A Cost analysis of multiple triage strategies for early detection of cervical cancer screening programs

: 1.005_PCF A Cost analysis of multiple triage strategies for early detection of cervical cancer screening programs E. Corona, Y.N. Flores, M.A. Rodriguez, J. Meneses León, B. Rivera, B. Cortes Paredez, L. Rodriguez Ochoa, J. Armando Sosa Palacios, E. Lazcano-Ponce, J. Salmerón; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, U.S.A., UCLA Department of Health Policy and Management, Center for Cancer Prevention and Control Research, Fielding School of Public Health and Jonsson Comprehensive Cancer Center Los Angeles, CA, U.S.A., Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, México, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México, Maestria en Salud Publica con area de concentracion en Administracion en Salud, Instituto Nacional deSalud Pública, Cuernavaca, Morelos, México Background: Although high-risk human papilloma virus (hrHPV) testing has been shown to be more sensitive than the conventional Pap smear (93.1% vs 59.4%, respectively) in preventing cervical cancer, the specificity of hrHPV testing is lower (91.8% vs. 98.3%, respectively). Due to the lower specificity of the hrHPV test more women who will ultimately not develop cervical cancer will undergo more invasive procedures such as colposcopy, which has a direct effect on patient anxiety levels, risk, and healthcare costs. Methods: The Forwarding Research for Improved Detection and Access for Cervical Cancer Screening Project (FRIDA Study) in Tlaxcala, México is evaluating a variety of reflex testingdor triagedstrategies to determine which option is the most efficient and effective in reducing the number of screening visits, number of follow-up procedures, and anxiety patients may feel due to additional screening. We determined the cost of the different screening and triage strategies that are being evaluated as part of the Forwarding Research for Improved Detection and Access for Cervical Cancer Screening Project (FRIDA Study) in Tlaxcala, México. We conducted a time and motion study to calculate personnel costs and identified the equipment, supply, capital, and overhead costs required to produce clinical results from bench to bedside. Findings: We visited three types of clinics classified as small (n 1⁄4 7), medium (n 1⁄4 1), and large (n 1⁄4 2), based on the volume of patients that are seen each day to determine if costs vary by clinic size. Personnel costs, physical area costs, and overhead costs per exam were $3.01, $1.91, and $2.13 in small, medium, and large clinics, respectively. Personnel costs were lowest for the Papanicolaou liquid based cytology triage strategy ($5.61 vs. 5.97 and $6.06 for p16/Ki-67 and E6 oncoprotein detection, respectively). Supply and equipment costs have not been calculated. Interpretation: Triage strategies using Liquid-Based Cytology Pap stain appear to be less expensive in personnel costs than triaging with the E6 oncoprotein assay or p16/ki-67 stain, but personnel costs for additional triage strategies are pending. This cost analysis will contribute to a cost-effectiveness analysis, which will determine the most costeffective screening strategy to be implemented throughout Mexico. Funding: This first author was provided with a travel grant from the UCLA Blum Center on Poverty and Health in Latin America. Abstract #: 1.006_PCF: 1.006_PCF The industrial Nakba: A study of industrial dumping in

Background: Although high-risk human papilloma virus (hrHPV) testing has been shown to be more sensitive than the conventional Pap smear (93.1% vs 59.4%, respectively) in preventing cervical cancer, the specificity of hrHPV testing is lower (91.8% vs. 98.3%, respectively). Due to the lower specificity of the hrHPV test more women who will ultimately not develop cervical cancer will undergo more invasive procedures such as colposcopy, which has a direct effect on patient anxiety levels, risk, and healthcare costs.
Methods: The Forwarding Research for Improved Detection and Access for Cervical Cancer Screening Project (FRIDA Study) in Tlaxcala, México is evaluating a variety of reflex testingdor triagedstrategies to determine which option is the most efficient and effective in reducing the number of screening visits, number of follow-up procedures, and anxiety patients may feel due to additional screening. We determined the cost of the different screening and triage strategies that are being evaluated as part of the Forwarding Research for Improved Detection and Access for Cervical Cancer Screening Project (FRIDA Study) in Tlaxcala, México. We conducted a time and motion study to calculate personnel costs and identified the equipment, supply, capital, and overhead costs required to produce clinical results from bench to bedside.

Findings:
We visited three types of clinics classified as small (n ¼ 7), medium (n ¼ 1), and large (n ¼ 2), based on the volume of patients that are seen each day to determine if costs vary by clinic size. Personnel costs, physical area costs, and overhead costs per exam were $3.01, $1.91, and $2.13 in small, medium, and large clinics, respectively. Personnel costs were lowest for the Papanicolaou liquid based cytology triage strategy ($5.61 vs. 5.97 and $6.06 for p16/Ki-67 and E6 oncoprotein detection, respectively). Supply and equipment costs have not been calculated.
Interpretation: Triage strategies using Liquid-Based Cytology Pap stain appear to be less expensive in personnel costs than triaging with the E6 oncoprotein assay or p16/ki-67 stain, but personnel costs for additional triage strategies are pending. This cost analysis will contribute to a cost-effectiveness analysis, which will determine the most costeffective screening strategy to be implemented throughout Mexico.
Funding: This first author was provided with a travel grant from the UCLA Blum Center on Poverty and Health in Latin America.
Abstract #: 1.006_PCF The industrial Nakba: A study of industrial dumping in Palestinian cities L. Elmuti 1 , D. Hryhorczuk 1 , B. Amous 2 , S. K'Aibni 2 , I. Qasem 3 , N. Sehweil-Elmuti 4 ; 1 University of Illinois at Chicago (UIC), Chicago, IL, USA, 2 Birzeit University, Birzeit, West Bank, Palestine, 3 Tulkarm Ministry of Environmental Affairs, 4 Eastern Illinois University, Charleston, IL, USA Background: Al-Nakba ("the catastrophe" in Arabic), in which the Palestinian people lost their sovereignty, began in 1948 and has continued to devastate the lives of millions of Palestinians. It has impacted the Palestinian narrative, freedom of movement, education, healthcare, and even clean water. Toxic dumping by Israeli industrial zones into Palestinian waterways has been detrimental to physical and psychosocial health. As a result of adverse health effects in Israeli cities, seven industrial zones have been relocated to Palestinian cities throughout the West Bank. This study focuses on two Palestinian cities, Salfit and Tulkarm, which house the Ariel Industrial Zone and Geshuri Industries, respectively. Palestinian lands are often located at foothills of industrial zones, making them particularly vulnerable to runoff from these complexes. Organizations like Friends of the Earth Middle East have documented unregulated dumping of agrochemical pesticides, batteries, gasoline byproducts, and heavy metals into drinking and groundwater of various West Bank cities. Several studies have raised concerns about industrial runoff contaminating crops, farmland, drinking water and the air. However, there are no previous studies with qualitative or quantitative evidence of these toxins. The lack of awareness, advocacy, and policies implemented to protect citizens of West Bank cities have exacerbated this issue.
Methods: In this study, two water samples from each category (ground, drinking, and wastewater runoff) were taken from Salfit and Tulkarm. Samples were collected in 1L mason jars, covered with aluminum foil and placed on ice to prevent contamination and chemical degradation. The samples were analyzed using gas chromatography-mass spectrometry at the Environmental Health and Toxicology Unit at Birzeit University. Poster Contest Finalists M a y eJ u n e 2 0 1 6 : 3 1 9 -3 2 7