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 : 1.10, 95 confidence interval (CI): 0.541.67; : 1.46, 95 CI: 1.001.92; and : 1.68, 95 CI: 1.252.11, respectively, initial treatment (: 0.36, 95 CI: 0.180.55; : 0.51, 95 CI: 0.350.66; and : 0.56, 95 CI: 0.420.70, respectively), and follow-up (: 0.63, 95 CI: 0.380.88; : 0.83, 95 CI: 0.611.04; and : 0.85, 95 CI: 0.651.06, respectively) compared to government-organized screening (all P 0.05). Earlier clinical staging and greater use of lower-level hospitals mediated 44.7454.97 of cost differences in diagnosis, 73.2785.04 in initial treatment, and 30.3854.73 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.
Dong et al. (Mon,) studied this question.