A Methodological Framework for the Economic Evaluation of Integrated Cervical Cancer Screening and HIV Care in Tanzania's High-Burden Districts

This methodology article presents a novel framework for conducting a full economic evaluation of integrating cervical cancer screening into existing HIV care programmes in Tanzania's high-burden districts. The urgent need is underscored by the disproportionate cervical cancer burden among women living with HIV in sub-Saharan Africa and the imperative for cost-effective, scalable interventions within constrained health systems. To address this, the proposed methodology employs a pragmatic hybrid design. This combines a prospective micro-costing study (2024-2025) within selected care and treatment clinics to capture real-world resource utilisation with a Markov cohort model to project long-term costs and health outcomes. The model will compare integrated services against a counterfactual of stand-alone care from both health system and societal perspectives, estimating incremental cost-effectiveness ratios (ICERs) in terms of cost per disability-adjusted life year (DALY) averted over a 20-year time horizon. Methodological rigour is strengthened through the use of locally validated epidemiological parameters, the explicit valuation of patient-incurred costs, and a comprehensive probabilistic sensitivity analysis to quantify parameter uncertainty. The framework is designed to generate crucial, context-specific evidence for Tanzanian and regional policymakers, directly informing investment decisions to optimise limited resources and accelerate progress towards the WHO's cervical cancer elimination goals within high HIV prevalence settings.