Impact of government-organized screening programs on the economic burden of cervical cancer across five disease courses: a multistage regression and mediation analysis.

Abstract

Objective: To evaluate the impact of government-organized screening on the economic burden among patients with cervical cancer and precancerous lesions, and explore mediating pathways across diagnosis, initial treatment, radiotherapy/chemotherapy, follow-up, and recurrence/progression/metastasis.

Methods: A multicentre, nationwide survey across 5 disease courses was conducted from 26 hospitals in China. Multivariable regression and structural equation modeling were used to assess the effects of government-organized screening on economic burden by comparing government-organized screening with workplace check-up, self-paid check-up, and symptom-based detection.

Results: Workplace check-up, self-paid check-up, and symptom-based detection were associated with progressively higher costs across diagnosis [β: 1.10, 95% confidence interval (CI): 0.54-1.67; β: 1.46, 95% CI: 1.00-1.92; and β: 1.68, 95% CI: 1.25-2.11, respectively], initial treatment (β: 0.36, 95% CI: 0.18-0.55; β: 0.51, 95% CI: 0.35-0.66; and β: 0.56, 95% CI: 0.42-0.70, respectively), and follow-up (β: 0.63, 95% CI: 0.38-0.88; β: 0.83, 95% CI: 0.61-1.04; and β: 0.85, 95% CI: 0.65-1.06, respectively) compared to government-organized screening (all P < 0.05). Earlier clinical staging and greater use of lower-level hospitals mediated 44.74%-54.97% of cost differences in diagnosis, 73.27%-85.04% in initial treatment, and 30.38%-54.73% in follow-up. Fifteen percent of the cost differences during initial treatment were related to lower overtreatment for precancerous lesions.

Conclusions: Government-led cervical cancer screening was associated with lower economic burden with pathways involving earlier-stage diagnosis, reduced overtreatment, and decreased reliance on higher-level hospitals, suggesting potential clinical benefits, efficient resource use, and improved equity in cancer care.