistic sensitivity analysis comparing to Uganda's WTP threshold, TTT emerged as the more cost-effective strategy. Discussion and Conclusion: This study found the TTT approach to be more cost-effective than T&T for cervical cancer screening at the Uganda Cancer Institute, supporting its adoption. A unique aspect was the use of overall test accuracy for comparison, differing from studies focusing solely on sensitivity or specificity. Further research is warranted to determine the optimal method for evaluating test accuracy within these screening strategies. These findings provide valuable evidence for cervical cancer screening policy in Uganda .