Background
Cervical cancer is the leading cause of cancer mortality for women in Uganda, yet fewer than a third of Ugandan women have ever been screened. Screen-and-treat programmes using visual inspection with acetic acid (VIA) are a key prevention strategy. Current guidelines recommend screening for women aged 25–49 every 3 years. However, there is limited evidence comparing the trade-offs between health gains, costs and implementation feasibility across alternative programme designs at scale.
Methods
We conducted a cost-effectiveness and budget impact analysis of 30 VIA screen-and-treat cervical cancer policies using a microsimulation parameterised to represent Ugandan women aged 25–49 over a 15-year time horizon. Policies varied across three implementation dimensions: (1) screening frequency, (2) screening uptake among eligible women and (3) treatment follow-through for precancerous lesions. We estimated population-level costs, deaths averted, quality-adjusted life years (QALYs) gained and incremental cost-effectiveness ratios (ICERs).
Results
We found that, depending on screening frequency, uptake and treatment follow-through, between 13% and 50% of deaths could be averted compared with the base case (current levels). The 15-year total costs ranged from $32.9 million to $158.6 million, or $5 to $23 per eligible woman. Both incremental costs and deaths averted increased at a diminishing rate as screening intensified. Policy scenarios with lower levels of treatment were dominated by those with higher treatment follow-through, regardless of screening uptake. ICERs ranged from $88 to $313 per QALY gained, and $2219 to $6881 per death averted.
Conclusion
The most effective and efficient policy scenarios were not simply those with the highest levels of screening or treatment, but those that optimally configured all three programme levers simultaneously. The findings revealed interactive effects of screening frequency, uptake and treatment follow-through on costs and health outcomes. These results equip Ugandan policymakers with context-specific evidence to prioritise screening policies that balance health impact, cost and implementation capacity.
